特发性正常压力脑积水患者纹状体多巴胺能缺失的详细视觉评估：无明显变化还是有变化？
Detailed visual assessment of striatal dopaminergic depletion in patients with idiopathic normal pressure hydrocephalus: unremarkable or not?
机构信息
Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.
Department of Nuclear Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
出版信息
BMC Neurol. 2020 Jul 11;20(1):277. doi: 10.1186/s12883-020-01861-7.
BACKGROUND
Dopamine transporter (DAT) imaging may enable clinicians to discriminate idiopathic normal pressure hydrocephalus (iNPH) from other parkinsonian disorders. However, a specific pattern of dopaminergic loss in DAT imaging of iNPH patients remains to be further elucidated.
METHODS
In this preliminary study, 11 patients with iNPH in our hospital between March 2017 and February 2019 were finally enrolled. A diagnosis of iNPH was made according to the two established criteria. For visual analysis of DAT imaging, a striatum was divided into five domains. A semi-quantitative visual assessment was performed with a consensus between a nuclear medicine specialist and an experienced neurologist who were blinded to the clinical diagnosis.
RESULTS
Striatal dopaminergic deficits were abnormal in 90.9% (10/11) of patients with iNPH. The degree of dopaminergic reduction was mild and heterogeneous. However, a tendency of preferential striatal DAT loss in the caudate nucleus (90.9%, 10/11) than in the putamen (72.7%, 8/11) was observed, whereas ventral portion (9.1%, 1/11) was relatively preserved.
CONCLUSION
Striatal dopaminergic depletion might be mild and heterogeneous in patients with iNPH. These dopaminergic deficits were more common in the caudate nucleus than in the putamen, suggesting a pattern different from other degenerative parkinsonian disorders.
背景
多巴胺转运体（DAT）成像可以帮助临床医生区分特发性正常压力脑积水（iNPH）与其他帕金森病。然而，iNPH 患者 DAT 成像中多巴胺能丧失的特定模式仍有待进一步阐明。
方法
在这项初步研究中，最终纳入了我院 2017 年 3 月至 2019 年 2 月间的 11 名 iNPH 患者。根据两项既定标准诊断为 iNPH。为了对 DAT 成像进行视觉分析，将纹状体分为五个区域。核医学专家和一位经验丰富的神经科医生对 DAT 成像进行了半定量视觉评估，他们对临床诊断并不知情。
结果
90.9%（11/11）的 iNPH 患者存在纹状体多巴胺能缺陷。多巴胺减少的程度较轻且不均匀。然而，观察到纹状体 DAT 丢失在尾状核（90.9%，10/11）比壳核（72.7%，8/11）更常见的趋势，而腹侧部分（9.1%，1/11）相对保留。
结论
iNPH 患者的纹状体多巴胺能缺失可能较轻且不均匀。这些多巴胺能缺陷在尾状核比壳核更常见，提示与其他退行性帕金森病不同的模式。
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