18F-FDG PET显像单病例统计参数图分析在帕金森综合征中的鉴别诊断价值

Differential diagnosis value of single-case statistical parametric mapping analysis with 18F-FDG PET imaging for Parkinsonism

目的探讨18F-脱氧葡萄糖(FDG)PET显像的单病例统计参数图(SPM)分析对帕金森综合征的鉴别诊断价值。方法使用SPM软件对2010年4月至2017年12月间160例临床初诊考虑为帕金森综合征且通过随访获得最终临床诊断的患者(男104例、女56例,年龄30~82岁)的18F-FDG PET图像进行回顾性分析,并与年龄相匹配的健康对照组行两样本t检验分析,基于分析结果得出影像学诊断,并与最终临床诊断进行比较,计算该法在整体队列及病程小于2年的早期亚队列(男56例、女22例,年龄50~82岁)中的诊断准确性。结果160例帕金森综合征患者中有146例(91.2%)的18F-FDG PET图像诊断结果与最终临床诊断一致。SPM对帕金森病(PD)、多系统萎缩(MSA)、进行性核上性麻痹(PSP)和皮质基底节变性(CBD)的诊断灵敏度分别为93.5%(86/92)、92.3%(24/26)、84.0%(21/25)和15/17,特异性分别为95.6%(65/68)、95.5%(128/134)、96.3%(130/135)和100%(143/143)。在早期亚队列中,该方法也有相似的诊断效能(92.3%)。结论18F-FDG PET显像单病例SPM分析能有效辅助早期鉴别诊断帕金森综合征。

Objective To investigate the value of statistical parametric mapping (SPM) analysis of 18F-fluorodeoxyglucose (FDG) PET imaging in the differential diagnosis of Parkinsonism in single-case level. Methods SPM software was used to retrospectively analyze the 18F-FDG PET images of 160 patients (104 males, 56 females, age: 30-82 years) who were suspected with Parkinsonism at baseline and were clinical confirmed by follow-up from April 2010 to December 2017. 18F-FDG PET images of patients was compared with those of age-matched healthy controls in single-case level using two-sample t test in SPM software to obtain the imaging diagnosis. By comparing imaging diagnosis with the final clinical diagnosis, the diagnostic accuracy of SPM in the overall cohort as well as the early subcohort (duration of disease less than 2 years (56 males, 22 females, age: 50-82 years)) were calculated respectively. Results Among 160 patients with Parkinsonism, 146(91.2%) had the same 18F-FDG PET diagnosis as their final clinical diagnosis. The diagnostic sensitivity for Parkinson′s disease (PD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and cortical basal ganglia degeneration (CBD) were 93.5%(86/92), 92.3%(24/26), 84.0%(21/25) and 15/17, respectively. The specificity were 95.6%(65/68), 95.5%(128/134), 96.3%(130/135) and 100%(143/143), respectively. In the early subcohort, the analysis also achieved similar differential diagnosis effectiveness(92.3%). Conclusion The single-case 18F-FDG PET imaging SPM analysis can be helpful in the early differential diagnosis of Parkinsonism effectively.