Yang YoungSoon, Cheon Miju, Kwak Yong Tae
Department of Neurology, Veterans Health Service Medical Center, Seoul, Korea.
Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, Korea.
Dement Neurocogn Disord. 2017 Sep;16(3):57-63. doi: 10.12779/dnd.2017.16.3.57. Epub 2017 Sep 30.
The aim of this paper was to investigate the utility of 18F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane (FP-CIT) positron emission tomography (PET) for evaluating the severity of Parkinson's disease (PD) according to various clinical stages, and to identify the relationship between the striatal substructure and the Unified Parkinson's Disease Rating Scale (UPDRS) motor score, cognitive symptoms through 18F-FP-CIT PET.
We retrospectively identified 542 patients with various clinical stages of PD who underwent an 18F-FP-CIT PET at our clinics. The difference between the 18F-FP-CIT PET according to the Hoehn-Yahr stage, correlation between 18F-FP-CIT PET and the UPDRS III grouped motor items, and the Korean Mini-Mental State Examination (K-MMSE) were investigated.
As disease progressed, the right caudate and both the anterior putamen and caudate/putamen ratios exhibited a significantly lower uptake. The uptake of all striatal substructures was significantly correlated with the UPDRS total motor score. The right caudate nucleus was significantly related to both the UPDRS tremor items and the right UPDRS akinesia-rigidity items. The left caudate nucleus was related to both the UPDRS tremor items and UPDRS akinesia-rigidity items. The right anterior putamen was related to the axial items, right tremor and akinesia-rigidity items; while the left anterior putamen was related to the right tremor and right akinesia-rigidity items. Both of the posterior putamens were related to the axil items, left tremor and left akinesia rigidity items. K-MMSE was not significantly related to any striatal substructures.
The UPDRS total motor score was significantly correlated with the uptake of all striatal substructures. However, the 18F-FPCIT uptake in specific striatal substructures was rather complexly correlated with the UPDRS motor grouped items and was not significantly related to K-MMSE. These results suggest the possibility of the complex pathophysiology of motor symptoms of PD and limitation of 18F-FPCIT PET for the evaluation of the severity of PD motor and cognitive symptoms.
本文旨在研究18F-N-(3-氟丙基)-2β-羧甲氧基-3β-(4-碘苯基)去甲托烷（FP-CIT）正电子发射断层扫描（PET）在根据帕金森病（PD）不同临床分期评估疾病严重程度方面的效用，并通过18F-FP-CIT PET确定纹状体亚结构与统一帕金森病评定量表（UPDRS）运动评分、认知症状之间的关系。
我们回顾性纳入了542例在我院接受18F-FP-CIT PET检查的不同临床分期的PD患者。研究了根据Hoehn-Yahr分期的18F-FP-CIT PET差异、18F-FP-CIT PET与UPDRS III分组运动项目之间的相关性以及韩国简易精神状态检查表（K-MMSE）。
随着疾病进展，右侧尾状核以及前壳核和尾状核/壳核比值的摄取均显著降低。所有纹状体亚结构的摄取与UPDRS总运动评分均显著相关。右侧尾状核与UPDRS震颤项目以及右侧UPDRS运动迟缓-强直项目均显著相关。左侧尾状核与UPDRS震颤项目以及UPDRS运动迟缓-强直项目相关。右侧前壳核与轴性项目、右侧震颤和运动迟缓-强直项目相关；而左侧前壳核与右侧震颤和右侧运动迟缓-强直项目相关。双侧后壳核均与轴性项目、左侧震颤和左侧运动迟缓-强直项目相关。K-MMSE与任何纹状体亚结构均无显著相关性。
UPDRS总运动评分与所有纹状体亚结构的摄取均显著相关。然而，特定纹状体亚结构中18F-FPCIT的摄取与UPDRS运动分组项目的相关性较为复杂，且与K-MMSE无显著相关性。这些结果提示了PD运动症状复杂病理生理学的可能性以及18F-FPCIT PET在评估PD运动和认知症状严重程度方面的局限性。
