Otsuka M, Kuwabara Y, Ichiya Y, Hosokawa S, Sasaki M, Yoshida T, Fukumura T, Kato M, Masuda K
Department of Radiology, Kyushu University, Beppu, Japan.
Ann Nucl Med. 1997 Aug;11(3):251-7. doi: 10.1007/BF03164771.
Both the striatal 18F-dopa uptake and brain glucose metabolism were studied by PET with 6-L-[18F]fluorodopa (FD) and [18F]fluorodeoxyglucose (FDG) in 9 patients with multiple system atrophy (MSA) and 15 patients with idiopathic Parkinson's disease (PD). Five of the 9 MSA patients were diagnosed as having olivopontocerebellar atrophy, whereas 2 had striatonigral degeneration and 2 demonstrated Shy-Drager syndrome. The FD uptake ratios to the occipital cortex in the MSA patients at 120 min after the administration of FD were 2.07 +/- 0.31 (mean +/- SD) and 1.96 +/- 0.29 in the caudate and the putamen, respectively, and decreased compared to those in the controls (2.72 +/- 0.11, 2.71 +/- 0.10). The same ratios in the PD patients were 2.07 +/- 0.36 and 1.74 +/- 0.24, respectively, which also decreased, but the decreased uptake in the putamen was more prominent. The caudate-putamen index (CPI)(%), which was calculated by a formula based on the difference in the uptakes in the caudate and putamen divided by the caudate uptake, indicated 5.6 +/- 4.6 in the MSA patients and 14.8 +/- 5.4 in the PD patients. The CPI for all PD patients was more than 7.0, which was the mean + 2SD for the controls, but the CPI for 3 MSA patients was more than 7.0 (accuracy: 88%). The glucose metabolic rates for each region in the PD patients showed no difference from the normal controls. The frontal and the temporal cortical glucose metabolism and the caudate, the putaminal, the cerebellar and the brainstem glucose metabolism in the MSA patients decreased significantly in comparison to those in the controls. But, as the glucose metabolic rates in such regions of each patient overlapped in the two groups, the accuracy of the FDG study for differentiation was lower than that of the FD study. The putaminal glucose metabolic rates, for example, in 3 PD patients were less than 6.8 (mg/min/100 ml), which was the mean-2SD for the controls, while those in 3 MSA patients were more than 6.8 (accuracy: 75%). In addition, the combination of these two methods slightly improved the accuracy. The glucose metabolism is useful for evaluating the regional metabolic activity of the brain, and the FD study, which is specific to the dopamine system, seems to be more useful for differentiating between MSA and PD.
采用正电子发射断层扫描（PET）技术，使用6-L-[¹⁸F]氟多巴（FD）和[¹⁸F]氟脱氧葡萄糖（FDG）对9例多系统萎缩（MSA）患者和15例特发性帕金森病（PD）患者的纹状体¹⁸F - 多巴摄取和脑葡萄糖代谢进行了研究。9例MSA患者中，5例被诊断为橄榄脑桥小脑萎缩，2例为纹状体黑质变性，2例表现为Shy - Drager综合征。FD给药后120分钟时，MSA患者尾状核和壳核与枕叶皮质的FD摄取比值分别为2.07±0.31（均值±标准差）和1.96±0.29，与对照组（2.72±0.11，2.71±0.10）相比降低。PD患者的相同比值分别为2.07±0.36和1.74±0.24，也有所降低，但壳核摄取降低更为明显。根据基于尾状核和壳核摄取差异除以尾状核摄取计算的公式得出的尾状核 - 壳核指数（CPI）（%），MSA患者为5.6±4.6，PD患者为14.8±5.4。所有PD患者的CPI均大于7.0，这是对照组的均值 + 2标准差，但3例MSA患者的CPI大于7.0（准确率：88%）。PD患者各区域的葡萄糖代谢率与正常对照组无差异。与对照组相比，MSA患者额叶和颞叶皮质葡萄糖代谢以及尾状核、壳核、小脑和脑干葡萄糖代谢显著降低。但是，由于两组中各患者这些区域的葡萄糖代谢率存在重叠，FDG研究用于鉴别的准确率低于FD研究。例如，3例PD患者的壳核葡萄糖代谢率低于6.8（mg/min/100 ml），这是对照组的均值 - 2标准差，而3例MSA患者的壳核葡萄糖代谢率高于6.8（准确率：75%）。此外，这两种方法联合使用可略微提高准确率。葡萄糖代谢有助于评估脑的区域代谢活性，而针对多巴胺系统的FD研究似乎在区分MSA和PD方面更有用。
