Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
J Neural Transm (Vienna). 2013 Jul;120(7):1053-60. doi: 10.1007/s00702-013-0977-1. Epub 2013 Jan 24.
Subcortical arteriosclerotic encephalopathy (SAE) can affect the nigrostriatal system and presumably cause vascular parkinsonism (VP). However, in patients with SAE, the differentiation of VP from idiopathic Parkinson's disease (IPS) is challenging. The aim of the present study was to examine the striatal dopamine transporter (DAT) density in patients with parkinsonism and SAE. Fifteen consecutive patients with parkinsonian symptoms displayed SAE, as detected by magnetic resonance imaging (MRI). Fifteen retrospectively chosen, matched patients with diagnosis of IPS without any abnormalities in MRI served as a reference group. DAT SPECT was performed using the tracer ¹²³I-FP-CIT. Scans were acquired on a triple-head SPECT system (Multispect 3, Siemens) and analysed using the investigator-independent BRASS™ software (HERMES). In the SAE group, a DAT deficit was observed in 9/15 patients. In contrast, all patients from the IPS group showed a reduced DAT binding (p = 0.008). The specific binding ratios (BR) of putamen contralateral to the side of the more affected limb versus occipital lobe were in trend higher in patients with SAE versus patients in the IPS-group (p = 0.053). Indices for putaminal asymmetry (p = 0.036) and asymmetry caudate-to-putamen (p = 0.026) as well as the ratio caudate-to-putamen (p = 0.048) were significantly higher in IPS patients having no SAE. DAT deficit was less pronounced in patients with SAE and parkinsonism than in patients with IPS without any abnormalities in the MRI. A potential role of DAT SPECT in the differential diagnosis of VP and IPS requires more assessments within prospective studies.
皮质下动脉硬化性脑病（SAE）可影响黑质纹状体系统，并可能导致血管性帕金森病（VP）。然而，在 SAE 患者中，区分 VP 与特发性帕金森病（IPS）具有挑战性。本研究旨在检查帕金森病和 SAE 患者的纹状体多巴胺转运体（DAT）密度。15 例连续出现帕金森病症状的患者经磁共振成像（MRI）检测出 SAE。15 例回顾性选择的、MRI 无任何异常的 IPS 诊断患者作为参考组。使用示踪剂 ¹²³I-FP-CIT 进行 DAT SPECT。扫描在三探头 SPECT 系统（Multispect 3，西门子）上进行，并使用独立研究员的 BRASS™软件（HERMES）进行分析。在 SAE 组中，观察到 9/15 例患者存在 DAT 缺陷。相比之下，IPS 组的所有患者均显示 DAT 结合减少（p=0.008）。与枕叶相比，对侧壳核的特定结合比值（BR）在 SAE 患者中呈上升趋势，而在 IPS 组患者中呈下降趋势（p=0.053）。纹状体不对称指数（p=0.036）和尾状核-壳核不对称指数（p=0.026）以及尾状核-壳核比值（p=0.048）在无 SAE 的 IPS 患者中显著更高。与 IPS 患者相比，SAE 和帕金森病患者的 DAT 缺陷程度较轻，而 MRI 无任何异常。DAT SPECT 在 VP 和 IPS 的鉴别诊断中的潜在作用需要在前瞻性研究中进行更多评估。
