^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.     

帕金森病脑内多巴胺转运体的SPECT显像研究

多巴胺转运体是再摄取突触间隙多巴胺的功能蛋白。早期帕金森病患者的多巴胺转运体水平明显降低。对多巴胺转运体的深入研究将有助于帕金森病病因、发病机制的阐明和早期诊断。用放射性同位素标记的多巴胺转运体配体可用于它的ＳＰＥＣＴ显像。本文就常用多巴胺转运体配体恃点,ＳＰＥＣＦ显像研究方法及其意义作一综述。     

帕金森病患者纹状体多巴胺转运体显像与帕金森病临床量表评分的相关性

目的研究帕金森病(PD)患者纹状体多巴胺转运体(DAT)显像与PD临床量表评分的相关性。方法以99mTcTRODAT1为显像剂,用单光子发射断层扫描(SPECT)对29例PD患者进行纹状体DAT显像;应用统一PD评定量表(UPDRS)对患者的运动功能进行评分。将UPDRSⅡ(日常生活活动)、Ⅲ(运动评分)和Ⅴ(病情分期)的评分、患者年龄及病程分别与起病肢体同侧、对侧及两侧纹状体的DAT摄取值进行相关性分析。结果纹状体DAT摄取值与UPDRSⅡ、Ⅲ和Ⅴ评分、病程呈负相关(r分别为-0.70、-0.80、-0.49及-0.54,均P<0.01),与年龄无相关性(r=-0.018,P>0.05);纹状体DAT摄取值与UPDRSⅢ的肌僵直和运动迟缓评分呈负相关(r=-0.782、-0.83,均P<0.01),与震颤评分不相关。结论纹状体DAT显像是反映PD严重程度的客观指标,其与PD临床量表部分项目评分有相关性。     

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。     

脑多巴胺转运体 99mTc-TRODAT-1 SPECT显像对早期帕金森病与特发性震颤鉴别诊断的价值

目的探讨脑多巴胺转运体(DAT)99mTcTRODAT1单光子发射计算机断层脑显像(SPECT)对早期帕金森病(PD)与特发性震颤(ET)鉴别诊断的价值。方法对28例早期PD、15例ET、8例ET合并PD(ETPD)患者和15名健康志愿者进行99mTcTRODAT1SPECT显像,勾画出各组脑内感兴趣区[双侧纹状体(ST)及枕叶(OC)],计算机自动给出各区的放射性计数,计算左、右侧特异性放射性摄取比值(STOC/OC)及不对称指数,并加以比较。结果DAT特异性放射性摄取比值:正常对照组左侧为0.58±0.16、右侧为0.56±0.32,ET患者左侧为0.55±0.22、右侧为0.56±0.24,两侧及两组间比较差异均无显著性;ETPD组左侧为0.44±0.33、右侧为0.45±0.18,早期PD组症状肢体对侧为0.40±0.33、症状肢体同侧为0.51±0.12,以上两组与正常对照组和ET组比较呈显著性降低(P<0.01,P<0.05);且PD组症状肢体的对侧低于同侧,差异有显著性(P<0.05)。非对称性指数:PD组高于ET组,差异有显著性(P<0.05)。结论99mTcTRODAT1SPECT显像有助于早期PD与ET的鉴别诊断。     

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     

多巴胺转运体与帕金森病

多巴胺转运体(DAT)是再摄取突触间隙多巴胺的功能蛋白,也是神经毒素MPP~+进入神经元的通道。近年来的研究认为,DAT与帕金森病的关系密切。本文就其基础研究及在帕金森病中的意义作一综述。     

99mTc-TRODAT-1脑SPECT显像对帕金森病诊断

目的 :探讨99mTc TRODAT 1SPECT多巴胺转运体 (dopaminetransporter,DAT)显像对帕金森病 (Parkinson’sdisease ,PD)早期诊断的价值。方法 :对 7例早期PD患者、3例中晚期PD患者和 2例正常对照者行99mTc TRODAT 1SPECT脑断层显像 ,利用感兴趣区技术测定纹状体 /额叶 (striuatum/frontalcortex ,ST/FC)和纹状体 /枕叶 (striuatum/occipitalcortex ,ST/OC)的比值 ,表示纹状体的DAT活性。结果 :早期PD患者起病肢体对侧的ST/FC(1 10 6± 0 0 41)和ST/OC(1 12 3± 0 0 45 )比起病肢体同侧的ST/FC(1 2 47± 0 0 63 )和ST/OC(1 2 46± 0 0 3 4)明显降低 (两者P值均 <0 0 1)。早期PD患者起病肢体同侧的ST/FC和ST/OC比正常对照者显著降低 ,比中晚期PD患者起病肢体同侧的ST/FC和ST/OC显著增高。结论 :99mTc TRODAT 1脑SPECT显像有助于PD的早期诊断     

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.     

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.     

Disease-related and drug-induced changes in dopamine transporter expression might undermine the reliability of imaging studies of disease progression in Parkinson's disease

Parkinson's disease (PD) is a progressive neurodegenerative disorder. Standard therapeutic interventions are aimed at replenishment of empty dopamine stores with levodopa or substitution with dopamine receptor agonists. However, in the long term this symptomatic therapy fails. Currently, various neuroprotective agents are being developed, with the intention to slow down the degeneration of dopaminergic neurons. In this context, the early identification of persons at risk to develop the disease as well as the assessment of the effectiveness of putative neuroprotective agents, are critical issues. Dopamine transporter (DAT) scintigraphy with single photon emission computed tomography (SPECT) has been used to assess the dopaminergic function in PD. Initial studies with several radioligands show significant loss of DAT binding in PD patients as compared to controls. In this paper we review the evidence on the utility of DAT imaging with SPECT in early PD detection as well as in monitoring neurprotection.     

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。     

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。     

99m Tc -TRODAT-1 SPECT DAT显像评价帕金森病严重程度的研究

目的 探讨^99mTc－TRODAT－1SPECTDNAT多巴胺转运体（dopamine transporter,DAT）显像评价帕金森病（PD）严重程度的意义。方法 对18例健康自愿者、23例帕金林病患者行^99mTc－TRODAT－1SPECTDNAT断层显像，利用感兴趣区技术测定纹状体与小脑部位的DAT比值。对PD患者进行UPDR评分和Hoehn-Yahr分级。结果 PD患者^99mTc－TRODAT－1SPECTDNAT断层显像，纹状体DAT特异性摄取与UPDR评分总分、日常活动评分、运动检查评分呈显著性负相关，与精神活动、行为、心境评分和PD患者年龄无相关性。结论 ^99mTc－TRODAT－1SPECTDNAT断层显像有助于评估PD严重程度。     

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.     

Striatal dopamine transporter in different disability stages of Parkinson's disease studied with [I]β-CIT SPECT

Six healthy controls and eighteen patients with Parkinson's disease in different disability stages were studied with SPECT using [¹²³I]β-CIT to label the striatal dopamine transporter. The mean uptake of [¹²³I]β-CIT in the putamen was reduced to 54% of the control mean and to 65% of the average control value in the caudate nucleus. In patients with totally, or predominantly unilateral symptoms the reduction was greater on the side opposite to the predominant symptoms (to 56% of the control mean in the contralateral putamen and to 77% in the ipsilateral putamen).There was a significant negative correlation between [¹²³I]β-CIT uptake in the putamen and the Hoehn and Yahr stage (r = -0.81, p < 0.0001). An analysis of covariance was performed using age and disease duration as covarianes, and the correlation between putaminal [¹²³I]β-CIT uptake and parkinsonian disability according to the Hoehn and Yahr stage remained significant (r = -0.75, P = 0.02). A similar correlation was seen in the caudate nucleus (r = −0.79, p < 0.0001) between the uptake of [¹²³I]β-CIT and the Hoehn and Yahr stage. The correlation also remained significant after correction for the duration of disease and age of the patients (r= -0.76, P = 0.02).The present results show that [1231],Q-CIT SPECT is a useful method to study the function of presynaptic dopaminergic terminals in PD, and might be used in the early diagnosis and follow-up of the disease.     

The cholinergic system and Parkinson disease

Although Parkinson disease (PD) is viewed traditionally as a motor syndrome secondary to nigrostriatal dopaminergic denervation, recent studies emphasize non-motor features. Non-motor comorbidities, such as cognitive impairment, are likely the result of an intricate interplay of multi-system degenerations and neurotransmitter deficiencies extending beyond the loss of dopaminergic nigral neurons. The pathological hallmark of parkinsonian dementia is the presence of extra-nigral Lewy bodies that can be accompanied by other pathologies, such as senile plaques. Lewy first identified the eponymous Lewy body in neurons of the nucleus basalis of Meynert (nbM), the source of cholinergic innervation of the cerebral cortex. Although cholinergic denervation is recognized as a pathological hallmark of Alzheimer disease (AD), in vivo neuroimaging studies reveal loss of cerebral cholinergic markers in parkinsonian dementia similar to or more severe than in prototypical AD. Imaging studies agree with post-mortem evidence suggesting that basal forebrain cholinergic system degeneration appears early in PD and worsens coincident with the appearance of dementia. Early cholinergic denervation in PD without dementia appears to be heterogeneous and may make specific contributions to the PD clinical phenotype. Apart from well-known cognitive and behavioral deficits, central, in particular limbic, cholinergic denervation may be associated with progressive deficits of odor identification in PD. Recent evidence indicates also that subcortical cholinergic denervation, probably due to degeneration of brainstem pedunculopontine nucleus neurons, may relate to the presence of dopamine non-responsive gait and balance impairments, including falls, in PD.     

C57BL小鼠帕金森病模型多巴胺转运蛋白99mTc-TRODAT-1放射自显影研究

目的　评价不同损毁程度 Ｃ５７ Ｂ Ｌ 小鼠帕金森病（ Ｐ Ｄ）模型纹状体多巴胺转运蛋白（ Ｄ Ａ Ｔ）的变化。方法　根据腹腔注射 Ｍ Ｐ Ｔ Ｐ 的天数将小鼠分为 １、３、５ 和 ７ｄ 模型组以及对照组,静脉注射９９ｍ Ｔｃ Ｔ Ｒ Ｏ Ｄ Ａ Ｔ１６ｍ Ｃｉ,１ｈ 后处死行脑纹状体放射自显影,同时行免疫组化酪氨酸羟化酶（ Ｔ Ｈ）染色。结果　对照组的放射自显影可见９９ｍ Ｔｃ Ｔ Ｒ Ｏ Ｄ Ａ Ｔ１ 于纹状体部位有高度放射性聚集,且两侧纹状体基本相同。注射 Ｍ Ｐ Ｔ Ｐ １ｄ 者,其纹状体的放射性浓集比对照组有所下降。注射 Ｍ Ｐ Ｔ Ｐ ３、５ 及 ７ｄ 者,两侧纹状体的放射性浓集逐日降低,第 ７ｄ 者几乎消失。 Ｔ Ｈ 染色发现黑质 Ｔ Ｈ 阳性神经元亦随注射 Ｍ Ｐ Ｔ Ｐ 天数的增加而数量减少。结论　不同程度损毁的 Ｃ５７ Ｂ Ｌ 小鼠 Ｐ Ｄ 模型可模拟 Ｐ Ｄ 的发展过程,９９ｍ Ｔｃ Ｔ Ｒ Ｏ Ｄ Ａ Ｔ１ 作为 Ｄ Ａ Ｔ 的显影剂可用于早期诊断的神经显像学研究。