帕金森患者脑多巴胺转运体11C-CFT PET/CT显像特点的分析

目的 探讨帕金森病（PD）患者11C-2β-甲氧甲酰-3β-（4-氟苯基）托烷（CFT）脑多巴胺转运体（DAT）PET/CT显像的特点，分析其对PD的临床诊断价值。 方法 回顾性分析2018年8月至2021年2月于贵州医科大学附属医院行11C-CFT PET/CT脑显像且经临床确诊的41例原发性PD患者的临床资料和影像学资料，其中男性21例、女性20例，年龄34~81岁（57.6±12.2）岁。根据Hoehn-Yahr（H-Y）分级将PD患者分为早期PD组（19例）和晚期PD组（22例）。同时纳入与PD组患者年龄匹配的8名健康受检者作为正常对照组，其中男性4名、女性4名，年龄42~72（61.0±9.8）岁。通过勾画感兴趣区（ROI）得到双侧尾状核、壳核及小脑3个层面的11C-CFT摄取值，按相应公式计算双侧尾状核、壳核、新纹状体的11C-CFT摄取值和不对称指数、壳核与尾状核摄取值的比值。计量资料的比较采用两独立样本t检验；计数资料的比较采用卡方检验；采用Pearson相关性分析评价PD患者新纹状体及各亚区DAT分布与各临床指标之间的相关性。 结果 在11C-CFT PET/CT脑显像中，PD组双侧尾状核放射性分布呈稍降低但尚均匀，双侧壳核放射性分布呈不同程度的降低或稀疏缺损。其中，早期PD组患者双侧壳核放射性分布呈不对称性降低或缺损；晚期PD组患者双侧壳核放射性分布呈较对称性稀疏缺损。与正常对照组比较，PD组新纹状体11C-CFT摄取值减低，且差异有统计学意义（12.29±2.75 对 7.69±2.42，t=4.818，P<0.01）；PD组不对称指数增高，且在壳核中表现最显著，差异有统计学意义（0.06±0.08 对 0.14±0.09，t=2.184，P<0.05）；PD组壳核与尾状核摄取值的比值降低，且差异有统计学意义（1.13±0.13 对 0.74±0.21，t=4.929，P<0.01）。与早期PD组比较，晚期PD组在新纹状体的摄取值降低最明显，且差异有统计学意义（8.50±1.77 对 6.99±2.71，t=2.070，P<0.05），晚期PD组在尾状核、壳核不对称指数之间的差异均有统计学意义（0.06±0.06 对 0.11±0.08、0.18±0.10 对 0.11±0.07，t=2.251、2.858，均P<0.05）。PD患者新纹状体11C-CFT摄取值与年龄、起病年龄、H-Y分级均呈负相关（r=?0.444、?0.514、?0.426，均P<0.01），与壳核11C-CFT摄取不对称指数呈正相关（r=0.331，P<0.05）。PD患者尾状核11C-CFT摄取值与年龄、起病年龄、H-Y分级均呈负相关（r=?0.537、?0.581、?0.380，均P<0.05），与壳核不对称指数呈正相关（r=0.410，P<0.01）；PD患者壳核11C-CFT摄取值与起病年龄、H-Y分级均呈负相关（r=?0.353、?0.453，均P<0.05），与病程、壳核与尾状核摄取值的比值均呈正相关（r=0.322、0.396，均P<0.05）。 结论 PD患者DAT在11C-CFT PET/CT脑显像上主要表现为双侧尾状核及壳核的放射性分布降低，11C-CFT PET/CT脑DAT显像有助于PD的诊断及其严重程度的评估。

Characteristics of 11C-CFT PET/CT imaging of brain dopamine transporter in patients with Parkinson's disease

Objective To investigate the characteristics of 11C-2-carbomethoxy-3-(4-fluorophenyl) tropane (11C-CFT) brain dopamine transporter (DAT) PET/CT imaging and analyze its clinical diagnostic value in patients with Parkinson's disease (PD). Methods A retrospective analysis was performed on the clinical and images data of 41 patients with primary PD who underwent 11C-CFT PET/CT brain imaging in the Affiliated Hospital of Guizhou Medical University from August 2018 to February 2021. The patients included 21 males and 20 females aged 34–81(57.6±12.2) years. The patients were divided into early PD group (19 cases) and late PD group (22 cases) according to the Hoehn and Yahr (H-Y) grade. Moreover, eight healthy subjects matched with the PD group were included as the normal control group. The subjects including 4 males and 4 females aged 42–72 (61.0±9.8) years. The 11C-CFT uptake values of the bilateral caudate nucleus, putamen, and cerebellum were obtained by delineating the regions of interest. The 11C-CFT uptake values of the bilateral caudate nucleus, putamen, and new striatum; the asymmetry index and the ratio of the putamen to the caudate nucleus were calculated according to the corresponding formula. Two independent sample t-test was used to compare the measurement data. Chi square test was used to compare counting data, and Pearson correlation analysis was used to evaluate the correlation between DAT distribution in the new striatum and subareas of PD patients and clinical indicators. Results In 11C-CFT PET/CT brain imaging, the radioactivity distribution of the bilateral caudate nucleus in the PD group was slightly reduced but still uniform, and the radioactivity distribution of the bilateral putamen nucleus in the PD group was reduced or sparse. The radiation distribution of the bilateral putamen was asymmetrically reduced or defective in the early PD group and symmetrical and sparse in the late PD group. Compared with the normal control group, the 11C-CFT value of the new striatum in the PD group was significantly decreased, and the difference was statistically significant (12.29±2.75 vs.7.69±2.42, t=4.818, P<0.01). The asymmetry index increased in the PD group and was most obvious in the putamen, and the difference was statistically significant (0.06±0.08 vs. 0.14±0.09, t=2.184, P<0.05). The ratio of the 11C-CFT uptake value in the putamen to that in the caudate nucleus decreased in the PD group, and the difference was statistically significant (1.13±0.13 vs. 0.74±0.21, t=4.929, P<0.01). Compared with the early PD group, the late PD group had the most significant decrease in 11C-CFT uptake in the new striatum, and the difference was statistically significant(8.50±1.77 vs. 6.99±2.71, t=2.070, P<0.05). Significant differences were found in the asymmetry indexes between the caudate nucleus and putamen in the early PD group and the late PD group, and the differences were statistically significant (0.06±0.06 vs. 0.11±0.08, 0.18±0.10 vs. 0.11±0.07; t=2.251, 2.858; both P<0.05). In the PD patients, the 11C-CFT uptake index in the new striatum was negatively correlated with age, onset age, and H-Y grade (r=?0.444, ?0.514, ?0.426; all P<0.01), and positively correlated with the asymmetry index of 11C-CFT uptake in putamen (r=0.331, P<0.05). The 11C-CFT values of the caudate nucleus in the PD patients were negatively correlated with age, onset age, and H-Y grade (r=?0.537, ?0.581, ?0.380; all P<0.05) but positively correlated with the putamen asymmetry index (r=0.410, P<0.01). In the PD patients, the putamen 11C-CFT was negatively correlated with the onset age and H-Y grade (r=?0.353, ?0.453; both P<0.05) and positively correlated with the course of disease and the ratio of the putamen to the caudate nucleus (r=0.322, 0.396; both P<0.05). Conclusions In 11C-CFT PET/CT brain DAT imaging, the patients with PD showed decreased radioactivity distribution in the bilateral caudate nucleus and putamen. 11C-CFT PET/CT brain DAT imaging is helpful for PD diagnosis and severity assessment.