^(18)F-FDG PET/CT评估帕金森综合征脑葡萄糖代谢并鉴别其类型

^(18)F-FDG PET/CT for evaluating cerebral glucose metabolism and differentiating types of Parkinsonism

目的观察^(18)F-FDG PET/CT评估帕金森综合征脑葡萄糖代谢并鉴别其类型的价值。方法回顾性分析93例帕金森综合征患者脑PET/CT代谢显像,包括帕金森病(PD)20例、多系统萎缩(MSA)20例[MSA小脑型(MSA-C)14例和MSA帕金森型(MSA-P)6例]、进行性核上性麻痹(PSP)20例、皮质基底节变性(CBD)13例及路易体痴呆(DLB)20例;以视觉法和Neuro-Q定量法评估脑代谢,分析各型疾病脑代谢特点,评价其鉴别诊断价值。结果视觉法与Neuro-Q定量法评估代谢异常脑区的一致性高(Kappa=0.75,P<0.01)。Neuro-Q定量分析显示,PD特征性表现包括壳核、丘脑、中脑、脑桥及小脑代谢增高,额叶外侧及顶叶代谢减低。MSA-C以脑桥及小脑代谢减低为主;MSA-P以壳核、脑桥及小脑代谢减低为主;PSP以额叶内侧、额叶外侧、尾状核头、丘脑及中脑代谢减低为主;CBD以额叶内侧、额叶外侧、顶叶、壳核、尾状核头及丘脑代谢减低为主;DLB则表现为枕叶、顶叶葡萄糖代谢减低,壳核、脑桥及小脑代谢增高,而后扣带回代谢无明显变化。结论^(18)F-FDG PET/CT可较好地评估帕金森综合征脑葡萄糖代谢,并有助于鉴别其类型。

Objective To explore the value of^(18)F-FDG PET/CT for evaluating cerebral glucose metabolism and differentiating types of Parkinsonism.Methods Brain metabolic PET/CT data of 93 patients with Parkinsonism were retrospectively analyzed,including 20 cases of Parkinson disease(PD),20 of multiple system atrophy(MSA)(14 of MSA cerebellar-type[MSA-C]and 6 of MSA Parkinson-type[MSA-P]),20 of progressive supranuclear palsy(PSP),13 of cortical basal ganglia degeneration(CBD)and 20 cases of dementia with Lewy body(DLB).Brain metabolism was evaluated with visual method and Neuro-Q quantitative method,the characteristics of different types of Parkinsonism were observed,and the differential diagnostic values were analyzed.Results The consistency between results of visual method and Neuro-Q quantitative method was high(Kappa=0.75,P<0.01).Neuro-Q quantitative analysis showed that PD mainly presented as the metabolisms of putamen,thalamus,midbrain,pons and cerebellum increased,while of lateral frontal lobe and parietal lobe decreased.MSA-C mainly presented as the metabolisms of pons and cerebellum decreased,MSA-P as the metabolisms of putamen,pons and cerebellum decreased,while PSP as the metabolisms of medial frontal lobe,lateral frontal lobe,caudate nucleus head,thalamus and midbrain decreased.CBD mainly presented as the metabolisms of medial frontal lobe,lateral frontal lobe,parietal lobe,putamen,caudate nucleus and thalamus decreased.DLB mainly presented as the metabolisms of occipital and parietal lobes decreased,and of putamen,pons and cerebellum increased,without obvious changes of posterior cingulate gyrus.Conclusion^(18)F-FDG PET/CT could be used to evaluate cerebral glucose metabolism in Parkinsonism,hence being helpful for differentiating different types of Parkinsonism.