帕金森病和路易体痴呆患者的脑微出血：磁共振成像与 99mTc-ECD SPECT 减影成像的比较。

Cerebral Microbleeds in Patients with Parkinson's Disease and Dementia with Lewy Bodies: Comparison Using Magnetic Resonance Imaging and 99 mTc-ECD SPECT Subtraction Imaging.

机构信息

Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Kita-ku, Okayama, Japan.

出版信息

J Alzheimers Dis. 2021;80(1):331-335. doi: 10.3233/JAD-201495.

DOI:10.3233/JAD-201495

PMID:33523013

Abstract

BACKGROUND

Cerebral microbleeds (CMBs) in patients with Parkinson's disease (PD) or dementia with Lewy bodies (DLB) have not been adequately studied.

OBJECTIVE

This study aims to find a difference in the total number, prevalence, and common locations of CMBs between PD and DLB and evaluate 99 mTc-ECD SPECT subtraction images of these two diseases.

METHODS

We examined 112 patients with PD (53 males and 59 females; age: 77.4±3.6 years) and 28 age-matched patients with DLB (15 males and 13 females; age: 77.1±6.7 years) using brain magnetic resonance imaging (MRI) and 99 mTc-ECD SPECT subtraction imaging.

RESULTS

The total number of CMBs was higher in patients with DLB (41.2%) than in those with PD (11.5%), and the prevalence was significantly higher in the former (0.7±1.1) than the latter (0.2±0.5, p < 0.05). The odds ratio was 5.4 (95% confidence interval [CI]: 1.7-17.4). Furthermore, CMBs were commonly located in the basal ganglia of patients with PD (6 out of 87 patients) but in the occipital lobe of patients with DLB (8 out of 17 patients). 99 mTc-ECD SPECT subtraction imaging indicated lower cerebral blood flow in the posterior cingulate gyrus among the patients with CMB-positive DLB than among those with CMB-positive PD; additionally, the cerebral blood flow was lower in the bilateral basal ganglia and midbrain among patients with CMB-positive DLB compared to those with CMB-negative DLB.

CONCLUSION

A reduction in occipital glucose metabolism may be related to CMBs in the occipital lobe of patients with DLB.

摘要

背景

帕金森病（PD）或路易体痴呆（DLB）患者的脑微出血（CMBs）尚未得到充分研究。

目的

本研究旨在发现 PD 和 DLB 之间 CMB 总数、患病率和常见部位的差异，并评估这两种疾病的 99mTc-ECD SPECT 减影图像。

方法

我们使用脑部磁共振成像（MRI）和 99mTc-ECD SPECT 减影成像检查了 112 例 PD 患者（53 名男性和 59 名女性；年龄：77.4±3.6 岁）和 28 名年龄匹配的 DLB 患者（15 名男性和 13 名女性；年龄：77.1±6.7 岁）。

结果

DLB 患者的 CMB 总数（41.2%）高于 PD 患者（11.5%），且前者的患病率（0.7±1.1）明显高于后者（0.2±0.5，p<0.05）。优势比为 5.4（95%置信区间 [CI]：1.7-17.4）。此外，CMBs 常见于 PD 患者的基底节（87 例患者中有 6 例），但常见于 DLB 患者的枕叶（17 例患者中有 8 例）。99mTc-ECD SPECT 减影成像显示，CMB 阳性 DLB 患者的后扣带回皮质脑血流较低，而 CMB 阳性 PD 患者则较低；此外，与 CMB 阴性 DLB 患者相比，CMB 阳性 DLB 患者的双侧基底节和中脑脑血流较低。