^(11)C-CFT PET显像评价帕金森病与多系统萎缩P型患者脑内多巴胺转运体分布特点的研究

Dopamine Transporter PET Imaging in Patients with Parkinson Variant of Multiple System Atrophy and Parkinson's Disease

目的基于^(11)C-CFT正电子发射计算机断层(PET)显像评价帕金森病(PD)与多系统萎缩P型(MSA-P)患者脑内多巴胺转运体(DAT)分布特点,评估^(11)C-CFT PET显像在PD与MSA-P鉴别诊断中的价值。方法回顾性分析年龄、性别和疾病严重程度匹配的32例MSA-P患者(MSA-P组)和56例PD患者(PD组)的临床资料以及^(11)C-CFT PET影像资料;另选择年龄匹配的健康对照者20例为对照组。应用感兴趣区技术获得3组研究对象的尾状核、前壳核和后壳核的DAT分布半定量值,对各感兴趣区的DAT分布半定量值、相互比值和不对称性进行对比研究。建立受试者工作特征曲线(ROL),利用曲线下面积评估基于^(11)C-CFT PET显像所得相关参数对PD和MSA-P的鉴别能力。结果与PD组比较,MSA-P组患者病程更短、进展速度更快(P<0.000 1)。与对照组比较,PD组和MSA-P组尾状核、前壳核和后壳核的DAT分布半定量值均显著减低(P<0.000 1),且后壳核降低最为显著。PD组和MSA-P组尾状核、前壳核和后壳核的DAT分布半定量值及其不对称指数比较均差异无显著性。PD组和MSA-P组纹状体各感兴趣区DAT分布半定量值中,前壳核/尾状核比值(AP/C)、后壳核/前壳核比值(PP/AP)均差异无显著性;但MSA-P组后壳核/尾状核比值(PP/C)>PD组(P<0.05),两组PP/C比值的ROL曲线下面积为0.696(P=0.002);以0.611作为PP/C比值的临界值,其对MSA-P和PD鉴别诊断的灵敏度和特异度分别为71.9%和62.5%。结论 ^(11)C-CFT PET显像可以精准显示MSA-P及PD患者脑内多巴胺能神经元的突触前功能损害,但尚不能有效鉴别两种疾病。

Aim To characterize dopamine transporter PET imaging in patients with Parkinson variant of multiple system atrophy（MSA-P） and Parkinson＇s disease（PD） and appraise its value of differential diagnosis. Methods The clinical data from 32 patients with MSA-P（13 men/19 women,age 61.3±6.0 years old,UPDRS score 39.91±14.60） and 56 patients with PD（32 men/24 women,age 63.3±6.4 years old,UPDRS score 36.86±11.87） were collected,and a semi-quantitative analysis of dopamine transporter（DAT） binding in different parts of striatum in their ^（11）C-CFT PET imaging with the region of interest（ROI） approach were analyzed retrospectively. Various ratios and asymmetrical index of different parts of striatum based on the pattern of DAT distribution were compared. Patients＇ data were also compared with age-matched 20 healthy controls（age 62.6±4.0 years）. And then the accuracy of specific parameter in differentiating PD and MSA-P according to the area under receiver operating characteristic curve（ROC） was measured. Results MSA-P patients showed a faster disease progression when compared with PD patients（P〈0.0001）. Significant reductions in DAT binding in caudate（C）, anterior putamen（AP） and posterior putamen（PP） of both MSA-P and PD patients were observed when compared to healthy controls（P〈0.000 1）, and the most reduction in both PD and MSA-P were present in posterior putamen. Asymmetrical index and DAT binding in any part of striatum did not differ between MSA-P and PD, whereas the ratio of DAT binding in posterior putamen to caudate（PP/C） was relatively higher in MSA-P patients than in PD patients（P〈0.05）. The area under the curve（AUC） from ROC curve of PP/C was 0.696（P=0.002） and the sensitivity and specificity of PP/C were 71.9% and 62.5% respectively in differentiating these two diseases as the cutoff was 0.611. Conclusion ^（11）C-CFT PET reliably enabled the visualization of the presynaptic dopaminergic lesion in patients with MSA-P and PD. In most patients, however, it does not seem to be possible to differentiate these two disorders from each other.