帕金森病认知功能障碍的18F-FDG PET/CT研究

摘要

Objective To investigate the characteristics of cerebral glucose metabolism (CGM) in PD patients with cognitive impairment (PD-CI) using 18F-FDG PET/CT,and to analyze the correlation between the progress of PD-CI and CGM changes.Methods A total of 31 idiopathic PD patients (14 males,17 females,aged 37-77 years) from May 2013 to February 2014 were divided into 3 groups based on Montreal cognitive assessment (MOCA):none CI in PD (PD-NC) group (MOCA＞26 scores),mild CI in PD (PD-MCI) group (MOCA 21-26 scores),PD with dementia (PDD) group (MOCA＜21 scores).The normal controls (NC) group included 12 age-and gender-matched healthy adults (7 males,5 females,aged 40-76 years).All subjects underwent PET/CT imaging after intravenous injection of 18F-FDG(5.55 MBq/kg).MIMneuro software was used to analyze the data.The correlation between the CGM and cognitive function was analyzed using Pearson or Spearman correlation analysis.Results (1) Compared with NC group,PDD group presented a widespread cortical metabolism decrease in frontal,parietal,temporal,occipital 19bes and the limbic lobe;PD-MCI group showed hypometabolic areas in the parietal and occipital lobes,and with less extent in the frontal and temporal lobes;PD-NC group showed no significant cerebral hypometabolism.(2) Compared with PD-NC group,PDD group showed widespread cortical metabolism decrease in occipital lobe,temporal lobe,partial parietal cortex and the posterior cingulated cortex.Compared with PD-MCI group,PDD group had lower metabolism,mainly in posterior brain areas (parietal,occipital and temporal lobes).Compared with PD-NC group,PD-MCI group showed hypometabolism in right supramarginal gyrus and the left parahippocampal gyrus.(3) There were positive correlations between visuospatiaL/executive function and visual cortex metabolism,angular gyrus metabolism or superior parietal lobule metabolism (r =0.535,0.443,0.395;all P＜0.05).A positive correlation was also found between delayed memory and heschl's gyrus metabolism (r=0.337,P＜0.05).Conclusions The cerebral glucose metabolism detected with 18F-FDG PET/CT is well correlated with MOCA assessments.Thus it may be helpful in evaluation of the progress of cognitive impairments in PD.%目的 利用18F-FDG PET/CT研究PD认知功能障碍(PD-CI)患者的脑葡萄糖代谢特点,分析PD-CI的进展过程及认知功能变化与脑代谢显像的相关性.方法 将2013年5月至2014年2月31例(男14例,女17例,年龄37～77岁)原发性PD患者,按蒙特利尔认知评估量表(MOCA)分为无认知功能障碍(PD-NC)组(MOCA评分＞26分)、轻度认知功能障碍(PD-MCI)组(MOCA评分21～26分)和痴呆(PDD)组(MOCA分＜21分),同时以12名(男7名,女5名,年龄40～76岁)年龄、性别匹配的健康体检者作为健康对照(NC)组,进行前瞻性研究.受检者按体质量静脉注射5.55 MBq/kg的18F-FDG后行PET/CT显像,采用MIMneuro软件分析图像,比较各组间脑代谢及认知功能的差异和相关性.采用Pearson和Spearson相关分析数据间相关性.结果 (1)PD各组与NC组比较:PDD组与NC组相比出现广泛皮质代谢减低;PD-MCI组与NC组相比在枕叶、顶叶等后部皮质出现代谢减低,额叶、颞叶也有部分区域代谢减低;PD-NC组与NC组相比脑代谢未见明显减低.(2)PD各组间脑代谢比较:相比于PD-NC组,PDD组在枕叶广泛皮质、颞叶、部分顶叶及后扣带回出现代谢减低;相比于PD-MCI组,PDD组在后部皮质中的枕叶、颞叶和顶叶出现代谢减低;相比于PD-NC组,PD-MCI组在右侧缘上回及左侧海马旁回出现代谢减低.(3) PD-CI患者脑代谢与认知功能相关性分析:视空间与执行功能与视觉皮质区、角回、顶上小叶代谢均成正相关(r=0.535、0.443和0.395,均P＜0.05),延迟回忆与颞横回代谢成正相关(r=0.337,P＜0.05).结论 18F-FDG PET/CT显像能客观反映PD-CI的进展过程,由其测得的脑代谢改变同MOCA量表的评估结果间具有良好的相关性.