帕金森病脑^(18)F-FDG PET显像临床研究

The study on glucose metabolism of the brain of patients with Parkinson's disease using ^(18)F-FDG PET

目的 探讨帕金森病 (PD)患者1 8F 脱氧葡萄糖 (FDG)PET脑代谢显像的影像学特征及其临床意义。方法 静脉注射1 8F FDG后行脑断层显像 ,获得 33例PD患者及 32例正常人纹状体、丘脑、黑质、顶叶、颞叶、额叶、枕叶、海马单位面积放射性计数与小脑计数的比值 (Rcl cb) ,并与MRI进行对照。结果 正常人脑PET显像可见大脑各叶、基底节、丘脑、中脑及小脑放射性分布均匀对称。PD患者的PET异常率为 96 .97% ,MRI异常率为 30 .30 %。PD患者黑质、纹状体、丘脑及大脑半球各叶代谢低于正常人 ,差异有非常显著性 (P <0 .0 0 1) ,并与症状严重程度有关。症状重侧肢体对侧脑半球的黑质、纹状体、丘脑及额叶代谢较另侧降低。PD患者PET显像特征 :非对称性黑质(93 94% )、纹状体 (6 9.70 % )、丘脑 (36 .36 % )代谢减低 ;非对称性纹状体或丘脑代谢轻度增高 ,占15 15 % ;非对称性大脑各叶代谢下降 ,其中以颞叶 (5 1.5 2 % )、额叶 (39.39% )、海马 (4 5 .46 % )为著 ;非对称性额叶、颞叶、海马代谢轻度增高占 9.0 9%。结论 在除外脑内结构特异性损害基础上 ,1 8F FDGPET发现单侧或不对称性双侧黑质、纹状体、丘脑代谢减低或轻度增高有助PD的早期诊断。

Objective To study glucose metabolism of the brain of patients with Parkinson's disease (PD) by PET, to investigate the imaging characteristics of 18 F-FDG PET in Chinese patients with PD. Methods 50 min after intravenous administration of 18 F-FDG, brain scan was performed on 33 patients with PD and 32 age-matched healthy subjects. Semiquantitative analysis was applied to assess the metabolic function of the brain by the ratio of mean radioactivity of various cerebral lobes (substantia nigra, putamen, caudatum, thalamus, temporal lobe, frontal lobe, parietal lobe, occipital lobe, hippocampus) to cerebellum(Rcl/cb). PET scan was compared with MRI. Results In healthy subjects PET scan showed clear and symmetrical distribution of radioactivity in the cerebral lobes. 96.97% of PD patients showed abnormal PET images, 30.30% of PD patients' MRI showed abnormal, but only 9.09% of that was special. The radioactivity ratio of cerebral lobes to cerebellum of PD patients in nigra-striatum dopaminergic system and cerebral lobes was significantly decreased than that in healthy subjects. The opposite nigra-striatum system and frontal lobe of the more serious sick limbs were significantly more hypometabolic than the same side cerebral lobes. The characteristic PET images of PD patients showed that asymmetrical substantia nigra hypometabolism in 93.94% of the PD cases, striatum, thalamus asymmetrical hypometabolism in 69.70% and 36.36% PD cases; slight asymmetrical increase of radioactivity in striatum and thalamus in 15.15% PD cases; cerebral lobes asymmetrical hypometabolism of temporal lobe in 51.52%, frontal in 39.39%, parietal in 15.15%, occipital in 9.09%, hippocampal in 45.46% PD cases; slight cerebral asymmetrical hypermetabolism in 9.09% PD cases. Conclusions In addition to cerebral structural lesions in the brain, asymmetrical hypometabolism and slight hypermetabolism can be found in nigra-striatum dopaminergic system accompany with cerebral hypometabolism or slight hypermetabolism by 18 F-FDG PET and that is helpful to the early diagnosis of Parkinson's disease. It is very important for detecting the cerebral function impairment of PD.