Ibrahim Nevein, Kusmirek Joanna, Struck Aaron F, Floberg John M, Perlman Scott B, Gallagher Catherine, Hall Lance T
Department of Radiology, University of Wisconsin School of Medicine and Public Health USA.
Department of Radiology, University of Wisconsin School of Medicine and Public HealthUSA; Department of Neurology, William S. Middleton VA HospitalUSA.
Am J Nucl Med Mol Imaging. 2016 Jan 28;6(1):102-9. eCollection 2016.
Idiopathic Parkinson's disease (PD) is the second most common neurodegenerative disorder. Early PD may present a diagnostic challenge with broad differential diagnoses that are not associated with nigral degeneration or striatal dopamine deficiency. Therefore, the early clinical diagnosis alone may not be accurate and this reinforces the importance of functional imaging targeting the pathophysiology of the disease process. (18)F-DOPA L-6-[(18)F] fluoro-3,4-dihydroxyphenylalnine ((18)F-DOPA) is a positron emission tomography (PET) agent that measures the uptake of dopamine precursors for assessment of presynaptic dopaminergic integrity and has been shown to accurately reflect the monoaminergic disturbances in PD. In this study, we aim to illustrate our local experience to determine the accuracy of (18)F-DOPA PET for diagnosis of PD. We studied a total of 27 patients. A retrospective analysis was carried out for all patients that underwent (18)F-DOPA PET brain scan for motor symptoms suspicious for PD between 2001-2008. Both qualitative and semi-quantitative analyses of the scans were performed. The patient's medical records were then assessed for length of follow-up, response to levodopa, clinical course of illness, and laterality of symptoms at time of (18)F-DOPA PET. The eventual diagnosis by the referring neurologist, movement disorder specialist, was used as the reference standard for further analysis. Of the 28 scans, we found that one was a false negative, 20 were true positives, and 7 were true negatives. The resultant values are Sensitivity 95.4% (95% CI: 100%-75.3%), Specificity 100% (95% CI: 100%-59.0%), PPV 100% (95% CI 100%-80.7%), and NPV 87.5% (95% CI: 99.5%-50.5%).
特发性帕金森病（PD）是第二常见的神经退行性疾病。早期帕金森病可能带来诊断挑战，其鉴别诊断范围广泛，且与黑质变性或纹状体多巴胺缺乏无关。因此，仅靠早期临床诊断可能并不准确，这凸显了针对疾病病理生理过程进行功能成像的重要性。（18）F - DOPA（L - 6 - [（18）F]氟 - 3,4 - 二羟基苯丙氨酸）是一种正电子发射断层扫描（PET）剂，可测量多巴胺前体的摄取，用于评估突触前多巴胺能完整性，并且已被证明能准确反映帕金森病中的单胺能紊乱。在本研究中，我们旨在阐述我们本地的经验，以确定（18）F - DOPA PET诊断帕金森病的准确性。我们共研究了27例患者。对2001年至2008年间因运动症状可疑为帕金森病而接受（18）F - DOPA PET脑扫描的所有患者进行了回顾性分析。对扫描结果进行了定性和半定量分析。然后评估患者的病历，以了解随访时间、对左旋多巴的反应、疾病临床过程以及（18）F - DOPA PET检查时症状的偏侧性。由转诊的神经科医生、运动障碍专家做出的最终诊断被用作进一步分析的参考标准。在28次扫描中，我们发现1次为假阴性，20次为真阳性，7次为真阴性。所得结果为敏感度95.4%（95%置信区间：100% - 75.3%），特异度100%（95%置信区间：100% - 59.0%），阳性预测值100%（95%置信区间100% - 80.7%），阴性预测值87.5%（95%置信区间：99.5% - 50.5%）。
