Scheifele Maximilian, Gnörich Johannes, Schröder Elisabeth, Kunte Sophie C, Ells Zachary, Hagen Johannes, Katzdobler Sabrina, Palleis Carla, Bernhardt Alexander, Jäck Alexander, Franzmeier Nicolai, Fischer Maximilian, Levin Johannes, Höglinger Günter U, Werner Rudolf A, Brendel Matthias
Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
BZKF (Bavarian Center for Cancer Research), Partner Site, Munich, Germany.
Eur J Nucl Med Mol Imaging. 2025 Mar 11. doi: 10.1007/s00259-025-07188-0.
Due to new advances in molecular and imaging biomarkers, a biological classification of Parkinson's disease (PD) called SyNeurGe (Hoglinger et al. Lancet Neurol 2024;23:191-204) has been proposed for research use recently. [I]ioflupane dopamine transporter single-photon-emission-computed tomography (DaT-SPECT) and cardiac [I]meta-iodobenzylguanidine (MIBG) scintigraphy are included in this biological classification scheme together with 2-[F]fluoro-2-deoxy-D-glucose (FDG-PET) as central imaging biomarkers for the assessment of dopaminergic function, cardiac sympathetic denervation, and metabolic patterns in brain. In order to facilitate this prospectively high imaging demand and optimize diagnostic workup in PD we propose a single-day protocol.
First, we excluded relevant binding of MIBG in the brain as well as DaT in the heart by acquisition of brain scans in patients that received MIBG as well as by acquisition of chest scans in patients that received DaT. Then, we performed a single-day protocol including DaT-SPECT and cardiac MIBG scintigraphy in ten patients with clinically suspected α-synucleinopathies (9 male, 1 female; 68.2 ± 7.3 years). Both radiotracers were injected simultaneously and cardiac imaging was performed at 3.5 h after injection followed by brain imaging at 4 h after injection using standard protocols for MIBG-scintigraphy and DaT-SPECT. Additionally, five patients of the dual tracer protocol group received brain FDG-PET after DaT and MIBG imaging.
Single tracer imaging confirmed no relevant uptake of [I]ioflupane in the heart or [I]MIBG in the brain. Six out of the ten dual tracer protocol patients (PD or multiple system atrophy with Parkinsonian phenotype (MSA-P)) showed a significantly reduced DaT-SPECT binding (z-score < -2) in at least one hemisphere (mean putaminal z-score -4.01 ± 1.39) while seven patients had a pathological heart-to-mediastinum ratio in the MIBG scan (mean H/M-ratio: 1.12 ± 0.08). Both DaT and MIBG scans could visually be interpreted without any signs of image artifacts or decrease in imaging quality and also quantitatively did not reveal significant differences to the single tracer scans. FDG-PET brain scans of the triple tracer protocol patients also showed no relevant interference in regard to image quality as well was generation of surface projections and z-scores.
A single day protocol for DaT-SPECT, MIBG, and FDG-PET facilitates biomarker assessments needed for efficient biological characterization of Parkinsonian syndromes according to the SyNeurGe criteria.
由于分子和成像生物标志物方面的新进展，最近提出了一种用于研究的帕金森病（PD）生物学分类方法，称为SyNeurGe（霍格林格等人，《柳叶刀神经病学》2024年；23:191 - 204）。[I]碘氟潘多巴胺转运体单光子发射计算机断层扫描（DaT - SPECT）和心脏[I]间碘苄胍（MIBG）闪烁扫描与2 - [F]氟 - 2 - 脱氧 - D - 葡萄糖（FDG - PET）一起被纳入该生物学分类方案，作为评估多巴胺能功能、心脏交感神经去神经支配和脑代谢模式的核心成像生物标志物。为了满足这一前瞻性的高成像需求并优化PD的诊断检查，我们提出了一种单日方案。
首先，我们通过对接受MIBG的患者进行脑部扫描以及对接受DaT的患者进行胸部扫描，排除了MIBG在脑内以及DaT在心脏中的相关结合。然后，我们对10例临床疑似α - 突触核蛋白病的患者（9例男性，1例女性；68.2±7.3岁）实施了包括DaT - SPECT和心脏MIBG闪烁扫描的单日方案。两种放射性示踪剂同时注射，注射后3.5小时进行心脏成像，随后在注射后4小时使用MIBG闪烁扫描和DaT - SPECT的标准方案进行脑部成像。此外，双示踪剂方案组的5例患者在DaT和MIBG成像后接受了脑部FDG - PET检查。
单示踪剂成像证实心脏中无[I]碘氟潘的相关摄取，脑内无[I]MIBG的相关摄取。10例双示踪剂方案患者中有6例（帕金森病或帕金森综合征型多系统萎缩（MSA - P））在至少一个半球显示DaT - SPECT结合显著降低（z评分＜ - 2）（壳核平均z评分 - 4.01±1.39），而7例患者在MIBG扫描中心脏与纵隔比值异常（平均H/M比值：1.12±0.08）。DaT和MIBG扫描在视觉上均可解释，无任何图像伪影迹象或成像质量下降，并且在定量方面与单示踪剂扫描相比也未显示出显著差异。三示踪剂方案患者的FDG - PET脑部扫描在图像质量、表面投影生成和z评分方面也未显示出相关干扰。
DaT - SPECT、MIBG和FDG - PET的单日方案有助于根据SyNeurGe标准对帕金森综合征进行有效生物学特征分析所需的生物标志物评估。
