早期帕金森病患者的影像学特征 (18)~F-脱氧葡萄糖符合线路正电子发射计算机断层显像评估

Imaging characteristics of patients with early Parkinson disease Evaluation with ^(18)F-fluorodeoxyglucose PET/SPECT imaging

目的:探讨早期帕金森病患者18F-脱氧葡萄糖符合线路正电子发射计算机断层显像的影像学特征。方法:选择2003-12/2004-12首都医科大学宣武医院神经内科帕金森门诊诊治的Hoehn-Yahr分级Ⅰ～Ⅱ级的早期帕金森病患者53例,纳入标准:①性别、年龄不限。②患者均知情同意。③诊断标准:按1984年全国椎体外系疾病讨论会制定的帕金森病诊断标准做出诊断。排除标准:化学药物、创伤、脑血管病及其他病因所致的帕金森综合征。符合上述条件的患者31例,男18例,女13例;年龄43～78(62±11)岁;病程0.5～4.0(2.4±1.2)年。静脉注射18F-脱氧葡萄糖后进行符合线路正电子发射计算机脑断层显像,获得双侧纹状体、丘脑葡萄糖代谢图像,由3名核医学科医师共同阅片,以横断面为基础,参照冠状及矢状断面,以两个以上的断面出现肉眼可辨的放射性减低为异常,作为定性指标。勾画双侧纹状体、丘脑、顶叶、颞叶、额叶、枕叶及小脑感兴趣区,获单位面积放射性计数。将各脑叶分别与小脑放射性计数相比较,其比值作为半定量指标。采用目测法对脑各部位的葡萄糖代谢进行判断,并用半定量指标评价脑代谢损伤程度。结果:按意向处理分析,31例患者均进入结果分析。①影像学表现结果:31例早期原发偏侧帕金森病患者18F-脱氧葡萄糖符合线路正电子计算机断层显像脑内有不同程度的放射性分布异常占93.55%(29/31),非对称性纹状体放射性减低26例(83.87%),其中18例为双侧减低;非对称性纹状体放射性增高1例(3.22%);非对称性丘脑放射性减低12例(38.71%),其中3例为双侧减低;大脑各叶放射性摄取及代谢出现不同程度下降,颞叶放射性明显减低7例(22.58%),其同侧纹状体放射性也减低;额叶放射性明显减低2例(6.45%),均为双侧减低,顶叶放射性明显减低12例(38.71%),其中5例为双侧减低,枕叶放射性分布未见明显异常;脑内示踪剂放射性分布正常2例。②帕金森病患者临床表现与18F-脱氧葡萄糖符合线路正电子计算机断层显像的关系:对26例非对称性纹状体放射性减低的患者的双侧纹状体放射性计数进行半定量比较,发现运动障碍肢体对侧(病侧)纹状体的脑代谢为80.09±22.35,另侧(脑健侧)为108.37±33.41,病侧与健侧脑相应区域相比下降,差异显著(t=8.242,P<0.001)。结论:93.55%(29/31)的帕金森病患者18F-脱氧葡萄糖符合线路正电子计算机断层显像示纹状体、丘脑或脑叶的不对称性代谢改变,其中83.87%(26/31)为非对称性纹状体放射性减低,表明此项技术对帕金森病的早期诊断有较重要价值。

AIM： To study the imaging characteristics of ^18F-fluorodeoxyglucose （FDG） PET/SPECT in patients with early Parkinson disease. METHODS： Fifty-three patients with early Parkinson disease at Hoehn-Yahr grade Ⅰ-Ⅱ were selected from Out-patient clinic of Parkinson disease of Department of Neurology of Xuanwu Hospital of Capital University of Medical Science from December 2003 to December 2004. Inclusion criteria： ① Of either sex, and different ages; ② Patients all knew the fact and agreed to participate in the study; ③ Diagnosis standard： Follow the Parkinson disease diagnosis standard made by national extrapyramidal conference in 1984. Exclusion criteria： Parkinsonian syndrome induced by chemical drug, trauma and cerebrovascular disease etc. Thirty-one patients were coincident with the upper standard including 18 males and 13 females, aged from 43 to 78 （62±11）, course from 0.5 to 4.0 （2.4±1.2） years. After intravenous injection with FDG, PET/SPECT was used to gain the image of bilateral corpus striatum and thalamo-cartose metabolism. It was checked by 3 nuclear medicine physicians on the basis of cross section in accordance with coronal and broken side. The decrease of radioactivity easy to see by naked eyewhich appeared more than two as fixed index. Describing the double side corpus striatum, thalamo, parietal lobe, temporal lobe, frontal lobe, occipital lobe and other areas attracted cerebellum to gain unit area radioactivity counting, Every lobe of brain was compared with cerebellum radioactivity counting, and its value was considered as semi-ratio index, Cartose metabolism of every part of brain was judged by eyes, and the damage degree of brain metabolism was evaluated with semi-ratio index. RESULTS： According to intention-to-treat analysis, 31 patients were all involved in the analysis of results. ① The result of sereenage expression： The abnormal radioactivity in 31 patients with early primary Parkinson disease detected with FDG PET/SPECT accounted for 93.55% （29/31）; Twenty-six radioactivity in non-symmetry corpus striatum were reduced （83.87%）, in which 18 was double side reduced; The intape and metabolism of every lobe in brain decreased in different degree, and the radioactivity of temporal lobe significantly decreased in 7 cases （22.58%）, and its corpus striatum radioactivity of the same side also decreased; Two cases frontal lobe radioactivity significantly decreased （6.45%）, both were double side decrease; Twelve cases parietal lobe radioactivity significantly decreased （38.71%）, in which 5 cases were double side decrease; The Occipital lobe radioactivity did not show significant abnormity; The distribution of tracer radioactivity in brain was normal in two cases. ② The relationship between the clinical expression of patients with PD and FDG PET/SPECT： The number of double side corpus striatum radioactivity twenty-six patients whose non-symmetry corpus striatum radioactivity decreased was compared on semi-ratio, by which it was indicated that the brain metabolism of other side of dyskinesia limb （disease side） was 80.09±22.35, and other side （brain unaffected side） was 108.37±33.41. The disease side compared with unaffected side brain decreased, and had significantly difference （t=8.242, P 〈 0.001 ）. CONCLUSION： The FDG PET/SPECT in 93.55% （29/31）PD patients show the asymmetry changes of corpus striatum, thalamus or lobe of brain, in which 83.87% （26/31） patients is asymmetry corpus striatum that indicate this technique has important effects on the diagnosis of the earlier period of PD.