Dethy S, Hambye A S
Service de Neurologie, C.H.U. Tivoli, La Louvière.
Rev Med Brux. 2008 Sep;29(4):238-47.
The diagnosis of idiopathic Parkinson's disease (IPD) remains mostly clinical. Nevertheless, differentiating IPD from essential tremor or other parkinsonian syndromes solely by clinical examination can be challenging in some cases, especially in the early stage of the disease. The introduction of new isotopic functional imaging techniques, and more specifically the labelling of dopamine transporter derivatives, has improved the understanding and early detection of some diseases affecting the basal ganglia. Iodine-123-FP-CIT (DaTSCAN), a (presynaptic) dopamine transporter analogue for nuclear medicine imaging, has recently been introduced for the non-invasive differential diagnosis between IPD and essential tremor or secondary (e.g. drug-related) parkinsonian syndromes. DaTSCAN scintigraphy has also demonstrated some usefulness in the evaluation of other neurodegenerative parkinsonian syndromes such as Lewy-body dementia or multiple system atrophy. For this latter however, the DaTSCAN has to be combined with a second scintigraphy, imaging the post-synaptic dopaminergic receptors, such as the D2-ligand 123I-iodobenzamide. Combining DaTSCAN scintigraphy to a functional study of the brain cortical activity using a brain perfusion scintigraphy or to the evaluation of the cardiac adrenergic system by means of a myocardial MIBG scintigraphy (a norepinephrine storage analogue) can also be helpful to refine the diagnosis. Our experience shows that a good collaboration between the neurologist specialized in movement disorders and the nuclear medicine physician is useful, if not mandatory, to optimize the diagnostic performances of DaTSCAN scintigraphy.
特发性帕金森病（IPD）的诊断主要仍依赖临床。然而，在某些情况下，尤其是在疾病早期，仅通过临床检查将IPD与特发性震颤或其他帕金森综合征区分开来可能具有挑战性。新的同位素功能成像技术的引入，更具体地说是多巴胺转运体衍生物的标记，提高了对一些影响基底神经节疾病的认识和早期检测。碘-123-FP-CIT（DaTSCAN），一种用于核医学成像的（突触前）多巴胺转运体类似物，最近已被用于IPD与特发性震颤或继发性（如药物相关）帕金森综合征之间的无创鉴别诊断。DaTSCAN闪烁扫描在评估其他神经退行性帕金森综合征如路易体痴呆或多系统萎缩方面也显示出一定作用。然而对于后者，DaTSCAN必须与第二种闪烁扫描相结合，对突触后多巴胺能受体进行成像，如D2配体123I-碘苄胺。将DaTSCAN闪烁扫描与使用脑灌注闪烁扫描的大脑皮质活动功能研究相结合，或通过心肌MIBG闪烁扫描（一种去甲肾上腺素储存类似物）评估心脏肾上腺素能系统，也有助于完善诊断。我们的经验表明，运动障碍专科神经科医生与核医学医生之间良好的合作对于优化DaTSCAN闪烁扫描的诊断性能是有用的，甚至是必不可少的。
