Langston J William, Wiley Jesse C, Tagliati Michele
1Parkinson's Institute, 675 Almanor Ave, Sunnyvale, CA 94085 USA.
2Department of Comparative Medicine, University of Washington, 1959 NE Pacific Ave Seattle, Seattle, WA USA.
NPJ Parkinsons Dis. 2018 Feb 23;4:5. doi: 10.1038/s41531-018-0041-9. eCollection 2018.
The diagnosis of Parkinson's disease (PD) currently relies almost exclusively on the clinical judgment of an experienced neurologist, ideally a specialist in movement disorders. However, such clinical diagnosis is often incorrect in a large percentage of patients, particularly in the early stages of the disease. A commercially available, objective and quantitative marker of nigrostriatal neurodegeneration was recently provided by 123-iodine I-ioflupane SPECT imaging, which is however unable to differentiate PD from a variety of other parkinsonian syndromes associated with striatal dopamine deficiency. There is evidence to support an algorithm utilizing a dual neuroimaging strategy combining I-ioflupane SPECT and the noradrenergic receptor ligand I-metaiodobenzylguanidine (MIBG), which assesses the post-ganglion peripheral autonomic nervous system. Evolving concepts regarding the synucleinopathy affecting the central and peripheral autonomic nervous systems as part of a multisystem disease are reviewed to sustain such strategy. Data are presented to show how MIBG deficits are a common feature of multisystem Lewy body disease and can be used as a unique feature to distinguish PD from atypical parkinsonisms. We propose that the combination of cardiac (MIBG) and cerebral I-ioflupane SPECT could satisfy one of the most significant unmet needs of current PD diagnosis and management, namely the early and accurate diagnosis of patients with typical Lewy body PD. Exemplary case scenarios will be described, highlighting how dual neuroimaging strategy can maximize diagnostic accuracy for patient care, clinical trials, pre-symptomatic PD screening, and special cases provided by specific genetic mutations associated with PD.
帕金森病（PD）的诊断目前几乎完全依赖于经验丰富的神经科医生的临床判断，最好是运动障碍方面的专家。然而，这种临床诊断在很大比例的患者中往往是错误的，尤其是在疾病的早期阶段。123碘I-碘氟烷单光子发射计算机断层扫描（SPECT）成像最近提供了一种可商购的、客观且定量的黑质纹状体神经退行性变标志物，然而它无法将PD与多种其他与纹状体多巴胺缺乏相关的帕金森综合征区分开来。有证据支持一种利用I-碘氟烷SPECT和去甲肾上腺素能受体配体I-间碘苄胍（MIBG）相结合的双重神经成像策略的算法，该算法可评估节后外周自主神经系统。本文综述了关于作为多系统疾病一部分影响中枢和外周自主神经系统的突触核蛋白病的不断发展的概念，以支持这种策略。文中给出的数据表明，MIBG缺陷是多系统路易体病的一个常见特征，可作为区分PD与非典型帕金森病的独特特征。我们提出，心脏（MIBG）和脑I-碘氟烷SPECT的联合应用可以满足当前PD诊断和管理中最显著的未满足需求之一，即对典型路易体PD患者进行早期准确诊断。将描述示例性病例场景，突出双重神经成像策略如何能最大限度地提高诊断准确性，以用于患者护理、临床试验、症状前PD筛查以及由与PD相关的特定基因突变引起特殊病例。
