Metabolički profil centralnog nervnog sistema određen pozitronskom emisionom tomografijom pomoću 18 fluorodeoksiglukoze u diferencijalnoj dijagnozi parkinsonizma

Abstract

Cilj ove studije preseka je da se kod različitih oblika neurodegenerativnog parkinsonizma: idiopatske Parkinsonove bolesti (IPB), multiple sistemske atrofije (MSA) i progresivne supranuklearne paralize (PSP), pozitronskom emisionom tomografijom (PET) pomoću 18-fluorodeoksiglukoze (FDG) odrede karakteristični, za bolest specifični obrasci regionalnog metabolizma glukoze u mozgu i proceni njihov značaj u diferencijalnoj dijagnozi ovih parkinsonih sindroma u kliničkoj praksi. Metodologija: Studijsku populaciju je činilo 72 bolesnika sa neurodegenerativnim parkinsonizmom (50 muškaraca, 22 žene; starosti 61±10god.) koji su upućeni na FDG-PET pregled od strane neurologa eksperata za bolesti nevoljnih pokreta, Odeljenja za bolesti nevoljnih pokreta i neurodegenerativne bolesti, Neurološke klinike, Kliničkog centra Srbije. Selekcija i grupisanje bolesnika je izvršeno prema kliničkim dijagnozama postavljenim na osnovu važećih kliničkih dijagnostičkih kriterijuma. Dijagnoza IPB postavljena je kod 29 pacijenata (22 muškarca, 7 žena, starosti 60,8±10,4 god.), MSA kod 20 pacijenata (8 muškaraca, 12 žena, starosti 56,3±5,6 god.), PSP kod 21 pacijenta (18 muškaraca, 3 žene, starosti 67,3±5,3 god.). U studiju su uključena i 2 pacijenta (1 žena, 1 muškarac, starosti 59,5±10,6 god.) sa kortikobazalnom degeneracijom (KBD) kao retkim oblikom neurodegenerativnog parkinsonizma. Kod svih pacijenata je urađen detaljan neurološki pregled, procena težine i stadijuma bolesti, i ispitivanje kognitivnog i psihičkog statusa. FDG-PET snimanje je obavljeno prema standardnom protokolu za statičke studije mozga, PET/CT aparatom (Biograph 64 TruePoint, Siemens), 45-60 min nakon injekcije radiofarmaka (doza 121-185 MBq (3-5 mCi) 18F-FDG). 3D akvizicija sprovedena je u trajanju od 15 minuta (CT topogram, niskodozni CT (45 mAs) bez kontrasta, 18F-FDG-PET). Rekonstrukcija tomografskih (FDG-PET) scintigrama (transverzalnih, sagitalnih, frontalnih) je vršena iterativnom metodom (OSEM) uz korekciju na atenuaciju i rasejanje...

The aim of this cross-section study is to determine a characteristic, disease-specific brain metabolic patterns using positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) in different forms of neurodegenerative parkinsonism: idiopathic Parkinson's disease (PD), Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP), and to estimate their importance in differential diagnosis of these Parkinsonian syndromes in clinical practice. Methodology: The study population consisted of 72 patients with neurodegenerative parkinsonism (50 men, 22 women; age 61 ± 10 years) who were referred to FDG-PET imaging of the brain by movement disorder specialists from the Department for Movement Disorders and Neurodegenerative Disorders, Neurology Clinic, Clinical Centre of Serbia. The patients were selected and categorized according to clinical diagnosis, based on valid clinical diagnostic criteria. There were 29 patients with IPD diagnosis (22 males, 7 females, mean age 60.8 ± 10.4 year), 20 patients with MSA (8 males, 12 females, mean age 56.3 ± 5.6 year), and 21 patients were diagnosed with PSP (18 men, 3 women, age 67.3 ± 5.3 years). This study also included 2 patients (1 female, 1 male, age 59.5 ± 10.6 year) with corticobasal degeneration (CBD) as a rare form of a neurodegenerative parkinsonism. Detailed neurological examination was performed in all patients , with assessment of severity and the stage of the disease, testing cognitive and psychological status. The standard 18F-fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography (FDG-PET/CT) static brain study was performed (with Biograph 64, True Point, SIEMENS) 45-60 min after the injection of the radiopharmaceutical (121-185 MBq (3-5mCi) dose of 18F-FDG, 3D mode, 1 bed, 15 minutes). Images were reconstructed using the iterative method (OSEM) and with attenuation and scatter correction. The characteristic pattern of regional glucose metabolism was obtained by qualitative visual assessment and quantitative SPM (Statistic Parametric Mapping) image analysis of the individual scans, but also group analysis based on the final clinical diagnosis (IPD, PSP and MSA). Quantitative voxel-based statistical image analysis was performed using...