Institute of Neurology, University Magna Græcia, Catanzaro, Italy.
Neuroimaging Unit, IBFM, National Research Council, Catanzaro, Italy.
Parkinsonism Relat Disord. 2017 Oct;43:78-84. doi: 10.1016/j.parkreldis.2017.07.028. Epub 2017 Jul 28.
The objective of this study was to investigate the thalamic biochemical changes in tremor-dominant Parkinson's disease (tPD) patients in comparison with essential tremor with resting tremor (rET) patients, by using proton MR spectroscopy (H-MRS).
Fourteen tPD patients, 12 rET patients and 10 controls participated in this study. All patients underwent dopamine transporter single-photon emission computed tomography (DAT-SPECT) with I-ioflupane, and a short-echo single-voxel H-MRS on a 3T scanner. A voxel of 10 × 15 × 10 mm involving the Vim nucleus was acquired in both thalami of all subjects. Peak areas of N-acetyl-aspartate (NAA), creatine (Cr), glycerophosphocholine (Cho), and glutamate (Glu) were measured for each voxel using LCModel. The NAA/Cr, Cho/Cr, and Glu/Cr ratios were then calculated.
DAT-SPECT was abnormal in tPD patients, whereas it was normal in rET patients. Patients with tPD showed a significant reduction of NAA/Cr and Cho/Cr in the thalami compared to rET and healthy controls; whereas there were no significant differences between rET patients and controls. The combination of thalamic NAA/Cr and Cho/Cr ratios showed a 100% accuracy in distinguishing tPD patients from rET patients and controls.
This study provides preliminary evidence that thalamic neurometabolic abnormalities occur in tremor-dominant phenotype of PD, and suggests that H-MRS can help differentiate patients with tPD from those with rET.
本研究旨在通过质子磁共振波谱（H-MRS）比较震颤为主型帕金森病（tPD）患者与静止性震颤伴震颤（rET）患者的丘脑生化变化。
本研究纳入 14 例 tPD 患者、12 例 rET 患者和 10 例健康对照者。所有患者均接受 I-ioflupane 多巴胺转运体单光子发射计算机断层扫描（DAT-SPECT），并在 3T 扫描仪上进行短回波单体素 H-MRS。在所有受试者的两侧丘脑采集一个 10×15×10mm 的 Vim 核体素。使用 LCModel 测量每个体素中 N-乙酰天冬氨酸（NAA）、肌酸（Cr）、甘油磷酸胆碱（Cho）和谷氨酸（Glu）的峰面积。然后计算 NAA/Cr、Cho/Cr 和 Glu/Cr 比值。
tPD 患者的 DAT-SPECT 异常，而 rET 患者的 DAT-SPECT 正常。与 rET 和健康对照组相比，tPD 患者丘脑的 NAA/Cr 和 Cho/Cr 比值显著降低；而 rET 患者与对照组之间无显著差异。丘脑 NAA/Cr 和 Cho/Cr 比值的组合可 100%准确地区分 tPD 患者与 rET 患者和对照组。
本研究初步证明，震颤为主型 PD 患者存在丘脑神经代谢异常，并提示 H-MRS 有助于区分 tPD 患者与 rET 患者。
