Inui Yoshitaka, Toyama Hiroshi, Manabe Yuta, Sato Takahisa, Sarai Masayoshi, Kosaka Kenji, Iwata Nakao, Katada Kazuhiro
Department of Radiology, Fujita Health University, Toyoake, Japan.
J Nucl Med. 2007 Oct;48(10):1641-50. doi: 10.2967/jnumed.107.042143. Epub 2007 Sep 14.
We evaluated the diagnostic usefulness of combination studies with a statistical mapping method in N-isopropyl-p-(123)I-iodoamphetamine ((123)I-IMP) brain perfusion SPECT, cardiac sympathetic nerve function by (123)I-metaiodobenzylguanidine ((123)I-MIBG), and myocardial function by electrocardiographically gated (99m)Tc-sestamibi ((99m)Tc-MIBI) SPECT for patients with probable or possible dementia with Lewy bodies (DLB).
Twelve patients with probable DLB (7 male, 5 female; mean age +/- SD, 72.3 +/- 5.63 y; range, 65-82 y) and 9 patients with possible DLB (3 male, 6 female; mean age +/- SD, 73.1 +/- 9.23 y; range, 59-88 y) were enrolled in this study. (123)I-IMP SPECT images were analyzed with 3-dimensional stereotactic surface projections (3D-SSP) and the severity of ischemia was classified objectively using quantitatively analytic and display software; stereotactic extraction estimation (SEE) methods were compared with a normal database. In addition, we evaluated (123)I-MIBG heart-to-mediastinum (H/M) uptake ratios. Moreover, we performed (99m)Tc-MIBI SPECT to evaluate myocardial perfusion and the left ventricular ejection fraction (LVEF) compared with a normal database.
3D-SSP images of group comparison with healthy control subjects showed significantly decreased perfusion in the parietotemporal, occipital cortex, posterior cingulated, and precuneus regions in the probable DLB group but no significant reduction in the possible DLB group. Mean H/M ratios in the probable DLB group were significantly lower than those of the possible DLB group and the control group, respectively. Ten of 12 patients (83.3%) with probable DLB and 1 of 9 patients (11.1%) with possible DLB showed severe reduction in the bilateral occipital lobe and also a low (123)I-MIBG uptake. One patient (8.3%) with probable DLB and 2 patients (22.2%) with possible DLB showed no bilateral occipital hypoperfusion but showed low (123)I-MIBG uptake. One patient (8.3%) with probable DLB and 6 patients (66.7%) with possible DLB showed no occipital hypoperfusion and normal (123)I-MIBG uptake. (99m)Tc-MIBI gated SPECT did not indicate any wall motion abnormality in any subjects.
These results suggest that combined examination of cerebral blood flow with 3D-SSP and SEE analysis, and cardiac sympathetic nerve function with (123)I-MIBG, would be a useful supporting diagnostic method in patients with DLB-particularly, in possible DLB and when cerebral blood flow does not indicate occipital hypoperfusion.
我们评估了采用统计映射方法联合研究对疑似或可能患有路易体痴呆（DLB）患者进行N-异丙基-p-（123）I-碘安非他明（（123）I-IMP）脑灌注单光子发射计算机断层扫描（SPECT）、（123）I-间碘苄胍（（123）I-MIBG）评估心脏交感神经功能以及心电图门控（99m）锝-甲氧基异丁基异腈（（99m）Tc-MIBI）SPECT评估心肌功能的诊断价值。
本研究纳入12例疑似DLB患者（7例男性，5例女性；平均年龄±标准差，72.3±5.63岁；范围，65 - 82岁）和9例可能患有DLB的患者（3例男性，6例女性；平均年龄±标准差，73.1±9.23岁；范围，59 - 88岁）。使用三维立体定向表面投影（3D - SSP）分析（123）I-IMP SPECT图像，并使用定量分析和显示软件客观地对缺血严重程度进行分类；将立体定向提取估计（SEE）方法与正常数据库进行比较。此外，我们评估了（123）I-MIBG的心/纵隔（H/M）摄取率。而且，我们进行了（99m）Tc-MIBI SPECT以评估心肌灌注，并将左心室射血分数（LVEF）与正常数据库进行比较。
与健康对照受试者进行组间比较的3D - SSP图像显示，疑似DLB组的顶颞叶、枕叶皮质、后扣带回和楔前叶区域灌注显著降低，而可能患有DLB的组无显著降低。疑似DLB组的平均H/M比值分别显著低于可能患有DLB的组和对照组。12例疑似DLB患者中有10例（83.3%）和9例可能患有DLB的患者中有1例（11.1%）显示双侧枕叶严重灌注减少且（123）I-MIBG摄取低。1例疑似DLB患者（8.3%）和2例可能患有DLB的患者（22.2%）未显示双侧枕叶灌注不足，但显示（123）I-MIBG摄取低。1例疑似DLB患者（8.3%）和6例可能患有DLB的患者（66.7%）未显示枕叶灌注不足且（123）I-MIBG摄取正常。（99m）Tc-MIBI门控SPECT未显示任何受试者有壁运动异常。
这些结果表明，采用3D - SSP和SEE分析联合检查脑血流以及用（123）I-MIBG检查心脏交感神经功能，对于DLB患者，特别是可能患有DLB且脑血流未显示枕叶灌注不足的患者，将是一种有用的辅助诊断方法。
