From the Department of Nuclear Medicine (R.R.), Chung-Ang University Hospital, and Departments of Neurology (J.H.S., H.-J.K., B.J.), and Nuclear Medicine (H.C., G.J.C.), Seoul National University Hospital, Korea.
Neurology. 2021 Mar 23;96(12):e1663-e1671. doi: 10.1212/WNL.0000000000011634. Epub 2021 Feb 3.
To validate the role of the dopamine transporter (DAT) imaging as a biomarker in multiple system atrophy (MSA), we analyzed the association between spatial patterns of [F]fluoro-propyl-carbomethoxy-iodophenyl-tropane ([F]FP-CIT) PET and the clinical characteristics of MSA.
Sixty-five patients with MSA who underwent [F]FP-CIT PET between 2009 and 2018 were retrospectively enrolled. To identify spatial patterns of [F]FP-CIT PET, principal component (PC) analysis was used and correlated with the clinical presentation.
Of the 65 patients, 42 presented with parkinsonian subtype of MSA, and 23 presented with cerebellar subtype of MSA (mean age 63.7 ± 9.3 years; disease duration, 1.8 ± 1.8 years). Each PC represents a specific pattern of degeneration: PC1 and PC2 were associated with the DAT binding of the entire putamen and the posterior putamen, respectively. PC3 was associated with increased [F]FP-CIT uptake of the caudate and decreased uptake of the dorsal pons. PC2 was significantly correlated with the presence of parkinsonism ( = 5.34 × 10) and a positive levodopa response ( = 0.044), with age as a cofactor. PC3 was correlated with the presence of urinary incontinence ( = 0.036). Onset age was significantly correlated with both PC2 ( = 0.48, = 5.0 × 10) and PC3 ( = -0.39, = 0.0013).
The spatial pattern of DAT binding can reflect distinct clinical features of MSA and provides insight into the underlying pathophysiology of a broad spectrum of clinical features in MSA.
为了验证多巴胺转运体（DAT）成像作为多系统萎缩（MSA）生物标志物的作用，我们分析了[F]氟丙基-羰甲基-碘代苯托烷([F]FP-CIT) PET 的空间模式与 MSA 临床特征之间的关联。
回顾性纳入 2009 年至 2018 年间接受[F]FP-CIT PET 的 65 例 MSA 患者。为了识别[F]FP-CIT PET 的空间模式，使用主成分（PC）分析，并将其与临床表现相关联。
65 例患者中，42 例为帕金森型 MSA，23 例为小脑型 MSA（平均年龄 63.7±9.3 岁；病程 1.8±1.8 年）。每个 PC 代表一种特定的退化模式：PC1 和 PC2 分别与整个壳核和后壳核的 DAT 结合相关，PC3 与尾状核的[F]FP-CIT 摄取增加和背侧脑桥的摄取减少相关。PC2 与帕金森症的存在显著相关（=5.34×10）和左旋多巴的阳性反应（=0.044），年龄为协变量。PC3 与尿失禁的存在相关（=0.036）。发病年龄与 PC2（=0.48，=5.0×10）和 PC3（=−0.39，=0.0013）均显著相关。
DAT 结合的空间模式可以反映 MSA 的不同临床特征，并深入了解 MSA 广泛临床特征的潜在病理生理学。
