Tateno Masaru, Kobayashi Seiju, Shirasaka Tomohiro, Furukawa Yoshimori, Fujii Kazuki, Morii Hidetoshi, Yasumura Shuichi, Utsumi Kumiko, Saito Toshikazu
Department of Neuropsychiatry, Sapporo Medical University, Chuo-ku, Sapporo, Japan.
Dement Geriatr Cogn Disord. 2008;26(5):453-7. doi: 10.1159/000165918. Epub 2008 Oct 31.
Supportive features in the diagnostic criteria for dementia with Lewy bodies (DLB) include occipital hypoperfusion and decreased cardiac uptake of (123)I-metaiodobenzylguanidine (MIBG). In this study, we performed both brain perfusion single photon emission computed tomography (SPECT) and MIBG myocardial scintigraphy in the same subjects and evaluated their sensitivity to detect the characteristic features of DLB.
Twenty-five patients with probable DLB (76.8 +/- 5.1 years old, 10 male) underwent (99m)Tc-ethylcysteinate dimer brain perfusion SPECT and (123)I-MIBG myocardial scintigraphy. The results of SPECT were analyzed using a qualitative analysis program, easy Z score imaging system (eZIS), and an automated quantitative analysis program, 3DSRT.
Qualitative analysis using eZIS demonstrated occipital hypoperfusion in 17 subjects (68%). The quantified mean blood perfusion in the occipital segment on the 3DSRT template was 40.7 +/- 5.03 ml/100 g/min (right) and 40.5 +/- 5.38 ml/100 g/min (left), and in 19 DLB patients these values were below the normal limit. Twenty-four of 25 subjects (96%) had decreased cardiac MIBG uptake in the delayed image.
MIBG myocardial scintigraphy was superior to brain perfusion SPECT in detecting a characteristic feature of DLB. Our results suggest that combining SPECT and MIBG scintigraphy could increase the accuracy of clinical diagnosis of DLB.
路易体痴呆（DLB）诊断标准中的支持性特征包括枕叶灌注不足和（123）I-间碘苄胍（MIBG）心肌摄取减少。在本研究中，我们对同一组受试者进行了脑灌注单光子发射计算机断层扫描（SPECT）和MIBG心肌闪烁显像，并评估了它们检测DLB特征的敏感性。
25例可能患有DLB的患者（76.8±5.1岁，10例男性）接受了（99m）Tc-乙半胱氨酸二聚体脑灌注SPECT和（123）I-MIBG心肌闪烁显像。使用定性分析程序简易Z评分成像系统（eZIS）和自动定量分析程序3DSRT分析SPECT结果。
使用eZIS进行的定性分析显示17例受试者（68%）存在枕叶灌注不足。3DSRT模板上枕叶节段的定量平均血流灌注为右侧40.7±5.03 ml/100 g/min，左侧40.5±5.38 ml/100 g/min，19例DLB患者的这些值低于正常范围。25例受试者中有24例（96%）在延迟图像中心肌MIBG摄取减少。
MIBG心肌闪烁显像在检测DLB特征方面优于脑灌注SPECT。我们的结果表明，联合SPECT和MIBG闪烁显像可提高DLB临床诊断的准确性。
