帕金森病、进行性核上性麻痹和多系统萎缩的纹状体多巴胺转运体优先丢失的亚区模式不同。

Subregional patterns of preferential striatal dopamine transporter loss differ in Parkinson disease, progressive supranuclear palsy, and multiple-system atrophy.

机构信息

Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

出版信息

J Nucl Med. 2012 Mar;53(3):399-406. doi: 10.2967/jnumed.111.095224. Epub 2012 Feb 9.

DOI:10.2967/jnumed.111.095224

PMID:22323779

Abstract

UNLABELLED

Parkinson disease (PD), progressive supranuclear palsy (PSP), and multiple-system atrophy (MSA) are known to affect dopaminergic neurons of the brain stem and striatum with different preferential involvement. Here we investigated differences in striatal subregional dopamine transporter loss in PD, PSP, and MSA and assessed the diagnostic value of (18)F-fluorinated-N-3-fluoropropyl-2-β-carboxymethoxy-3-β-(4-iodophenyl)nortropane ((18)F-FP-CIT) PET in differentiating PSP and MSA from PD.

METHODS

Forty-nine patients with PD, 19 patients with PSP, 24 patients with MSA, and 21 healthy people (healthy controls) were examined with (18)F-FP-CIT PET. The PET images were spatially normalized and analyzed with 12 striatal subregional volume-of-interest (VOI) templates (bilateral ventral striatum [VS], anterior caudate [AC], posterior caudate, anterior putamen, posterior putamen [PP], and ventral putamen [VP]) and 1 occipital VOI template. The nondisplaceable binding potential (BP(ND)) and intersubregional ratio (ISR; defined as the ratio of the BP(ND) of one striatal subregion to that of another striatal subregion) of subregional VOIs were calculated.

RESULTS

The BP(ND) of all VOIs in the PD, MSA, and PSP groups were significantly lower than those in the healthy controls (P < 0.05). The BP(ND) of AC and the AC/VS ISR in the PSP group were significantly lower than those in the PD group. The BP(ND) of VP was significantly lower, but the PP/VP ISR was significantly higher in the MSA group than in the PD group. At the cutoff value for the AC/VS ISR (<0.7), the sensitivity and specificity for differentiating PSP from PD were 94% and 92%, respectively. At the cutoff value for the PP/VP ISR (>0.65), the sensitivity and specificity for differentiating MSA from PD were 90% and 45%, respectively. The diagnostic accuracy of visual analysis was similar to that of quantitative analysis for differentiating PSP from PD but was significantly higher for differentiating MSA from PD.

CONCLUSION

Compared with PD, PSP and MSA showed more prominent and earlier dopamine transporter loss in the AC and VP, respectively. These findings could be useful for suggesting PSP or MSA in parkinsonian cases without characteristic atypical features.

摘要

目的

研究帕金森病（PD）、进行性核上性麻痹（PSP）和多系统萎缩（MSA）中纹状体多巴胺转运体（DAT）的区域性差异，评估 18F-氟代-N-3-氟丙基-2-β-羧甲基氧基-3-β-（4-碘苯基）-n-托烷（18F-FP-CIT）正电子发射断层扫描（PET）在鉴别 PSP 和 MSA 与 PD 中的诊断价值。

方法

对 49 例 PD 患者、19 例 PSP 患者、24 例 MSA 患者和 21 名健康人（健康对照组）进行 18F-FP-CIT PET 检查。将 PET 图像进行空间标准化，并使用 12 个纹状体亚区容积感兴趣区（VOI）模板（双侧腹侧纹状体[VS]、前尾状核[AC]、后尾状核、前壳核、后壳核[PP]和腹侧壳核[VP]）和 1 个枕叶 VOI 模板进行分析。计算各亚区 VOI 的不可置换结合位（BP（ND））和亚区间比值（ISR；定义为一个纹状体亚区的 BP（ND）与另一个纹状体亚区的 BP（ND）的比值）。

结果

PD、MSA 和 PSP 组的所有 VOI 的 BP（ND）均明显低于健康对照组（P<0.05）。PSP 组的 AC 的 BP（ND）和 AC/VS ISR 明显低于 PD 组。MSA 组的 VP 的 BP（ND）明显降低，但 PP/VP ISR 明显高于 PD 组。AC/VS ISR 截断值（<0.7）时，鉴别 PSP 和 PD 的敏感性和特异性分别为 94%和 92%。PP/VP ISR 截断值（>0.65）时，鉴别 MSA 和 PD 的敏感性和特异性分别为 90%和 45%。与定量分析相比，视觉分析鉴别 PSP 和 PD 的诊断准确性相似，但鉴别 MSA 和 PD 的诊断准确性明显更高。