中国现代神经疾病杂志 ›› 2024, Vol. 24 ›› Issue (12): 1047-1055. doi: 10.3969/j.issn.1672-6731.2024.12.012

• 临床研究 • 上一篇    下一篇

2 18F-FDG PET在帕金森病和以帕金森综合征为主要表现的多系统萎缩诊断与鉴别诊断中的应用

杜筱筱, 董万惠, 李翼, 孙智慧, 范康丽, 张颖*()   

  1. 130021 长春, 吉林大学第一医院神经内科
  • 收稿日期:2024-02-02 出版日期:2024-12-25 发布日期:2025-01-10
  • 通讯作者: 张颖
  • 基金资助:
    国家自然科学基金资助项目(81974194); 吉林省自然科学基金资助项目(YDZJ202201ZYTS116)

The value of 18F-FDG PET in the diagnosis and differential diagnosis of Parkinson's disease and multiple system atrophy with parkinsonism-predominant

Xiao-xiao DU, Wan-hui DONG, Yi LI, Zhi-hui SUN, Kang-li FAN, Ying ZHANG*()   

  1. Department of Neurology, The First Hospital of Jilin University, Changchun 130021, Jilin, China
  • Received:2024-02-02 Online:2024-12-25 Published:2025-01-10
  • Contact: Ying ZHANG
  • Supported by:
    National Natural Science Foundation of China(81974194); Natural Science Foundation of Jilin(YDZJ202201ZYTS116)

摘要:

目的: 探讨18F-FDG PET在帕金森病(PD)和以帕金森综合征为主要表现的多系统萎缩(MSA-P)诊断与鉴别诊断中的价值。方法: 纳入2019年5月至2022年12月吉林大学第一医院收治的96例帕金森病患者(PD组)和52例MSA-P患者(MSA-P组),均行18F-FDG PET显像,并采用CortexID Suite软件对图像数据进行分析,获得感兴趣区26个脑区的Z值(Z-score),通过与正常对照数据库对比,最终获得帕金森病和MSA-P患者大脑葡萄糖代谢模式;采用受试者工作特征(ROC)曲线并计算曲线下面积(AUC)评价18F-FDG PET对帕金森病和MSA-P的诊断与鉴别诊断效能,Kappa检验评价18F-FDG PET与“金标准”的诊断一致性。结果: (1)代谢模式:与正常对照数据库相比,PD组脑桥(t=2.851,P=0.005)、小脑(t=2.295,P=0.024)及颞叶内侧(t=5.850,P=0.000)呈现显著高代谢,枕叶外侧(t=-7.116,P=0.000)、顶叶上部(t=-13.466,P=0.000)、顶叶下部(t=-21.838,P=0.000)、楔前叶(t=-7.121,P=0.000)、感觉运动区(t=-6.931,P=0.000)及前额叶外侧(t=-6.778,P=0.000)则呈现显著低代谢;而MSA-P组脑桥(t=-8.364,P=0.000)、小脑(t=-9.900,P=0.000)、顶叶上部(t=-4.830,P=0.000)及顶叶下部(t=-11.287,P=0.000)呈显著低代谢,初级视觉皮质呈高代谢(t=5.579,P=0.000)。(2)诊断与鉴别诊断:与MSA-P组相比,PD组感觉运动区(t=-2.695,P=0.008)、楔前叶(t=-4.516,P=0.000)、顶叶上部(t=-4.611,P=0.000)、顶叶下部(t=-5.903,P=0.000)、枕叶外侧(t=-5.088,P=0.000)及初级视觉皮质(t=-3.218,P=0.002)Z-score较低,颞叶内侧(t=3.718,P=0.002)、小脑(t=9.880,P=0.000)及脑桥(t=9.520,P=0.000)Z-score较高。ROC曲线显示,小脑(Z=3.595,P=0.000;Z=2.942,P=0.003;Z=2.942,P=0.003;Z=3.519,P=0.000)、脑桥(Z=3.363,P=0.001;Z=3.237,P=0.000;Z=2.376,P=0.018;Z=3.012,P=0.003)、6个脑区联合(Z=4.354,P=0.000;Z=4.242,P=0.000;Z=3.711,P=0.000;Z=4.233,P =0.000)AUC均大于楔前叶、顶叶上部、顶叶下部、枕叶外侧,且6个脑区联合AUC大于脑桥(Z =1.986,P=0.047);Kappa检验显示18F-FDG PET诊断两种疾病与“金标准”的一致性均较高(均κ=0.678,P =0.000)。结论: 基于18F-FDG PET可以获得帕金森病和MSA-P的特征性大脑葡萄糖代谢模式,对帕金森病和MSA-P具有较好的诊断与鉴别诊断效能。

关键词: 帕金森病, 多系统萎缩, 正电子发射断层显像计算机体层摄影术, 诊断, 鉴别

Abstract:

Objective: To investigate the value of 18F-FDG PET in the diagnosis and differential diagnosis of Parkinson's disease (PD) and multiple system atrophy with parkinsonism-predominant (MSA-P). Methods: Total 96 patients with PD and 52 patients with MSA-P from The First Hospital of Jilin University from May 2019 to December 2022 were included, and 18F-FDG PET data were collected from all patients and 18F-FDG PET data was analyzed using CortexID Suite software. The diagnostic and differential diagnostic efficacy of PD and MSA-P of 18F-FDG PET was evaluated using the receiver operating characteristic (ROC) curve and area under the curve (AUC). The Z-scores of 26 brain regions were obtained, and the brain glucose metabolism patterns of patients with PD and MSA-P were finally obtained by comparing with the normal control database. The consistency between 18F-FDG PET and "gold standard" diagnosis was evaluated using the Kappa test. Results: 1) Metabolic pattern: compared with the normal control database, the PD group showed significantly hypermetabolism in pons (t=2.851, P=0.005), cerebellum (t=2.295, P=0.024) and mesial temporal (t=5.850, P=0.000), and significantly hypometabolism in lateral occipital (t=-7.116, P=0.000), superior parietal (t=-13.466, P=0.000), inferior parietal (t=-21.838, P=0.000), precuneus (t=-7.121, P=0.000), sensorimotor (t=-6.931, P=0.000) and lateral prefrontal (t=-6.778, P=0.000); while the MSA-P group showed significant hypometabolism in pons (t=-8.364, P=0.000), cerebellum (t=-9.900, P=0.000), superior parietal (t=-4.830, P=0.000) and inferior parietal (t=-11.287, P=0.000), and hypermetabolism in the primary visual (t=5.579, P=0.000). 2) Diagnosis and differential diagnosis: compared with the MSA-P group, the PD group had lower Z-score in sensorimotor (t=-0.646, P=0.008), precuneus (t=-4.516, P=0.000), superior parietal (t=-4.611, P=0.000), inferior parietal (t=-5.903, P=0.000), lateral occipital (t=-5.088, P=0.000) and primary visual (t=-3.218, P=0.002), while the Z-scores in mesial temporal (t=3.718, P=0.002), cerebellum (t=9.880, P=0.000) and pons (t=9.520, P=0.000) were higher. The ROC curve was drew for the differential diagnostic efficacy of 18F-FDG PET through the six brain regions with statistical difference and P=0.000 between the 2 groups, the result showed that the AUC of cerebellum (Z=3.595, P=0.000; Z=2.942, P=0.003; Z=2.942, P=0.003; Z=3.519, P=0.000), pons (Z=3.363, P=0.001; Z=3.237, P=0.000; Z=2.376, P=0.018; Z=3.012, P=0.003) and the combination of the six brain regions (Z=4.354, P=0.000; Z=4.242, P=0.000; Z=3.711, P=0.000; Z=4.233, P=0.000) were bigger than the AUC of precuneus, superior parietal, inferior parietal and lateral occipital; the AUC of the combination of the six brain regions was bigger than pons (Z=1.986, P=0.047). Kappa test indicated that the diagnosis of the 18F-FDG PET had good agreement with the diagnosis of the "gold standard" in the two diseases (κ=0.678, P=0.000, for all). Conclusions: The characteristic brain glucose metabolism patterns of PD and MSA-P can be obtained by 18F-FDG PET. 18F-FDG PET has good diagnostic and differential diagnostic efficacy for PD and MSA-P.

Key words: Parkinson disease, Multiple system atrophy, Positron emission tomography computed tomography, Diagnosis, differential