EARLY DIFFERENTIAL-DIAGNOSIS OF PARKINSONS-DISEASE WITH F-18 FLUORODEOXYGLUCOSE AND POSITRON EMISSION TOMOGRAPHY
EARLY DIFFERENTIAL-DIAGNOSIS OF PARKINSONS-DISEASE WITH F-18 FLUORODEOXYGLUCOSE AND POSITRON EMISSION TOMOGRAPHY
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DOI：
10.1212/wnl.45.11.1995
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发表时间：
1995-11-01
期刊：
影响因子：
9.9
通讯作者：
FAHN, S
中科院分区：
文献类型：
--
作者：
EIDELBERG, D;MOELLER, JR;FAHN, S
早期帕金森病（EPD）的临床表现往往不对称。我们使用f -18-氟脱氧葡萄糖（FDG）和PET来评估EPD是否可以通过区域代谢不对称的特征模式来检测。为了确定这种模式，我们研究了10例EPD （Hoehn和Yahr I期）患者（平均年龄61.1±11.1岁），使用F-18-FDG和PET计算区域葡萄糖代谢率。将比例亚剖面模型（SSM）应用于EPD患者和正常受试者联合组的代谢不对称测量，以确定区分EPD患者和正常受试者的特定协变模式。为了确定这种模式是否可以用于诊断，我们研究了5名EPD患者（平均年龄50.9 +/- 18.3），5名正常受试者（平均年龄44.6 +/- 15.3）和9名非典型耐药早期帕金森（APD）患者（平均年龄44.6 +/- 14.0）。在这个前瞻性队列的每个成员中，我们逐个计算epd相关协变模式（受试者分数）的表达。我们还对11例EPD患者、5例APD患者和10例正常人进行了FDOPA和PET检测，测量突触前黑质纹状体多巴胺能功能，并通过判别分析评估两种PET方法鉴别诊断的准确性。SSM分析揭示了以协变量基底节区和丘脑不对称为特征的显著地形对比剖面。受试者评分准确区分EPD患者与正常受试者和APD患者（p < 0.0001）。FDG/PET组与FDOPA/PET组的正常或帕金森分类相当，尽管后者无法区分APD和EPD患者。FDG/PET代谢性脑显像对EPD的鉴别诊断有一定的价值。
Early-stage Parkinson's disease (EPD) is often clinically asymmetric. We used F-18-fluorodeoxyglucose (FDG) and PET to assess whether EPD can be detected by a characteristic pattern of regional metabolic asymmetry. To identify this pattern, we studied 10 EPD (Hoehn and Yahr stage I) patients (mean age 61.1 +/- 11.1 years) using F-18-FDG and PET to calculate regional metabolic rates for glucose. The scaled subprofile model (SSM) was applied to metabolic asymmetry measurements for the combined group of EPD patients and normal subjects to identify a specific covariation pattern that discriminated EPD patients from normal subjects. To determine whether this pattern could be used diagnostically, we studied a subsequent group of five presumptive EPD patients (mean age 50.9 +/- 18.3), five normal subjects (mean age 44.6 +/- 15.3), and nine patients with atypical drug-resistant early-stage parkinsonism (APD) (mean age 44.6 +/- 14.0). In each member of this prospective cohort, we calculated the expression of the EPD-related covariation pattern (subject scores) on a case-by-case basis. We also studied 11 of the EPD patients, five patients with APD, and 10 normal subjects with F-18-fluorodopa (FDOPA) and PET to measure presynaptic nigrostriatal dopaminergic function, and we assessed the accuracy of differential diagnosis with both PET methods using discrimination analysis. SSM analysis disclosed a significant topographic contrast profile characterized by covariate basal ganglia and thalamic asymmetries. Subject scores for this profile accurately discriminated EPD patients from normal subjects and APD patients (p < 0.0001). Group assignments into the normal or parkinsonian categories with FDG/PET were comparable to those achieved with FDOPA/PET, although APD and EPD patients were not differentiable by the latter method. Metabolic brain imaging with FDG/PET may be useful in the differential diagnosis of EPD.