Kwon Hye Ryeong, Lee Hyunjong, Sung Duk Hyun, Choi Joon Young
From the Department of Nuclear Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang.
Departments of Nuclear Medicine.
Clin Nucl Med. 2022 Dec 1;47(12):e725-e730. doi: 10.1097/RLU.0000000000004383. Epub 2022 Sep 6.
This study aimed to investigate the therapeutic efficacy of 18F-FDG PET/CT-assisted botulinum toxin (BTX) injection therapy and predictive PET findings in relation to a good response in patients with idiopathic cervical dystonia (ICD).
A total of 78 patients was enrolled from November 2007 to July 2018. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) score was determined at baseline and 4 weeks after BTX injection guided by electromyography and PET/CT. The number of hypermetabolic muscles, the highest SUVmax among hypermetabolic muscles, and the total SUVmax of hypermetabolic muscles were evaluated as pretreatment PET parameters. A good response was defined as a reduction rate ≥30% and a point decrease ≥15 of the TWSTRS total score.
Half of the subjects showed a good response. Good responders had significantly higher baseline TWSTRS scores than poor responders (total score, P < 0.001; severity, P < 0.001; disability, P < 0.001; pain, P = 0.026). Good responders also had significantly higher numbers of hypermetabolic muscles and BTX-injected hypermetabolic muscles (P < 0.001, both). In multivariable analysis, the baseline TWSTRS disability subscale score and the number of BTX-injected hypermetabolic muscles were significant predictors for good response (P = 0.001 and P = 0.028). The aforementioned 3 PET parameters were positively correlated with the baseline TWSTRS scores. In addition, PET/CT well detected dystonic deep cervical muscles.
FDG PET/CT-assisted BTX injection therapy showed good therapeutic efficacy in ICD patients. The numbers of hypermetabolic cervical muscles and BTX-injected hypermetabolic muscles may be helpful in predicting a good response.
本研究旨在探讨18F-FDG PET/CT辅助肉毒杆菌毒素（BTX）注射疗法对特发性颈部肌张力障碍（ICD）患者的治疗效果以及与良好反应相关的PET预测结果。
2007年11月至2018年7月共纳入78例患者。在肌电图和PET/CT引导下进行BTX注射，于基线时及注射后4周测定多伦多西部痉挛性斜颈评定量表（TWSTRS）评分。将高代谢肌肉的数量、高代谢肌肉中的最高SUVmax以及高代谢肌肉的总SUVmax作为治疗前PET参数进行评估。良好反应定义为TWSTRS总分降低率≥30%且分数下降≥15分。
一半的受试者显示出良好反应。良好反应者的基线TWSTRS评分显著高于反应不佳者（总分，P<0.001；严重程度，P<0.001；功能障碍，P<0.001；疼痛，P = 0.026）。良好反应者的高代谢肌肉数量和接受BTX注射的高代谢肌肉数量也显著更多（两者均P<0.001）。多变量分析中，基线TWSTRS功能障碍子量表评分和接受BTX注射的高代谢肌肉数量是良好反应的显著预测因素（P = 0.001和P = 0.028）。上述3个PET参数与基线TWSTRS评分呈正相关。此外，PET/CT能很好地检测出张力障碍的颈深部肌肉。
FDG PET/CT辅助BTX注射疗法在ICD患者中显示出良好的治疗效果。高代谢颈部肌肉数量和接受BTX注射的高代谢肌肉数量可能有助于预测良好反应。
