SPECT and PET imaging of the dopaminergic system in Parkinson's disease
SPECT and PET imaging of the dopaminergic system in Parkinson's disease
复制标题
帕金森病多巴胺能系统的 SPECT 和 PET 成像
作者：
Thomas Brücke;S. Djamshidian;G. Bencsits;W. Pirker;Susanne Asenbaum;Ivo Podreka
总结本文概述了多巴胺能系统SPECT和PET成像在鉴别诊断和确定帕金森病（PD）进展率方面的临床重要性。D2受体显像有助于鉴别多系统萎缩（MSA）和进行性核上性麻痹（PSP）与PD。在用抗精神病药物治疗的患者中，可以使用该技术确定纹状体D2受体阻断率。这一入住率与帕金森病副作用的发生率平行。它的测量有助于选择新的非典型精神抑制剂，可用于治疗PD中的药物诱导的精神病，因为它们不会加重帕金森症状。用[123 I]β-CIT SPECT或[18 F]DOPA PET对多巴胺能神经元进行成像是一种可视化和定量PD黑质纹状体多巴胺能损伤的方法。研究结果与临床评定量表相关，并证明了检测偏侧帕金森病或家族性PD患者临床前病变的可行性。[123 I]β-CIT SPECT可以很容易地区分原发性震颤患者和皮质下血管性脑病所致的“下半身帕金森综合征”患者。单独使用该方法不能将MSA和PSP与PD分离。[123 I]β-CIT SPECT和[18 F]DOPA PET的纵向研究可以量化PS的进展率。我们自己组的SPECT结果显示，病程较长的患者的进展率较低，而病程较短的患者的进展率更显着。在前一组中，在第一次SPECT扫描时纹状体中具有较高β-CIT结合的区域比具有较低结合的区域下降得更快。这些发现表明，在不同的纹状体区域，在不同的时间点开始，并在疾病持续数年后趋于平稳的曲线进展过程。这些发现与PET研究的数据一致，并强调了早期开始神经保护策略的重要性。早期PD的PET和SPECT研究的初步数据表明，多巴胺受体激动剂可能具有轻微的神经保护作用，并可能减缓疾病的进展速度。
Summary This paper gives an overview of the clinical importance of SPECT and PET imaging of the dopaminergic system in the differential diagnosis and for the determination of the progression rate of Parkinson's disease (PD). D2 receptor imaging can help to differentiate multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) from PD. In patients treated with neuroleptics it is possible to determine the rate of striatal D2 receptor blocking using this technique. This occupancy rate parallels the occurrence of parkinsonian side effects. Its measurement helps in the selection of newer atypical neuroleptics, which can be used to treat drug-induced psychosis in PD because they do not aggravate parkinsonian symptoms. Imaging of dopaminergic neurons with [123I]β-CIT SPECT or [18F]DOPA PET is a way to visualize and quantify the nigrostriatal dopaminergic lesion in PD. Findings correlate with clinical rating scales and demonstrate the feasibility of detecting the preclinical lesion in patients with hemiparkinson or familial PD. [123I]β-CIT SPECT can easily distinguish patients with essential tremor and patients with “lower body parkinsonism” due to a subcortical vascular encephalopathy. MSA and PSP cannot be separated from PD with this method alone. Longitudinal studies with [123I]β-CIT SPECT and [18F]DOPA PET can quantify the progression rate in PS. SPECT results from our own group show a low rate of progression in patients with a long duration of disease and a more marked progression rate in patients with shorter disease duration. In the former groups regions in the striatum with higher β-CIT binding at the time of the first SPECT scan decline faster than regions with lower binding. These findings suggest a curvilinear course of progression which starts at different time points in different striatal regions and which levels off after several years of disease duration. These findings are in line with data from PET studies and underline the importance of an early start of neuroprotective strategies. Preliminary data from PET and SPECT studies in early PD suggest that dopamine agonists might have a slight neuroprotective effect and might slow down the rate of progression of the disease.
影响因子：
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作者：
L. Farde;A. Nordström;F. Wiesel;S. Pauli;C. Halldin;G. Sedvall
通讯作者：
L. Farde;A. Nordström;F. Wiesel;S. Pauli;C. Halldin;G. Sedvall