摘要目的 探讨帕金森病痴呆(PDD)患者的18F-脱氧葡萄糖正电子发射体层(18F-FDGPET)脑显像特点及意义.方法 对20例PDD患者、8例非痴呆PD患者和30名相匹配的健康对照进行18F-FDG PET脑显像,应用视觉分析法和统计参数图(SPM)分析法比较病例组与对照组大脑葡萄糖代谢差异.结果 与对照组相比,视觉分析法显示非痴呆PD患者示踪剂分布均匀对称,PDD患者双侧额叶、颞叶、顶叶、枕叶及基底节、丘脑葡萄糖代谢减低;在一定显著性水平(P<0.001)和像素阈值(K=100像素)下,SPM分析显示非痴呆PD患者仅双侧顶叶后部代谢减低;PDD患者局部脑葡萄糖代谢率(rCMRglc)减低的脑区包括双侧顶上小叶、顶下小叶、额上回、额中回、颞中回、楔叶、扣带回、枕叶舌回、额叶内侧部及壳核、丘脑等部位.根据幻觉及记忆损害程度将PDD分为幻觉(HD)组和记忆障碍(MD)组,2组MMSE及Hoehn-Yahr分级差异无统计学意义(P>0.05),而HD组的年龄与病程明显低于MD组(P<0.05),应用SPM分析法与正常对照进行比较,发现HD组顶枕叶代谢减低尤为显著而类似于路易体痴呆,而MD组颞顶联合区皮质、楔前叶糖代谢明显减低,与阿尔茨海默病的代谢特点一致.结论 18F-FDG PET脑显像有助于PDD的诊断及发病机制的阐述.

abstractsObjective To assess the regional cerebral glucose utilization and the imagingcharacteristic of Parkinson's disease with dementia (PDD) with 18 F-fluorodeoxyglucose (FDG) positronemission tomography (PET). Methods Questionnaire survey, mini-mental state examination (MMSE),physical examination, and FDG PET on brain at rest state were performed on 20 patients with PDD, 13males and 7 females, aged (70±6), and sex- and age-matched 8 patients with non-demented PD, and 30healthy parsons. Visual inspection and statistical parametric mapping (SPM) were used to investigate theregional cerebral metabolic rate of glucose (rCMRgle) and the distribution of the tracer. Results TheMMSR score of the PDD group was (27.5 ± 2.4), (10 - 24), significantly lower than those of the non-PDDgroup [(27.5±2.4) (22-30)] and control group [(27.9±2.2) (21 -30)] (F =60.31 ,P =0.000).There were no significant differences in Hoehn-Yahr staging and disease courses between the two PD groups(P > 0.05). Visual inspection showed that there were no significant focal hypometabolic areas in theimaging of the non-demented PD patients, while compared to the controls, the rCMRgle levels of the PDDpatients decreased in bilateral superior parietal lobules (BA 7), inferior parietal lobules (BA 40,39), superiorfrontal gyri(BA 6), middle frontal gyri (BA 6,8,9), middle temporal gyri (BA 21), cuneate lobes (BA 17,18,19), cingulate cortices (BA 31), lingual gyri (BA 19) basal ganglia, and thalamus. According to theseverity of memory impairment and the onset of hallucination, the subtype of PDD was classified into memoryimpairment dominant group (MD) and hallucination dominant group (HD). The rCMRglc of MD subgroupdecreased significantly in the parietotemporal association cortex, especially in the precunens lobe. TherCMRglc of the HD subgroup decreased significantly in the occipital cortex. There were no significantdifferences in MMSE score and Hoehn-Yahr staging between the MD and HD groups(beth P >0.05), whilethe age of the HD subgroup was significantly lower, and the disease duration of the HD subgroup wassignificantly longer than those toe MD group (beth P < 0.05). Conclusions 18F-FDG/PET imaging ishelpful to the diagnosis of PDD and may help investigate the potential pathophysiology of PDD.