多模态多探针PET/MRI鉴别诊断帕金森病与进行性核上性麻痹

Multi-modal multi-probe PET/MRI for differential diagnosis of Parkinson's disease and progressive supranuclear palsy

目的观察多巴胺转运体和葡萄糖代谢PET/MRI鉴别诊断帕金森病(PD)、进行性核上性麻痹(PSP)Richardson综合征(PSP-RS)及PSP-帕金森综合征(PSP-P)的价值。方法纳入34例PD(PD组)、19例PSP-RS(PSP-RS组)及15例PSP-P(PSP-P组)患者,采集各组^(11)C-CFT和^(18)F-FDG PET/MRI,基于体素水平分析组间结构MRI差异;基于图谱分割各脑区并获得标准摄取值比值(SUVR)、尾状核及壳核不对称指数(AI)及尾状核-壳核比(CPR),比较组间PET参数差异;应用logistic回归分析和受试者工作特征曲线评价各参数鉴别诊断PD与PSP的价值。结果PSP-RS组、PSP-P组双侧尾状核及右侧壳核皮质、中脑及右侧额叶白质均显著萎缩(P均<0.05),PD组双侧颞叶及右侧顶枕区白质显著萎缩(P均<0.05)。^(11)C-CFT PET示PD组双侧尾状核SUVR及CPR均高于PSP-RS组及PSP-P组(P均<0.05)。^(18)F-FDG PET示PD组右侧额上回、右侧额下回及双侧尾状核SUVR均高于PSP-RS组及PSP-P组(P均<0.05);PSP-RS组右侧丘脑、右侧小脑皮质、中脑及脑桥SUVR低于、而左侧颞横回SUVR高于PSP-P组(P均<0.05)。以结构MRI表现、^(11)C-CFT PET参数、^(18)F-FDG PET参数及上述三者联合临床特征鉴别PD与PSP的曲线下面积分别为0.868、0.853、0.978及0.973。结论多模态多探针PET/MRI可有效鉴别PD与PSP,^(18)F-FDG PET更可为鉴别PSP亚型提供可能。

Objective To observe the value of dopamine transporter and glucose metabolism PET/MRI for differentiating Parkinson's disease(PD),progressive supranuclear palsy(PSP)Richardson syndrome(PSP-RS)and PSP-Parkinsonism(PSP-P).Methods Totally 34 patients with PD(PD group),19 patients with PSP-RS(PSP-RS group)and 15 patients with PSP-P(PSP-P group)were enrolled.^(11)C-CFT and^(18)F-FDG PET/MRI were acquired.Voxel-wise difference analysis of structural MRI was performed.Based on the graph,brain segmentation was performed to obtain standard uptake value ratio(SUVR),caudate nucleus and putamen asymmetry index(AI)as well as caudate putamen ratio(CPR)for each brain region,and PET parameters were compared among groups.Logistic regression and receiver operating characteristic curve were used to evaluate the value of parameters for differential diagnosis of PD and PSP.Results Significant cortex atrophy in bilateral caudate nucleus and right putamen cortex,as well as white matter atrophy in midbrain and right frontal lobe were detected in PSP-RS group and PSP-P group,while significant white matter atrophy in bilateral temporal lobe and right parietal occipital region were noticed in PD group(all P<0.05).In^(11)C-CFT PET,SUVR of bilateral caudate nucleus and CPR in PD group were higher than those in PSP-RS group and PSP-P group(all P<0.05).In^(18)F-FDG PET,SUVR of right superior frontal gyrus,right inferior frontal gyrus and bilateral caudate nucleus in PD group were higher than those in PSP-RS group and PSP-P group(all P<0.05),SURV of right thalamus,right cerebellar cortex,midbrain and pons were lower,while of left transverse temporal gyrus in PSP-RS group were higher than those in PSP-P group(all P<0.05).The area under curve of structural MRI manifestations,^(11)C-CFT PET parameters and^(18)F-FDG PET parameters,as well as the combination of the above indexes and clinical features for differential diagnosis of PD and PSP was 0.868,0.853,0.978 and 0.973,respectively.Conclusion Multi-modal multi-probe PET/MRI could be used to effectively distinguish PSP from PD.^(18)F-FDG PET was more valuable for being able to provide possibility for classifying subtypes of PSP.