Markus H S, Costa D C, Lees A J
Department of Neurology, University College and Middlesex School of Medicine, London, UK.
J Neurol Neurosurg Psychiatry. 1994 Feb;57(2):180-5. doi: 10.1136/jnnp.57.2.180.
Regional cerebral perfusion was evaluated by SPECT with technetium 99m hexamethylpropyleneamine oxime (99mTc HMPAO) as a tracer in 21 patients presenting with Parkinson's disease and in 11 normal controls. In the parkinsonian patients, scans were performed both off treatment, and after levodopa, and clinical dopaminergic responsiveness was evaluated. Uptake of HMPAO by the basal ganglia was significantly decreased in the parkinsonian subjects, compared with normal controls. This reduction was seen in both responders (n = 14) and non-responders (n = 7) to dopaminergic treatment. Uptake of HMPAO by the basal ganglia rose after treatment with levodopa, but the change was similar in both responders and non-responders. By contrast a striking difference in cortical HMPAO uptake was found between responders and non-responders, with significantly lower uptake in the medial temporal and posterior parietal cortex in the non-responders. This reduction was symmetrical. Basal ganglia perfusion assessed by this technique is unlikely to be of use in the diagnosis of Parkinson's disease that is responsive to dopaminergic treatment. The presence of extensive cortical involvement on a baseline scan correlates with a lack of dopaminergic responsiveness, however, and this may be useful diagnostically.
在21例帕金森病患者和11名正常对照者中，以锝99m六甲基丙烯胺肟（99mTc HMPAO）作为示踪剂，通过单光子发射计算机断层扫描（SPECT）评估局部脑灌注情况。对帕金森病患者在未治疗时、服用左旋多巴后均进行扫描，并评估临床多巴胺能反应性。与正常对照相比，帕金森病患者基底神经节对HMPAO的摄取显著降低。在对多巴胺能治疗有反应者（n = 14）和无反应者（n = 7）中均观察到这种降低。服用左旋多巴治疗后，基底神经节对HMPAO的摄取增加，但有反应者和无反应者的变化相似。相比之下，有反应者和无反应者之间在皮质HMPAO摄取上存在显著差异，无反应者的内侧颞叶和顶叶后部皮质摄取明显更低。这种降低是对称的。通过该技术评估的基底神经节灌注不太可能用于诊断对多巴胺能治疗有反应的帕金森病。然而，基线扫描显示广泛皮质受累与缺乏多巴胺能反应性相关，这在诊断上可能有用。
