多巴胺 PET 诊断的帕金森病患者心脏（123）I-MIBG 闪烁显像的验证。
Validation of cardiac (123)I-MIBG scintigraphy in patients with Parkinson's disease who were diagnosed with dopamine PET.
机构信息
Department of Neurology and Neurological Science, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
Eur J Nucl Med Mol Imaging. 2010 Jan;37(1):3-11. doi: 10.1007/s00259-009-1202-1.
PURPOSE
The aim of this study was to evaluate the diagnostic potential of cardiac (123)I-labelled metaiodobenzylguanidine ((123)I-MIBG) scintigraphy in idiopathic Parkinson's disease (PD). The diagnosis was confirmed by positron emission tomography (PET) imaging with (11)C-labelled 2beta-carbomethoxy-3beta-(4-fluorophenyl)-tropane ((11)C-CFT) and (11)C-raclopride (together designated as dopamine PET).
METHODS
Cardiac (123)I-MIBG scintigraphy and dopamine PET were performed for 39 parkinsonian patients. To estimate the cardiac (123)I-MIBG uptake, heart to mediastinum (H/M) ratios in early and delayed images were calculated. On the basis of established clinical criteria and our dopamine PET findings, 24 patients were classified into the PD group and 15 into the non-PD (NPD) group.
RESULTS
Both early and delayed images showed that the H/M ratios were significantly lower in the PD group than in the NPD group. When the optimal cut-off levels of the H/M ratio were set at 1.95 and 1.60 in the early and delayed images, respectively, by receiver-operating characteristic analysis, the sensitivity of cardiac (123)I-MIBG scintigraphy for the diagnosis of PD was 79.2 and 70.8% and the specificity was 93.3 and 93.3% in the early and delayed images, respectively. In the Hoehn and Yahr 1 and 2 PD patients, the sensitivity decreased by 69.2 and 53.8% in the early and delayed images, respectively.
CONCLUSION
In early PD cases, cardiac (123)I-MIBG scintigraphy is of limited value in the diagnosis, because of its relatively lower sensitivity. However, because of its high specificity for the overall cases, cardiac (123)I-MIBG scintigraphy may assist in the diagnosis of PD in a complementary role with the dopaminergic neuroimaging.
目的
本研究旨在评估心脏（123）I-间位碘苄胍（（123）I-MIBG）闪烁显像在特发性帕金森病（PD）中的诊断潜力。该诊断通过正电子发射断层扫描（PET）成像用（11）C-标记的 2β-羧甲氧基-3β-（4-氟苯基）-托烷（（11）C-CFT）和（11）C-氯丙嗪（统称为多巴胺 PET）来确认。
方法
对 39 例帕金森病患者进行心脏（123）I-MIBG 闪烁显像和多巴胺 PET。为了估计心脏（123）I-MIBG 摄取，计算早期和延迟图像中的心脏与纵隔（H/M）比值。根据既定的临床标准和我们的多巴胺 PET 结果，将 24 例患者分为 PD 组，15 例患者分为非 PD（NPD）组。
结果
早期和延迟图像均显示，PD 组的 H/M 比值明显低于 NPD 组。通过接收者操作特征分析，当 H/M 比值的最佳截断值分别设定为早期和延迟图像中的 1.95 和 1.60 时，心脏（123）I-MIBG 闪烁显像对 PD 的诊断灵敏度分别为 79.2%和 70.8%，特异性分别为 93.3%和 93.3%。在 Hoehn 和 Yahr 1 和 2 期 PD 患者中，早期和延迟图像的灵敏度分别下降了 69.2%和 53.8%。
结论
在早期 PD 病例中，由于其相对较低的灵敏度，心脏（123）I-MIBG 闪烁显像在诊断中价值有限。然而，由于其对所有病例的高特异性，心脏（123）I-MIBG 闪烁显像可能会以辅助作用与多巴胺能神经影像学一起辅助 PD 的诊断。
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