恩他卡朋可有效提高18F-DOPA PET/CT对帕金森病的诊断效能

Entacapone improves the diagnostic efficiency of 18F-DOPA PET/CT in patients with Parkinson's disease

目的探讨恩他卡朋在提高6-18F-氟-L-多巴(18F-DOPA)PET/CT显像效果和帕金森病(PD)诊断效能中的价值。方法纳入2016年7月至2017年9月间44例确诊PD患者[男24例,女20例,年龄(51.3±11.0)岁]和14名健康受试者[男7名,女7名,年龄(57.6±14.4)岁]行18F-DOPAPET/CT显像,其中24例PD患者显像前服用恩他卡朋(PD1组),余20例PD患者不服用恩他卡朋(PD2组);6名健康受试者显像前服用恩他卡朋(对照1组),余8名不服用恩他卡朋(对照2组)。以枕叶为参考区域,计算并比较各组纹状体各区域的放射性计数比值(SOR)。采用两样本t检验和受试者工作特征(ROC)曲线分析处理数据。结果PD1组和对照1组纹状体显影更清晰,脑皮质放射性摄取下降明显。PD1组起病肢体对侧壳核前部、后部和尾状核SOR较PD2组分别提高15%、14%和15%(t值:2.92、3.11和2.49,均P<0.05),起病肢体同侧上述部位SOR分别提高17%、21%和17%(t值:2.90、3.56和3.00,均P<0.05)。对照1组左侧壳核前部、后部和左侧尾状核SOR较对照2组分别提高29%、35%和27%(t值:3.64、3.48和4.48,均P<0.05),右侧上述部位SOR分别提高29%、28%和29%(t值:2.92、2.73和3.61,均P<0.05)。全部服用恩他卡朋者左侧(起病肢体对侧)壳核前部、后部和右侧(起病肢体同侧)壳核后部曲线下面积(AUC)分别为0.999、0.999和0.972,远大于未服用恩他卡朋者(0.865、0.889和0.848;z值:3.24、3.03、2.77,均P<0.01);右侧壳核前部、左侧尾状核和右侧尾状核AUC分别为0.927、0.941和0.906,亦大于未服用组(0.754、0.766和0.696;z值:2.01、2.36、2.17,均P<0.05)。结论恩他卡朋可有效提高纹状体的18F-DOPA摄取,从而提高18F-DOPA显像对PD患者与健康人的鉴别诊断效能。

Objective To investigate the application and value of entacapone in 6-18F-fluoro-L-dopa(18F-DOPA)PET/CT imaging on Parkinson's disease(PD).Methods From July 2016 to September 2017,44 PD patients(24 males,20 females,age:(51.3±11.0)years)and 14 healthy volunteers(7 males,7 females,age:(57.6±14.4)years)who underwent 18F-DOPA PET/CT imaging were enrolled.They were divided into 4 groups:PD1 group with entacapone treatment(n=24);PD2 group without entacapone treatment(n=20);healthy control group with entacapone treatment(HC1,n=6);healthy control group without entacapone treatment(HC2,n=8).The striatal-to-occipital ratio(SOR)was calculated.Two-sample t test and receiver operating characteristic(ROC)curve analysis were used to analyze the data.Results The striatum was more clear and the uptake of cerebral cortex decreased significantly in PD1 and HC1 groups.The SOR of contralateral anterior putamen,posterior putamen and caudate nucleus in PD1 group were 15%,14% and 15% higher(t values:2.92,3.11,2.49,all P<0.05)than those in PD2 group,and SOR of ipsilateral anterior putamen,posterior putamen and caudate nucleus in PD1 were 17%,21% and 17% higher(t values:2.90,3.56,3.00,all P<0.05).SOR of left anterior putamen,posterior putamen and caudate nucleus in HC1 group were improved 29%,35% and 27%(t values:3.64,3.48,4.48,all P<0.05)compared to those in HC2 group,and SOR of right anterior putamen,posterior putamen and caudate nucleus in HC1 group were improved 29%,28% and 29%(t values:2.92,2.73,3.61,all P<0.05).The area under curve(AUC)for SOR of the left anterior and posterior putamen and the right posterior putamen in subjects with entacapone treatment were 0.999,0.999 and 0.972,which were far greater than 0.865,0.889 and 0.848(z values:3.24,3.03,2.77,all P<0.01)in those without entacapone treatment.The AUC for SOR of the right anterior putamen,the left caudate nucleus and the right caudate nucleus subjects with entacapone treatment were 0.927,0.941 and 0.906,respectively,which were also significantly greater than 0.754,0.766 and 0.696(z values:2.01,2.36,2.17,all P<0.05)in subjects without entacapone treatment.Conclusion Entacapone can increase the uptake of 18F-DOPA in the striatum of patients with PD,and it can improve the efficiency of 18F-DOPA to distinguish patients with PD from normal people.