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(123)I-碘氟潘单光子发射计算机断层扫描(SPECT)及心肌间碘苄胍闪烁显像在确定帕金森病脑深部电刺激术候选者中的重要性

Importance of (123)I-ioflupane SPECT and Myocardial MIBG Scintigraphy to Determine the Candidate of Deep Brain Stimulation for Parkinson's Disease.

作者信息

Asahi Takashi, Kashiwazaki Daina, Yoneyama Tatsuya, Noguchi Kyo, Kuroda Satoshi

机构信息

Departments of Neurosurgery, University of Toyama.

出版信息

Neurol Med Chir (Tokyo). 2016;56(3):125-31. doi: 10.2176/nmc.oa.2015-0234. Epub 2016 Jan 20.

Abstract

(123)I-ioflupane SPECT (DaTscan) is an examination that detects presynaptic dopamine neuronal dysfunction, and has been used as a diagnostic tool to identify degenerative parkinsonism. Additionally, myocardial (123)I-metaiodobenzyl guanidine (MIBG) scintigraphy measures the concentration of cardiac sympathetic nerve fibers and is used to diagnose Parkinson's disease (PD). These exams are used as adjuncts in the diagnosis of parkinsonism, however, the relationship of these two examinations are not well-known. We investigated the relationship of these two scanning results specifically for determining the use of deep brain stimulation therapy (DBS). Subjects were Japanese patients with suspected striatonigral degeneration, including PD; DaTscans and myocardial MIBG scintigraphy were performed. The mean values of the left-right specific binding ratios (SBRs) from the DaTscan, and the early/delayed heart-to-mediastinum ratios (HMRs) from the MIBG scintigraphy were calculated. Using simple linear regression analysis, we compared the SBR and early/delayed HMR values. Twenty-four patients were enrolled in this study. Twenty-one patients were positive via the DaTscan, and the MIBG scintigraphy results showed 14 patients were positive. SBR and both early and delayed HMR were positively correlated in cases of PD, but negative in non-PD cases. A mean SBR value less than 3.0 and a delayed HMR value less than 1.7 indicated a Hoehn-Yahr stage 3 or 4 for PD, which is commonly regarded as a level appropriate for initiating DBS therapy. Our results indicate that performing both DaTscan and MIBG scintigraphy is useful for the evaluation of surgical intervention in PD.

摘要

(123)I-碘氟潘单光子发射计算机断层扫描(DaTscan)是一种检测突触前多巴胺神经元功能障碍的检查方法,已被用作识别退行性帕金森综合征的诊断工具。此外,心肌(123)I-间碘苄胍(MIBG)闪烁显像可测量心脏交感神经纤维的浓度,用于诊断帕金森病(PD)。这些检查被用作帕金森综合征诊断的辅助手段,然而,这两项检查之间的关系尚不清楚。我们专门研究了这两项扫描结果之间的关系,以确定深部脑刺激疗法(DBS)的使用。研究对象为疑似纹状体黑质变性的日本患者,包括帕金森病患者;进行了DaTscan和心肌MIBG闪烁显像检查。计算了DaTscan左右特异性结合率(SBR)的平均值,以及MIBG闪烁显像早期/延迟心纵隔比(HMR)。通过简单线性回归分析,比较了SBR和早期/延迟HMR值。本研究共纳入24例患者。21例患者DaTscan检查呈阳性,MIBG闪烁显像结果显示14例患者呈阳性。在帕金森病患者中,SBR与早期和延迟HMR均呈正相关,但在非帕金森病患者中呈负相关。平均SBR值小于3.0且延迟HMR值小于1.7表明帕金森病处于Hoehn-Yahr 3或4期,这通常被认为是适合开始DBS治疗的水平。我们的结果表明,同时进行DaTscan和MIBG闪烁显像有助于评估帕金森病的手术干预。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6a43/4791306/083b2a82b58d/nmc-56-125-g1.jpg

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