^99mTc-TRODAT-1 SPECT多巴胺转运体显像在诊断早期帕金森病中的意义

目的探讨99mTc-TRODAT-1 SPECT多巴胺转运体(DAT)显像在诊断早期帕金森病(PD)中的意义.方法对62例早期PD、12例晚期PD及10名正常人进行99mTc-TRODAT-1 SPECT 基底节DAT显像,选取纹状体区和小脑为感兴趣区,计算两者的放射性比值,比较3组间该比值的差异,并分析早期PD患者DAT放射性结合率与H&Y分级及UPDRS评分之间的相关性.结果PD患者基底节99m Tc-TRODAT-1摄取率显著降低,早期PD患者病变较重肢体对侧纹状体放射性摄取率较同侧纹状体显著下降.PD患者纹状体区放射性摄取率与PD患者的H&Y分级呈负相关,而与UPDRS Ⅱ、Ⅲ评分无相关性.结论99mTc-TRODAT-1 SPECT基底节 DAT显像可用于临床早期PD的诊断.     

帕金森病~(99m)Tc-TRODAT-1多巴胺转运体SPECT初步临床应用研究

目的:评价多巴胺转运体(DTA)显象剂99mTc-2β-[N,N′-双(2-巯乙基)乙撑二氨基]甲基,3β(4-氯苯基)托烷(99mTc-TRODAT-1)诊断帕金森病(PD)及其严重程度(H/Y分级)相关性。方法:PD患者29例(H/Y1-4级),正常对照组22例,静脉注射99mTc-TRODAT-1,2-3hr后行DATSPECT显像,并应用ROI技术计算纹状体/小脑放射性比值(ST/CB),研究ST/CB与H/Y分级的相关性。结果:与正常对照组比较,PD患者纹状体内99mTc-TRODAT-1积聚显著下降,尤以壳核更为明显。早期PD患者(H/Y:1)不仅有病侧肢体对侧纹状体放射性分布减少,同侧纹状体放射性分布也明显减少,但对侧更明显,两侧壳核/小脑放射性比值有显著差异(P<0.05=。ST/CB与PD)的严程度重)(H/Y分级)无显著相关性。结论:99mTc-TRODAT-1DATSPECT显像有助于了解PD患者纹状体内突触前膜的DAT丢失情况,PD患者DAT明显减少,对PD的早期诊断及鉴别诊断有非常重要的意义。     

脑多巴胺转运体SPECT显像鉴别早期帕金森病与原发性震颤

目的探讨脑多巴胺转运体99mTc-TRODAT-1 SPECT显像在鉴别帕金森病与原发性震颤的应用.方法 19例帕金森病与17例原发性震颤患者均行脑多巴胺转运体99mTc-TRODAT-1 SPECT显像,勾画出两组患者脑内感兴趣区(双侧纹状体及小脑),计算机自动给出各区的放射性计数,计算左、右侧纹状体的特异性放射性摄取比值及不对称指数并加以比较.结果帕金森病患者的Hoehn-Yahr分期是1.7±0.6.原发性震颤患者脑多巴胺转运体对99mTc-TRODAT-1的特异性摄取比值左(0.5±0.1)、右(0.6±0.2)两侧差异无显著意义;而帕金森病患者症状对侧(0.3±0.2)与症状同侧(0.4±0.2)差异有显著意义, 症状对侧低, 症状同侧高,并且双侧均低于原发性震颤患者.不对称指数帕金森病患者(21.1±17.4)明显高于原发性震颤(9.2±11.2)患者.结论脑多巴胺转运体99mTc-TRODAT-1 SPECT显像可以鉴别帕金森病与原发性震颤.     

99mTc-TRODAT-1人脑多巴胺转运体显像初步研究

目的　探讨利用99Tcm 2 β [N ,N′ 双 ( 2 巯乙基 )乙撑二胺基 ]甲基 ,3 β ( 4 氯苯基 )托烷 ( 99mTc TRODAT 1 )进行人脑多巴胺转运体 (DAT)SPECT显像的可能性和方法 ,并对其临床应用价值进行初步探讨。方法　正常人与帕金森病病人 ,以99mTc TRODAT 1为显像放射性药物 ,进行SPECT显像。结果　99mTc TRODAT 1能快速通过血脑屏障入脑。注射后 3～ 5小时 ,正常人基底节区域有高度的放射性摄取 ,而大脑其他部分和小脑少或无明显放射性摄取。帕金森病病人 ,根据病情、病程不同 ,基底节放射性摄取有不同程度减少。结论　初步结果提示 ,99mTc TRODAT 1是一种较为理想的脑DATSPECT显像用放射性药物 ,99mTc TRODAT 1DATSPECT显像对帕金森病的诊断、病情评估具有临床应用价值     

脑多巴胺转运体SPECT鉴别帕金森病与血管性帕金森综合征

目的:多巴胺转运体(Dopamine transporter,DAT)99mTc-TRODAT-1SPECT显像有利于客观评价中枢多巴胺神经元的数量及其功能,本研究探讨DAT显像评估鉴别帕金-森病(PD)与血管性帕金森综合征(VP)的意义。方法:对临床确诊的51例PD患者和12例VP患者进行99mTc-TRODAT-1DATSPECT断层显像。注射示踪剂2-3h后采集图像,勾画出感兴趣区(双侧纹状体和枕叶),计算机自动计算感兴趣区的放射性计数,最后测算出纹状体与枕叶部位的放射性计数比值和非对称性指数并进行比较分析。结果:PD组特异性放射性比值是症状对侧0.38±0.18.症状同侧0.46±0.22,两侧差异有显著性(P<0.05)。VP组特异性放射性比值是左侧0.58±0.16.右侧0.56±0.32,两侧无显著性差异。VP组非对称性指数是6.72±10.53,PD组19.31±16.15,特异性放射性比值和非对称性指数组间比较均有显著性差异(P<0.05)。结论:多巴胺转运体99mTc-TRODAT-1SPECT显像有助于PD与VP的鉴别。     

帕金森病患者~(99m)Tc-TRODAT-1显像的临床研究

目的:探讨~(99m)Tc-TRODAT-1 SPECT显像对多巴胺转运蛋白(DAT)显像的临床应用价值。方法:选取42例患者(包括PD24例和非PD18例)行~(99)mTc-TRODAT-1 SPECT检查,通过视觉分析及感兴趣区(ROI)的半定量分析法来观察患者DAT的分布及密度。结果:PD组与非PD组相比较其成像视觉分析的特异性为0.89,敏感性为0.87。ROI的半定量分析(ST/OC)发现PD组较非PD组其DA再摄取率明显下降,且病情越重,下降越明显。但单侧症状者,其对侧纹状体DAT密度虽较同侧有下降,但无统计学意义。结论:PD患者DAT密度降低,且降低程度与病情严重程度密切相关,~(99m)Tc-TRODAT-1 SPECT显像研究有助于PD的早期诊断和病情监测。     

多巴胺转运体SPECT显像评估帕金森病严重程度的研究

目的本研究探讨显像评估帕金森病严重程度的意义.方法对15例对照者和30例帕金森病患者(根据Hoehn-Yahr分级分为早期组18例,中晚期组12例)行99mTc-TRODAT-1 DAT SPECT断层显像,注射示踪剂2～3 h后采集图像,勾画出感兴趣区(双侧纹状体和枕叶),计算机自动计算感兴趣区的放射性计数,最后测算出纹状体与枕叶部位的放射性计数比值和非对称性指数,并进行比较分析.结果对照组特异性放射性计数比值是0.58±0.16(左侧)、0.56±0.32(右侧),早期帕金森病组特异性放射性计数比值为0.40±0.33(症状对侧或症状严重肢体对侧)、0.51±0.12(症状同侧),中晚期帕金森病组特异性放射性计数比值为0.23±0.18(症状严重肢体对侧)、0.40±0.17(症状同侧);对照组非对称性指数是5.12±0.48,早期帕金森病组为9.05±14.61,中晚期组为20.67±14.2,3组间比较均有显著性差异(P＜0.05).结论多巴胺转运体99mTc-TRODAT-1 SPECT显像有助于帕金森病严重程度的判断.     

多巴胺转运体显像对特发性震颤与早期帕金森病的鉴别诊断价值

目的探讨多巴胺转运体(DAT)显像对特发性震颤(ET)、早期帕金森病(PD)鉴别诊断的价值.方法以99mTc-2β-[N,N'-双(2-巯乙基)乙撑二胺基]甲基-3β-(4-氯苯基)托烷(99mTc-TRODAT-1)为显像剂,用单光子发射计算机断层扫描(SPECT)对8例姿势性震颤(PT)患者,5例姿势性震颤伴静止性震颤(PT+RT)患者、12例早期PD(H-Y I级)患者进行DAT显像.结果与PT组相比,PT+RT组两侧纹状体(ST)与枕叶(OC)的ST/OC均值略高,但无显著性差异;早期PD组ST/OC均值显著性降低.PT+RT组两侧ST/OC均值明显高于早期PD组患肢对侧,但与其同侧无显著性差异.结论PT伴RT的ET患者存在轻度多巴胺神经元的缺失,99mTc-TRODAT-1 SPECT DAT显像对ET和早期PD有鉴别诊断的价值.     

99 mTc-TRODAT-1的SPECT成像评价早期帕金森病

目的探讨99mTc-TRODAT-1成像对于评价早期帕金森病的价值.方法对36例早期帕金森病患者和12例健康对照者进行检查.所有患者用Hoehn和Yahr模式进行评价,且均处于疾病的第二阶段以下.头部单光子发射计算机断层扫描(SPECT)于注射99mTc-TRODAT-1后2.5 h完成.特别注意纹状体及其周围区域,包括豆状核、尾状核,经计算进行对比分析.结果在帕金森病患者中发现,随着疾病的进展,患者纹状体的显影剂含量逐渐减少,(对照组、第一阶段、第二阶段分别为1.96、1.42、1.22)(P＜0.01).更有意义的是第一、二阶段患者受累严重侧肢体的对侧豆状核与同侧相比减低更明显(第一阶段患者1.27/1.46,第二阶段患者1.04/1.34)(P＜0.01).结论99mTc-TRODAT-1可以作为帕金森病患者早期诊断的显影剂.     

18^F-FP-CIT PET和99^Tc^m-TRODAT-1 SPECT纹状体DAT像在早期诊断帕金森病中的敏感性比较

目的:评价在早期诊断帕金森病(PD)中核素纹状体DAT显像的敏感方法。方法:同一患者先后进行18F-FP-CITPET、99Tcm-TRODAT-1和131I-FP-CITSPECT3种显像。共有6名正常人、21例早期PD和10例晚期PD患者参与。结果:18F-FP-CITPET纹状体DAT显像图像清晰;在早期PD中发现两侧纹状体DAT值不对称;病侧后壳核DAT减少特别明显;DAT损害区反映偏侧PD的吻合率为100%;能分清早、晚期PD。将18F-FP-CIT改为用碘标的131I-FP-CITSPECT后纹状体DAT显像不佳。99Tcm-TRODAT-1SPECT在早期PD诊断中类似于18F-FP-CIT,但无法早期发现病侧后壳核DAT值下降,DAT损害区反映偏侧PD的吻合率为81%。结论:18F-FP-CITPET纹状体DAT显像对早期PD诊断最佳。99Tcm-TRODAT-1纹状体DAT显像可用于早期PD诊断,适合国内目前应用。     

Experimental research on functional imaging of Parkinson's disease

Objective To analyse the change of density of dopamine transporter (DAT) in striatum of hemiparkinsonian monkeys by SPECT inaging with 99mTc-TRODAT i. Methods four rhesus monkeys were used for this study, and named M1-4. M1 was normal monkey, others were hemiparkinsonian models induced by unilateral infusion of MPTP into the right common carotid artery. Acquisitions were performed 1～2 hours after an injection ot 370 ～550MBq 99mTc-TRODAT-1, exceilent imagings were selected for analysis. Regions of interest(ROls)were drawn over the striata and the cerebral cortexes. Results In healthy monkey (M1), Left striatum/right striatum ratio was 1.00 in the radioactivtity of RO1, but in hemiparkinsonian monkeys, left striatum/right striatum ratios were 1.10～1.22, and right striatum/cerebral cotexes ratios were decreased compared with that of left striatum/corebral cotexes. Conclusion SPECT imaging with 99mTc-TRODAT-1 can be used to in vivoo evaluate the loss of DAT in the striatum of the hemiparkinsonian monkeys, and to adjunctively make a diagnosis for Parkinson's disease, even in the earlier stage.     

多巴胺转运体显像对特发性震颤与早期帕金森病的鉴别诊断价值

目的:探讨９９ｍＴｃ－ＴＲＯＤＡＴ－１ ＳＰＥＣＴ多巴胺转运体(ＤＡＴ)显像对特发性震颤(ＥＴ)、早期帕金森病(ＰＤ)鉴别诊断的价值。方法:对９例ＥＴ,１４例早期ＰＤ,５例ＥＴ合并ＰＤ(ＥＴ－ＰＤ)患者和２０名健康人进行９９ｍＴｃ－ＴＲＯＤＡＴ－１－ＳＰＥＣＴＤＡＴ断层显像。结果:与年龄、性别相配对的正常人相比,ＥＴ患者纹状体(ＳＴ)与小脑(ＣＢ)ＤＡＴ特异性摄取比值(ＳＴ/ＣＢ)无显著性差异,早期ＰＤ和ＥＴ－ＰＤ患者ＳＴ/ＣＢ显著性降低。结论:９９ｍＴｃ－ＴＲＯＤＡＴ－１ＳＰＥＣＴ ＤＡＴ显像有助于ＥＴ、早期ＰＤ的鉴别诊断。     

肝豆状核变性99m Tc-TRODAT-1的SPECT脑DAT显像研究

目的 研究肝豆状核变性(WD)患者99mTc-TRODAT-1 SPECT脑DAT显像特点及其与神经系统表现的关系.方法 对18例有神经症状WD患者(脑型)、11例无神经症状WD患者(非脑型)和12例正常对照行99mTc-TRODAT-1 SPECT脑DAT显像,利用计算机感兴趣技术(ROI)进行半定量分析(ST/CB比值作为半定量指标).据WD神经症状改良评分表对18例脑型WD患者的神经症状进行评分.结果 脑型WD患者ST/CB比值与正常对照组比较有显著性差异(P＜0.01),非脑型WD患者ST/CB比值与正常对照组比较无显著性差异(P=0.13).脑型WD患者神经症状改良评分与其ST/CB比值呈高度负相关,r=-0.78(P=0.001).结论 本研究结果提示WD患者DA能黑质纹状体通路突触前膜功能下降,其下降越明显,WD的神经症状就越严重.无神经症状的WD患者脑DAT功能无此改变.     

Dopamine transporter change in drug-naive schizophrenia: an imaging study with 99mTc-TRODAT-1

The aim of this study was to use a specific dopamine transporter (DAT) ligand, 99mTc-TRODAT-1 with single photon emission computed tomography (SPECT) to investigate the densities of DAT in the striatal dopaminergic system in patients with schizophrenia.Striatal DAT uptakes were measured in 12 drug-nai;ve schizophrenic patients and 12 age- and sex-matched healthy volunteers. The psychometric tools included the Standardized Clinical Assessment for Neuropsychiatry (SCAN) and the Positive and Negative Syndrome Scale (PANSS). Semiquantitative analyses using the ratio of uptake in caudate, putamen, and striatum to occipital lobe, and left-right asymmetry were performed.Decreased TRODAT uptake in the right striatum and increased uptake in the left striatum were found in the schizophrenics. However, there is no overall difference in the average striatum uptake. The right-left asymmetry of the caudate and putamen DAT binding seen in the healthy control group disappeared in the schizophrenia group. The decreased right uptake and increased left uptake in the striatum might lead to the lack of right-left asymmetry in neuroleptic-nai;ve schizophrenia patients, confirming that the disorder could be due to a disruption in brain lateralization.This is the first report on the use TRODAT to evaluate the DAT density in schizophrenia patients and shows lack of asymmetry in striatal uptake of TRODAT in schizophrenics. The findings also suggest that TRODAT SPECT may be a useful technique to measure dopamine transmission in the human brain and for understanding the pathophysiology of neuropsychiatric disorders.     

99Tcm-TRODAT-1 SPECT与131I-epideprideSPECT显像对早期帕金森病人的临床应用价值

目的探讨脑多巴胺转运体（DAT）^99Tc^m-TRODAT-1 SPECT显像与多巴胺D2受体（D2R）^131I-epidepride SPECT显像在早期帕金森病（PD）中的临床应用价值。方法10例正常对照者及46例早期未经替代治疗的PD患者分别接受脑DAT ^99Tc^m-TRODAT-1 SPECT与多巴胺D2R ^131I-epidepride SPECT断层显像，利用感兴趣区技术计算纹状体与枕叶、额叶的放射性比值（ST-OC／OC和ST-FC／FC）。结果PD患者起病肢体对侧脑DAT比值ST-OC／OC和ST-FC／FC比同侧均降低，双侧ST-OC／OC较对照组均降低。PD患者起病肢体对侧脑D2R比值ST-OC／OC和ST-FC／FC比同侧均增高。PD患者起病肢体对侧脑DAT比值ST-OC／OC与患者病程呈负相关，起病肢体对侧脑D2R比值ST-OC／OC与患者年龄及UPDRS运动评分呈负相关。结论人脑DAT ^99Tc^m-TRODAT-1 SPECT显像与D2R ^131I-epidepride SPECT显像均有助于PD的早期诊断及病情监测。     

99mTc-TRODAT-1 SPECT study in early Parkinson's disease and essential tremor

OBJECTIVE: The clinical differentiation between early Parkinson's disease (PD) and essential tremor (ET) could be difficult, therefore, the aim of this study was to investigate 99mTc-TRODAT-1 SPECT as an applicable tool in this field. METHODS: 99mTc-TRODAT-1 single photon emission computed tomography (SPECT) was performed in 10 healthy volunteers, 27 patients with idiopathic PD (Hoehn and Yahr 1-1.5) and 12 patients with ET. The ratio of striatal (99m)Tc-TRODAT-1 binding was calculated as the index of (striatum - occipital cortex)/occipital cortex. RESULTS: Compared with the striatal 99mTc-TRODAT-1 uptake in the ET group (0.49 +/- 0.07) or healthy controls (0.54 +/- 0.18), there was a significant decrease in the bilateral striatums of early PD, with a greater reduction in the contralateral striatum (0.27 +/- 0.08) than ipsilateral one (0.36 +/- 0.10, P < 0.01). Its sensitivity and specificity of differentiating early PD from ET was 96.4% and 91.7% respectively. CONCLUSION: 99mTc-TRODAT-1 SPECT can detect the dysfunction of nigrostriatal system in patients with early PD and provided a feasible tool to help differentiate early PD from ET.     

Dopamine transporter binding in Wilson's disease

INTRODUCTION: In Wilson's disease (WD), brain magnetic resonance images (MRI) show increased signal intensity in T2 weighted images in the lenticular nuclei, thalamus and brainstem, including the substantia nigra. A poor therapeutic response to levodopa in WD suggests the mechanism of a postsynaptic abnormality. However positron emission tomography studies show an involvement of the nigrostriatal presynaptic dopaminergic pathway. CASE REPORT: We report the clinical manifestations in a case of WD with akinetic-rigid syndrome and initial hesitation. The brain MRI showed an increased signal intensity lesion in the substantia nigra region, in addition to basal ganglion and thalamic lesions. However, dopamine transporter (DAT) imaging with 99mTc-TRODAT-1 revealed a nonsignificantly increased DAT uptake, suggesting a normal presynaptic nigrostriatal dopaminergic terminal. CONCLUSION: We suggest that significant heterogeneity can be found in WD patients and a normal presynaptic dopaminergic pathway may occur in some patients, even those with typical akinetic-rigid syndrome and evidence of substantia nigra involvement in the brain on MRI.     

Early-onset Parkinson's disease in a Chinese population: 99mTc-TRODAT-1 SPECT, Parkin gene analysis and clinical study

Early Onset Parkinson's Disease (EOPD) is characterized by selective degeneration of nigrostriatal dopaminergic neurons and a marked response to levodopa. However, at present, few methods are available as diagnostic tools for EOPD except for 18F-DOPA PET. In addition, little is known about the correlation between clinical severity, neuroimaging grading and genetic susceptibility. In the present study, 99mTc-TRODAT-1 SPECT and brain MRI were used to identify 30 cases of non-familial EOPD from a Chinese cohort of 230. All 30 PD patients had an age of onset of less than 55 years (mean age at onset, 41.5+/-9.3 years). Each of the 30 EOPD cases was sub-classified into one of five stages based on the 99mTc-TRODAT-1 SPECT findings. In the early stages of PD (stages 1 and 2), a lower uptake of 99mTc-TRODAT-1 in the putamen was found, while uptake in the caudate nucleus was normal. In the latter stages (stages 3, 4, 5), 24 patients revealed a diffuse and uniform loss of 99mTc-TRODAT-1 uptake in the putamen and the caudate nucleus. Further, in conventional genetic studies of the 30 patients, six novel mutations were found in the Parkin gene, and these included five heterozygous point mutations (C441R, Q311H, V258M, C212G, and S193I) and one homozygous deletion (exon 10-12). Known polymorphisms (Ser167Asn, Val380Leu) were also found in a number of patients. However, gene dosage analysis did not reveal any compound heterozygous mutations in these 30 patients using quantitative duplex PCR. This is the first study to examine EOPD patients of Chinese ethnic background (not exhibiting a definite familial trait), to offer a complete genetic analysis of the Parkin gene, and to correlate clinical stages of the disease with dopamine re-uptake.