Koeppe Robert A, Gilman Sid, Junck Larry, Wernette Kris, Frey Kirk A
Division of Nuclear Medicine, Department of Radiology, The University of Michigan, Ann Arbor, MI, USA.
Alzheimers Dement. 2008 Jan;4(1 Suppl 1):S67-76. doi: 10.1016/j.jalz.2007.11.016.
Several progressive neurologic disorders begin with cognitive decline or parkinsonism, notably Alzheimer's disease (AD), Parkinson's disease (PD), and dementia with Lewy bodies (DLB). We used positron emission tomography (PET) in attempts to differentiate these disorders.
We performed PET with (+)-[11C]dihydrotetrabenazine ([11C]DTBZ) to examine blood-to-brain ligand transport (K(1)) and striatal monoaminergic presynaptic binding (distribution volume [DV]) in 25 DLB, 30 PD, and 25 AD patients and 57 elderly controls (NC).
[11C]DTBZ DV was decreased significantly in caudate nucleus, anterior putamen, and posterior putamen in DLB and PD compared with AD and NC. DLB and PD groups showed an anterior-to-posterior gradient of binding loss relative to NC, least in caudate nucleus and largest in posterior putamen. The gradient was significantly steeper in PD than DLB. Both PD and DLB showed significantly greater interhemispheric striatal binding asymmetry than NC, and PD had greater asymmetry than DLB. Cerebral cortical [11C]DTBZ K(1) was decreased diffusely by 4% to 8% in PD. Larger K(1) deficits occurred in AD and DLB temporoparietal and prefrontal association cortices and posterior cingulate cortex. Greater reduction of K(1) occurred in occipital cortex in DLB than AD. Receiver operating characteristic curve analyses distinguished DLB from AD more effectively on the basis of striatal DV than occipital K(1) and distinguished DLB from PD more effectively on the basis of cerebral cortical K(1) than striatal DV patterns. Overall, 90% of cases were properly classified by combining these measures.
PET with [11C]DTBZ can differentiate DLB from both PD and AD in a single neuroimaging study.
几种进行性神经疾病始于认知功能下降或帕金森综合征，尤其是阿尔茨海默病（AD）、帕金森病（PD）和路易体痴呆（DLB）。我们使用正电子发射断层扫描（PET）来试图区分这些疾病。
我们对25例DLB患者、30例PD患者、25例AD患者和57例老年对照（NC）进行了（+）-[11C]二氢丁苯那嗪（[11C]DTBZ）PET检查，以检测血脑配体转运（K(1)）和纹状体单胺能突触前结合（分布容积[DV]）。
与AD和NC相比，DLB和PD患者尾状核、壳核前部和壳核后部的[11C]DTBZ DV显著降低。与NC相比，DLB和PD组显示出从前往后的结合丧失梯度，在尾状核中最小，在壳核后部最大。PD组的梯度比DLB组显著更陡。PD和DLB组的半球间纹状体结合不对称性均显著高于NC组，且PD组的不对称性大于DLB组。PD患者大脑皮质[11C]DTBZ K(1)弥漫性降低4%至8%。AD和DLB患者颞顶叶和前额叶联合皮质以及后扣带回皮质出现更大的K(1)缺陷。DLB患者枕叶皮质的K(1)降低幅度大于AD患者。受试者工作特征曲线分析显示，基于纹状体DV区分DLB和AD比基于枕叶K(1)更有效，基于大脑皮质K(1)区分DLB和PD比基于纹状体DV模式更有效。总体而言，通过结合这些测量方法，90%的病例得到了正确分类。
在一项单一的神经影像学研究中，使用[11C]DTBZ的PET能够区分DLB与PD和AD。
