Pogarell Oliver, Koch Walter, Gildehaus Franz J, Kupsch Andreas, Lindvall Olle, Oertel Wolfgang H, Tatsch Klaus
Department of Psychiatry, Ludwig Maximilians University, Munich, Germany.
Eur J Nucl Med Mol Imaging. 2006 Apr;33(4):407-11. doi: 10.1007/s00259-005-0032-z. Epub 2006 Jan 27.
Single-photon emission computed tomography (SPECT) of striatal dopamine transporters (DAT) has been used to demonstrate presynaptic dopaminergic dysfunction and to monitor the progression of Parkinson's disease. In parkinsonian patients who were implanted with embryonic mesencephalic tissue in the striatum, positron emission tomography (PET) has shown an increase in striatal [(18)F]dopa uptake as an indicator of graft survival and striatal reinnervation. The aim of this study was to investigate two patients who had undergone bilateral intrastriatal transplantation of human embryonic mesencephalic tissue using SPECT and the (123)I-labelled DAT ligand N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane (IPT).
Two patients were subjected to [(123)I]IPT SPECT according to a standardised protocol prospectively and repeatedly up to 8 years after transplantation.
From baseline to year 3 after transplantation, mean striatal DAT availability increased by a mean of 61% (93% and 29% in patients 1 and 2, respectively). It then remained relatively stable up to 8 years in patient 2, but increased further by another 77% of baseline values in patient 1. Clinically, both patients experienced a moderate improvement in motor performance but developed moderate (patient 2) to severe (patient 1) off-medication dyskinesias.
Our data indicate that DAT imaging using IPT and SPECT can be used to demonstrate graft survival following dopaminergic tissue implantation. Because SPECT with DAT ligands is widely available in the routine clinical setting, this methodology may be a useful alternative to [(18)F]dopa PET for repeated scanning of grafted parkinsonian patients. The relevance of the long-term increase in DAT binding for the development of off-medication dyskinesias remains to be elucidated further.
纹状体多巴胺转运体（DAT）的单光子发射计算机断层扫描（SPECT）已被用于证明突触前多巴胺能功能障碍，并监测帕金森病的进展。在纹状体内植入胚胎中脑组织的帕金森病患者中，正电子发射断层扫描（PET）显示纹状体[（18）F]多巴摄取增加，作为移植存活和纹状体再支配的指标。本研究的目的是使用SPECT和（123）I标记的DAT配体N-（3-碘丙烯-2-基）-2β-甲氧基羰基-3β-（4-氯苯基）托烷（IPT），对两名接受双侧纹状体内人胚胎中脑组织移植的患者进行研究。
两名患者按照标准化方案前瞻性地、反复地接受[（123）I]IPT SPECT检查，直至移植后8年。
从基线到移植后第3年，平均纹状体DAT可用性平均增加了61%（患者1和患者2分别为93%和29%）。在患者2中，直到8年时它保持相对稳定，但在患者1中又进一步增加了基线值的77%。临床上，两名患者的运动表现均有中度改善，但出现了中度（患者2）至重度（患者1）的撤药后运动障碍。
我们的数据表明，使用IPT和SPECT进行DAT成像可用于证明多巴胺能组织植入后的移植存活情况。由于使用DAT配体的SPECT在常规临床环境中广泛可用，这种方法可能是用于对移植后的帕金森病患者进行重复扫描的[（18）F]多巴PET的有用替代方法。DAT结合的长期增加与撤药后运动障碍发生的相关性仍有待进一步阐明。
