Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Parkinsonism Relat Disord. 2021 Jan;82:1-6. doi: 10.1016/j.parkreldis.2020.11.002. Epub 2020 Nov 10.
To determine whether vascular parkinsonism (VaP) patients with visually normal dopamine transporter (DAT) scans have presynaptic dopaminergic depletion.
We enrolled 23 VaP patients who had parkinsonism, relevant diffuse subcortical white matter hyperintensities (WMH), and visually normal DAT scans, 23 Parkinson's disease (PD) patients, and 31 control subjects. By quantitatively analyzing F-N-(3-fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane (F-FP-CIT) positron emission tomography, we compared the pattern of striatal DAT availability among groups. The discriminatory power of striatal DAT availability to differentiate VaP patients from control subjects or PD patients was assessed using receiver operating characteristics (ROC) analyses. Additionally, correlation analysis was performed to determine whether WMH severity or Unified Parkinson Disease Rating Scale Part III (UPDRS-III) score is related to presynaptic dopaminergic depletion in VaP.
VaP patients exhibited decreased DAT availability in all striatal subregions, including posterior putamen, compared to control subjects. VaP patients and control subjects had similar patterns of anteroposterior and ventrodorsal DAT gradients in caudate and putamen level, but VaP patients exhibited significantly different patterns at putamen level, relative to PD patients. The severity of periventricular WMH was significantly correlated with all substriatal DAT availability in VaP, but not with UPDRS-III scores. The ROC analysis showed that DAT availability in caudate and posterior putamen had a fair discriminatory power when differentiating VaP patients from control subjects.
This study demonstrates that VaP patients with WMH exhibited diffusely decreased DAT availability without any specific regional gradients of DAT patterns distinct from either control subjects or PD patients.
确定视觉上多巴胺转运体（DAT）扫描正常的血管性帕金森病（VaP）患者是否存在突触前多巴胺能耗竭。
我们纳入了 23 例帕金森病患者、23 例 VaP 患者和 31 例对照者，这些 VaP 患者有帕金森病、相关弥漫性皮质下白质高信号（WMH）和视觉上正常的 DAT 扫描。通过定量分析 F-N-(3-氟丙基)-2β-碳乙氧基-3β-(4-碘苯基)去甲托烷（F-FP-CIT）正电子发射断层扫描，我们比较了各组纹状体 DAT 可用性的模式。使用受试者工作特征（ROC）分析评估纹状体 DAT 可用性区分 VaP 患者与对照组或 PD 患者的判别能力。此外，进行了相关性分析，以确定 WMH 严重程度或帕金森病评定量表第三部分（UPDRS-III）评分是否与 VaP 中的突触前多巴胺能耗竭相关。
与对照组相比，VaP 患者所有纹状体亚区（包括后壳核）的 DAT 可用性均降低。与 PD 患者相比，VaP 患者和对照组在后壳核水平的尾状核和壳核的 DAT 前后梯度和腹背梯度相似，但在壳核水平的 DAT 模式明显不同。脑室周围 WMH 的严重程度与 VaP 中所有亚纹状体 DAT 可用性均显著相关，但与 UPDRS-III 评分无关。ROC 分析表明，区分 VaP 患者与对照组时，尾状核和后壳核的 DAT 可用性具有良好的判别能力。
本研究表明，有 WMH 的 VaP 患者表现为弥散性 DAT 可用性降低，而无任何特定的 DAT 模式区域梯度，与对照组或 PD 患者不同。
