Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
Eur J Nucl Med Mol Imaging. 2024 Jan;51(2):468-480. doi: 10.1007/s00259-023-06443-6. Epub 2023 Oct 9.
Multiple system atrophy (MSA) is a rare neurodegenerative disease, often presented with orthostatic hypotension (OH), which is a disabling symptom but has not been very explored. Here, we investigated MSA patients with OH by using positron emission tomography (PET) with F-fluorodeoxyglucose (F-FDG) and C-N-2-carbomethoxy-3-(4-fluorophenyl)-tropane (C-CFT) for in vivo evaluation of the glucose metabolism and dopaminergic function of the brain.
Totally, 51 patients with MSA and 20 healthy controls (HC) who underwent F-FDG PET/CT were retrospectively enrolled, among which 24 patients also underwent C-CFT PET/CT. All patients were divided into MSA-OH(+) and MSA-OH(-) groups. Then, statistical parametric mapping (SPM) method was used to reveal the regional metabolic and dopaminergic characteristics of MSA-OH(+) compared with MSA-OH(-). Moreover, the metabolic networks of MSA-OH(+), MSA-OH(-) and HC groups were also constructed and analyzed based on graph theory to find possible network-level changes in MSA patients with OH.
The SPM results showed significant hypometabolism in the pons and right cerebellar tonsil, as well as hypermetabolism in the left parahippocampal gyrus and left superior temporal gyrus in MSA-OH(+) compared with MSA-OH(-). A reduced C-CFT uptake in the left caudate was also shown in MSA-OH(+) compared with MSA-OH(-). In the network analysis, significantly reduced local efficiency and clustering coefficient were shown in MSA-OH(+) compared with HC, and decreased nodal centrality in the frontal gyrus was found in MSA-OH(+) compared with MSA-OH(-).
In this study, the changes in glucose metabolism in the pons, right cerebellar tonsil, left parahippocampal gyrus and left superior temporal gyrus were found closely related to OH in MSA patients. And the decreased presynaptic dopaminergic function in the left caudate may contribute to OH in MSA. Taken together, this study provided in vivo pathophysiologic information on MSA with OH from neuroimaging approach, which is essential for a better understanding of MSA with OH.
多系统萎缩（MSA）是一种罕见的神经退行性疾病，常伴有直立性低血压（OH），这是一种致残症状，但尚未得到充分研究。在这里，我们通过使用正电子发射断层扫描（PET）与 F-氟脱氧葡萄糖（F-FDG）和 C-N-2-甲氧基-3-（4-氟苯基）-托烷（C-CFT）对伴有 OH 的 MSA 患者进行研究，以对大脑的葡萄糖代谢和多巴胺能功能进行体内评估。
回顾性纳入 51 例 MSA 患者和 20 例健康对照者（HC）行 F-FDG PET/CT，其中 24 例患者还接受了 C-CFT PET/CT。所有患者分为 MSA-OH(+)和 MSA-OH(-)组。然后，使用统计参数映射（SPM）方法来揭示 MSA-OH(+)与 MSA-OH(-)相比的区域代谢和多巴胺能特征。此外，还基于图论构建和分析了 MSA-OH(+)、MSA-OH(-)和 HC 组的代谢网络，以发现 OH 患者中可能存在的网络水平变化。
SPM 结果显示，与 MSA-OH(-)相比，MSA-OH(+)患者的脑桥和右侧小脑扁桃体代谢明显降低，左侧海马旁回和左侧颞上回代谢明显增加。与 MSA-OH(-)相比，MSA-OH(+)患者的左侧尾状核摄取 C-CFT 也减少。在网络分析中，与 HC 相比，MSA-OH(+)患者的局部效率和聚类系数明显降低，与 MSA-OH(-)相比，MSA-OH(+)患者的额回节点中心度降低。
本研究发现，MSA 患者脑桥、右侧小脑扁桃体、左侧海马旁回和左侧颞上回葡萄糖代谢变化与 OH 密切相关，左侧尾状核的前突触多巴胺能功能下降可能导致 MSA 患者出现 OH。总之，该研究从神经影像学角度提供了 MSA 伴有 OH 的体内病理生理学信息，对更好地理解 MSA 伴有 OH 具有重要意义。
