123I-MIBG 心脏摄取、嗅觉识别和 123I-FP-CIT SPECT 在血管性帕金森病与帕金森病的鉴别诊断中的应用。

123I-MIBG cardiac uptake, smell identification and 123I-FP-CIT SPECT in the differential diagnosis between vascular parkinsonism and Parkinson's disease.

机构信息

Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociències Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer-IDIBAPS, Barcelona, Spain.

Nuclear Medicine Service Centre de Diagnòstic per la Imatge Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.

出版信息

Parkinsonism Relat Disord. 2014 Feb;20(2):192-7. doi: 10.1016/j.parkreldis.2013.10.025. Epub 2013 Nov 5.

DOI:10.1016/j.parkreldis.2013.10.025

PMID:24252299

Abstract

UNLABELLED

Vascular parkinsonism (VP) may occur as a distinct clinicopathological entity but the comorbid presence of vascular damage in Parkinson's disease (PD) is very frequent too. This differential diagnosis has therapeutic and prognostic implications but remains challenging as the usefulness of a number of supporting tools is still controversial.

OBJECTIVE

To ascertain the clinical value of cardiac (123)I-meta-iodobenzylguanidine ((123)I-MIBG) SPECT, olfactory function and (123)I-FP-CIT SPECT as supporting tools in the differential diagnosis between VP and PD.

METHODS

Cross-sectional study of 15 consecutive patients with suspected VP, 15 PD patients and 9 healthy subjects. Cardiac (123)I-MIBG SPECT (heart-to-mediastinum ratio) and olfactory testing (University of Pennsylvania Smell Identification Test-UPSIT) were performed in all of them. (123)I-FP-CIT SPECT was performed in VP-suspected patients.

RESULTS

Heart-to-mediatinum ratio was significant lower in suspected VP (mean 1.45) and PD (mean 1.16) compared to control group (mean 1.69) (p = 0.017 and p < 0.0001). VP patients presented a higher ratio than PD patients (p = 0.001). Control group presented a significant higher UPSIT score (mean 30.71) when compared to both VP (mean 18.33) and PD (mean 15.29) (p = 0.001 for both groups). Those VP with a cardiac (123)I-MIBG non suggestive of PD were more likely to have a higher UPSIT score (p = 0.006). (123)I-FP-CIT SPECT imaging was heterogeneous (7/15 VP normal, 3/15 abnormal suggestive of PD and 5/15 abnormal but atypical for PD).

CONCLUSIONS

The use of cardiac (123)I-MIBG SPECT and to a lesser extent UPSIT could assist the differential diagnosis between VP and PD in subjects in which the diagnosis remains uncertain despite (123)I-FP-CIT SPECT imaging.

摘要

目的

确定心脏（123）I-间碘苄胍（（123）I-MIBG）SPECT、嗅觉功能和（123）I-FP-CIT SPECT 作为支持工具在血管性帕金森病（VP）和帕金森病（PD）之间鉴别诊断的临床价值。

方法

对 15 例疑似 VP 患者、15 例 PD 患者和 9 例健康受试者进行横断面研究。对所有患者进行心脏（123）I-MIBG SPECT（心脏与纵隔比）和嗅觉测试（宾夕法尼亚大学嗅觉识别测试-UPSIT）。对疑似 VP 患者进行（123）I-FP-CIT SPECT 检查。

结果

与对照组（1.69）相比，疑似 VP（1.45）和 PD（1.16）患者的心脏与纵隔比值明显较低（p = 0.017 和 p < 0.0001）。VP 患者的比值高于 PD 患者（p = 0.001）。对照组的 UPSIT 评分（均值 30.71）明显高于 VP（均值 18.33）和 PD（均值 15.29）（两组均 p = 0.001）。那些心脏（123）I-MIBG 不提示 PD 的 VP 患者更有可能具有更高的 UPSIT 评分（p = 0.006）。（123）I-FP-CIT SPECT 成像结果呈异质性（7/15 VP 正常，3/15 异常提示 PD，5/15 异常但不典型 PD）。