From the Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 211N, MSC 323, Charleston, SC 29425 (M.K.M., S.E.); Department of Radiology, New York University Langone Health Long Island, New York, NY (J.W.R.); Department of Radiology, University of New Mexico, Albuquerque, NM (L.C.B.); Department of Radiology, Brooke Army Medical Center, San Antonio, Tex (K.P.B.); Department of Radiology, Eastern Virginia Medical School, Norfolk, Va (L.S.J., S.W.); Department of Radiology, University of Washington, Seattle, Wash (D.H.L.); and Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.).
Radiographics. 2024 Feb;44(2):e230133. doi: 10.1148/rg.230133.
Parkinsonian syndromes are a heterogeneous group of progressive neurodegenerative disorders involving the nigrostriatal dopaminergic pathway and are characterized by a wide spectrum of motor and nonmotor symptoms. These syndromes are quite common and can profoundly impact the lives of patients and their families. In addition to classic Parkinson disease, parkinsonian syndromes include multiple additional disorders known collectively as Parkinson-plus syndromes or atypical parkinsonism. These are characterized by the classic parkinsonian motor symptoms with additional distinguishing clinical features. Dopamine transporter SPECT has been developed as a diagnostic tool to assess the levels of dopamine transporters in the striatum. This imaging assessment, which uses iodine 123 (I) ioflupane, can be useful to differentiate parkinsonian syndromes caused by nigrostriatal degeneration from other clinical mimics such as essential tremor or psychogenic tremor. Dopamine transporter imaging plays a crucial role in diagnosing parkinsonian syndromes, particularly in patients who do not clearly fulfill the clinical criteria for diagnosis. Diagnostic clarification can allow early treatment in appropriate patients and avoid misdiagnosis. At present, only the qualitative interpretation of dopamine transporter SPECT is approved by the U.S. Food and Drug Administration, but quantitative interpretation is often used to supplement qualitative interpretation. The authors provide an overview of patient preparation, common imaging findings, and potential pitfalls that radiologists and nuclear medicine physicians should know when performing and interpreting dopamine transporter examinations. Alternatives to I-ioflupane imaging for the evaluation of nigrostriatal degeneration are also briefly discussed. RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Intenzo and Colarossi in this issue.
帕金森综合征是一组异质性的进行性神经退行性疾病，涉及黑质纹状体多巴胺能通路，其特征是广泛的运动和非运动症状。这些综合征相当常见，会对患者及其家属的生活产生深远影响。除了经典的帕金森病外，帕金森综合征还包括多种被称为帕金森叠加综合征或非典型帕金森病的其他疾病。这些疾病的特征是具有经典的帕金森运动症状和其他鉴别性临床特征。多巴胺转运体 SPECT 已被开发为一种诊断工具，用于评估纹状体中多巴胺转运体的水平。这种使用碘 123（I）碘氟烷的成像评估可用于区分由黑质纹状体变性引起的帕金森综合征与其他临床类似物，如特发性震颤或精神性震颤。多巴胺转运体成像在诊断帕金森综合征中起着至关重要的作用，特别是在那些不符合临床诊断标准的患者中。明确诊断可以使合适的患者得到早期治疗，并避免误诊。目前，美国食品和药物管理局仅批准了多巴胺转运体 SPECT 的定性解读，但定量解读通常用于补充定性解读。作者概述了患者准备、常见成像发现以及放射科医生和核医学医师在进行和解读多巴胺转运体检查时应了解的潜在陷阱。还简要讨论了用于评估黑质纹状体变性的 I-碘氟烷成像替代方法。本文的 RSNA 2024 知识测试问题可在补充材料中找到。请参阅本期特邀评论员 Intenzo 和 Colarossi 的评论。
