伴有轻度认知障碍的帕金森病^18F—FDGPET的统计参数图分析

Statistical parametric mapping analysis of ^18 F-FDG PET in Parkinson＇s disease with mild cognitiveimpairment

目的研究伴有轻度认知障碍的帕金森病患者（PD．MCI）的“F脱氧葡萄糖酸（“FFDG）代谢特点，以寻求PD—MCI的诊断及评估的影像学指标。方法纳入2016年3至11月就诊于北京天坛医院的帕金森病患者47例，其中15例伴有轻度认知障碍，32例认知评估正常。正常对照组为年龄、性别匹配的20名健康被试。对所有被试进行FDG—PET扫描以及临床量表的评估，并使用统计参数图（SPM）对PET图像进行分析以及三组间的统计分析。结果与正常对照相比PD—MCI患者代谢减低区域为双侧前额叶、双侧顶叶、左侧枕叶、左侧颞叶，代谢升高区域为双侧海马、双侧小脑以及小脑蚓部、辅助运动区。无认知障碍的帕金森病患者代谢减低区域为双侧额叶、双侧尾状核及壳核、双侧颞叶。PD．MCI患者与无认知障碍的患者相比脑代谢减低区主要为双侧枕叶；双侧小脑，双侧岛叶代谢升高。结论FDGPET的SPM统计分析可作为一个有效的帕金森病患者脑代谢分析方法，小脑、岛叶代谢升高、枕叶代谢减低或可作为诊断PD—MCI的影像学标志物，为PDD提供风险预警。

Objective To investigate the characteristics of cerebral metabolism associated with mild cognitive impairment （MCI） Parkinson＇s disease （PD）, cognitive normal PD and normal control to find a PET biomarker for the diagnose and estimate of PD-MCI. Methods Forty-seven patients diagnosed with PD （included 15 with mild cognitive impairment） and 20 control subjects were enrolled. All the subjects were evaluated with FDG-PET and clinical scale. The statistical parametric mapping （SPM） were analyzed to determine metabolic patterns that may be useful in differentiating between the three groups. Results SPM analysis showed that significant hypometabolism were observed in both side of front lobe, parietal lobe, left temporal lobe and left occipital lobe; in the contrast, the relative hypermetabolism had been observed in the cerebellum, vermis, hippocampus and supplement motor area （SMA） in patients with PD-MCI. PD without MCI showed hypometabolism in both side of front lob, eaudate and putamen. PD-MCI showed that the significant hypermetabolism were in the insular and cerebellum while hypometabolism were in the both side of occipital compared to PD without MCI. Conclusion A voxel-by-voxel based SPM method i.e. SPM8 analysis by PET scan is an effective way to analysis the FDG uptake pattern of PD patients. The hypermetabolism in the insula and cerebellum and hypometabolism in the both side of occipital may be a biomarker for make a diagnosis of PD-MCI.