CAJ | 학술논문

目的探讨PET/CT脑代谢显像在多系统萎缩(MSA)早期诊断和鉴别诊断中的价值.方法选择病程不超过2年,拟诊MSA的患者5例(均为小脑型,MSA-C)和病程不超过3年,临床确诊PD的患者10例,进行18F-FDG PET/CT静态显像.在健康人数据库中为每例患者挑选年龄匹配的健康对照者10名,用SPM 5分析软件进行两样本t检验,检验水平为P=0.01.同时对2组患者进行帕金森代谢模式(PDRP)评分,对2组评分进行t检验,探讨该评分在鉴别MSA-C和PD中的价值.结果与年龄匹配的健康对照组相比,在P =0.01 (n1 =1,n2=10,t ＞2.82)的检验水平下,5例MSA患者均观察到不同程度的小脑代谢减低,最大t值为-13.04～ -3.75,其中3例同时伴有壳核不同程度的代谢减低,最大t值为-5.14～ -3.21;而10例PD患者均观察到不同程度的小脑代谢增高,最大t值为4.16～11.72;壳核代谢未见异常.PD组的PDRP评分高于MSA组(11.9±4.96与-6.25±5.97,t =6.27,P＜0.01).结论小脑代谢减低是诊断和鉴别诊断MSA-C的重要影像学特征;MSA-C早期即可累及纹状体,引起壳核代谢减低;MSA-C和PD有不同的脑部代谢改变模式,PDRP评分可为两者的鉴别诊断提供有用信息.
목적 탐토PET/CT뇌대사현상재다계통위축(MSA)조기진단화감별진단중적개치.방법 선택병정불초과2년,의진MSA적환자5례(균위소뇌형,MSA-C)화병정불초과3년,림상학진PD적환자10례,진행18F-FDG PET/CT정태현상.재건강인수거고중위매례환자도선년령필배적건강대조자10명,용SPM 5분석연건진행량양본t검험,검험수평위P=0.01.동시대2조환자진행파금삼대사모식(PDRP)평분,대2조평분진행t검험,탐토해평분재감별MSA-C화PD중적개치.결과 여년령필배적건강대조조상비,재P =0.01 (n1 =1,n2=10,t ＞2.82)적검험수평하,5례MSA환자균관찰도불동정도적소뇌대사감저,최대t치위-13.04～ -3.75,기중3례동시반유각핵불동정도적대사감저,최대t치위-5.14～ -3.21;이10례PD환자균관찰도불동정도적소뇌대사증고,최대t치위4.16～11.72;각핵대사미견이상.PD조적PDRP평분고우MSA조(11.9±4.96여-6.25±5.97,t =6.27,P＜0.01).결론 소뇌대사감저시진단화감별진단MSA-C적중요영상학특정;MSA-C조기즉가루급문상체,인기각핵대사감저;MSA-C화PD유불동적뇌부대사개변모식,PDRP평분가위량자적감별진단제공유용신식.
Objective To evaluate the feasibility of 18F-FDG PET/CT imaging in the early diagnosis of multiple system atrophy (MSA) and differentiation from early PD.Methods Five patients with MSA were included in this study.These patients had a disease duration of less than 2 years,predominantly with cerebellar dysfunction (MSA-C).Ten clinically confirmed PD patients with disease duration less than 3 years were also enrolled.All patients underwent 18F-FDG PET/CT imaging.To compare the metabolic features of these two diseases,SPM 5 software and t-test were used for image data analysis.The PD related pattern (PDRP) expression was calculated in all patients and the efficacy of the PDRP score in distinguishing early MSA from PD was evaluated.Results At the t-test level of P =0.01,all the 5 MSA patients displayed cerebellar hypometabolism ( t:-13.04 to -3.75 ) and 3 of them also had decreased metabolism in the putamen (t:-5.14 to -3.21 ).On the contrary,all PD patients showed cerebellar hypermetabolism (t:4.16 to 11.72) and normal metabolism in putamen.The PDRP scores in the PD group were significantly higher than those in the MSA group(ll.9±4.96vs -6.25±5.97,t=6.27,P＜0.01).Conclusions Cerebellar hypometabolism is the predominant FDG-PET feature of MSA-C,which may be used to distinguish it from early PD.Striatum may be involved in the early phase of MSA-C,displaying hypometabolism in putamen.The PDRP scores are also helpful in differentiating early phase MSA-C from early PD.