帕金森病与多系统萎缩患者多模态正电子成像统计参数图对比分析

Multiple modalities PET/CT neuroimaging for the diagnosis of Parkinson＇s disease and multiple system atrophy： statistical parametric mapping analysis

目的利用统计参数图（SPM）脑功能处理软件分析帕金森病及多系统萎缩（MSA）患者头部多模态正电子成像（PET/CT）特点，以利于临床上进行诊断与鉴别诊断。方法收集2013年9月至2015年11月在解放军总医院就诊的39例帕金森病患者、15例MSA患者与16名正常对照，分别以11C-β-CFT、11C-雷氯必利及18F-氟脱氧葡萄糖（FDG）为示踪剂，行多巴胺转运蛋白（DAT）、多巴胺D2受体及葡萄糖代谢PET/CT显像。运用SPM分析软件进行3组3种不同成像结果的t检验，以P〈0.05为差异有统计学意义。结果与正常对照组相比，帕金森病患者DAT成像显示两侧壳核放射性摄取降低（Z=5.21-5.77, P=0.002-0.016），D2受体无明显差异，FDG示扣带回代谢减低（Z=4.51-4.67, P=0.010-0.017）；MSA患者DAT与D2受体成像均显示两侧壳核放射性摄取降低（Z=2.13-3.42, P=0.000-0.016），葡萄糖代谢显像显示MSA患者两侧小脑、壳核及部分额颞叶区域放射性摄取降低（Z=1.86-3.75, P=0.000-0.032）。结论MSA患者多模态（DAT、D2、FDG）PET/CT成像具有特殊模式，有助于临床进行诊断及与帕金森病鉴别诊断。

Objective To investigate the topographic distributions of dopamine transporter （DAT）, dopamine D2 receptor and glucose in Parkinson′s disease（PD） and multiple system atrophy （MSA） using positron emission tomography /computed tomography （PET/CT） scanning and statistical parametric mapping （SPM） analysis. Methods Seventy subjects （39 PD patients, 15 MSA patients and 16 normal controls） who came from People′s Liberation Army General Hospital from September 2013 to November 2015 underwent DAT, D2 receptor and glucose brain PET/CT scans using 11C-methyl-N-2-β-carbomethoxy-3-β-（4-fluorophenyl） tropane （11C-β-CFT）, 11C-raclopride and 18F-fluorodeoxyglucose （18F-FDG） as radiotracers, respectively. The uptake patterns were analyzed using SPM software.Results Striatal DAT binding decreased in the putamen in PD patients compared with controls（Z=5.21-5.77, P=0.002-0.016）. D2 receptor showed no significant differences. However, glucose uptake decreased in cingulate gyrus（Z=4.51-4.67, P=0.010-0.017）. For MSA patients, both DAT and D2 receptor binding decreased in the putamen（Z=2.13-3.42, P=0.000-0.016）. Glucose uptake decreased in the bilateral putamen, cerebellum and part of frontal temporal lobes（Z=1.86-3.75, P=0.000-0.032）. Conclusion Multiple modalities PET/CT scans using the ligands 11C-β-CFT, 11C-raclopride, and 18F-FDG are valuable in diagnosis of MSA and differential diagnosis of MSA from PD.