Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil.
Parkinsonism Relat Disord. 2014 May;20(5):477-81. doi: 10.1016/j.parkreldis.2014.01.015. Epub 2014 Feb 6.
Approximately 10% of patients with a presumed diagnosis of Parkinson's disease (PD) remain misdiagnosed despite recent advances in neuroimaging. The current study addresses the use of transcranial sonography and single-photon emission computed tomography (SPECT) using (99m)Tc-TRODAT-1 to evaluate the echogenicity of the substantia nigra (SN) and the density of striatal presynaptic dopamine transporters, respectively, in a sample of 20 PD patients (13 males and 7 females) and 9 healthy subjects. The median age of the PD patients was 62 years. The median age at disease onset was 56 years, and the median disease duration was 5 years. The SN echogenic area was larger in PD patients than healthy subjects. The cut-off value of 0.22 cm(2) for the SN echogenic area was associated with 100% sensitivity and 78% specificity for the diagnosis of PD. Striatal and putaminal (99m)Tc-TRODAT-1 binding was lower in PD patients than healthy subjects. The cut-off value of 0.90 for the striatal (99m)Tc-TRODAT-1 binding was associated with 100% sensitivity and an 89% specificity for the diagnosis of PD, and the cut-off value of 0.76 for putaminal (99m)Tc-TRODAT-1 binding was associated with an 85% sensitivity and an 89% specificity. The size of the SN echogenic area did not correlate with the degree of striatal (99m)Tc-TRODAT-1 binding in PD patients. In conclusion, both SN hyperechogenicity and decreased striatal or putaminal (99m)Tc-TRODAT-1 binding constitute surrogate markers for differentiating PD patients from healthy individuals with a slightly higher diagnostic specificity of (99m)Tc-TRODAT-1 SPECT.
大约 10%的帕金森病（PD）患者尽管神经影像学有了最近的进展，仍被误诊。本研究采用经颅超声和单光子发射计算机断层扫描（SPECT），分别使用（99m）Tc-TRODAT-1 评估 20 例 PD 患者（13 名男性和 7 名女性）和 9 名健康受试者的黑质（SN）回声强度和纹状体突触前多巴胺转运体密度。PD 患者的中位年龄为 62 岁。疾病发病中位年龄为 56 岁，疾病持续时间的中位数为 5 年。SN 回声面积在 PD 患者中大于健康受试者。SN 回声面积的截断值为 0.22cm2 时，对 PD 的诊断具有 100%的敏感性和 78%的特异性。PD 患者的纹状体和壳核（99m）Tc-TRODAT-1 结合均低于健康受试者。纹状体（99m）Tc-TRODAT-1 结合的截断值为 0.90 时，对 PD 的诊断具有 100%的敏感性和 89%的特异性，壳核（99m）Tc-TRODAT-1 结合的截断值为 0.76 时，对 PD 的诊断具有 85%的敏感性和 89%的特异性。SN 回声强度与 PD 患者纹状体（99m）Tc-TRODAT-1 结合程度无相关性。总之，SN 高回声和纹状体或壳核（99m）Tc-TRODAT-1 结合减少均可作为区分 PD 患者和健康个体的替代标志物，（99m）Tc-TRODAT-1 SPECT 的诊断特异性略高。
