Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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The Discriminating Nature of Dopamine Transporter Image in Parkinsonism: The Competency of Dopaminergic Transporter Imaging in Differential Diagnosis of Parkinsonism: $^{123}I-FP-CIT$ SPECT Study

도파민운반체 영상의 파킨슨증 감별진단 성능: $^{123}I-FP-CIT$ SPECT 연구

  • Kim, Bom-Sahn (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Jang, Sung-June (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Eo, Jae-Seon (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Park, Eun-Kyung (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Kim, Yu-Kyeong (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Kim, Jong-Min (Departments of Neurology, Seoul National University College of Medicine) ;
  • Lee, Won-Woo (Departments of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Kim, Sang-Eun (Departments of Nuclear Medicine, Seoul National University College of Medicine)
  • 김범산 (서울대학교 의과대학 핵의학교실) ;
  • 장성준 (서울대학교 의과대학 핵의학교실) ;
  • 어재선 (서울대학교 의과대학 핵의학교실) ;
  • 박은경 (서울대학교 의과대학 핵의학교실) ;
  • 김유경 (서울대학교 의과대학 핵의학교실) ;
  • 김종민 (서울대학교 의과대학 신경과교실) ;
  • 이원우 (서울대학교 의과대학 핵의학교실) ;
  • 김상은 (서울대학교 의과대학 핵의학교실)
  • Published : 2007.08.31
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Abstract

Purpose: The aim of this study was to evaluate the discriminating nature of $^{123}I-FP-CIT$ SPECT in patients with parkinsonism. Methods: $^{123}I-FP-CIT$ SPECT images acquired from the 18 normal controls; NC ($60.4{\pm}10.0$ yr) and 237 patients with parkinsonism ($65.9{\pm}9.2$ yr) were analyzed. From spatialIy normalized images, regional counts of the caudate, putamen, and occipital lobe were obtained using region of interest method. Binding potential (BP) was calculated with the ratio of specific to nonspecific binding activity at equilibrium. Additionally, the BP ratio of putamen to caudate (PCR) and asymmetric Index (ASI) were measured. Results: BPs of NC $3.37{\pm}0.57,\; 3.10{\pm}0.41,\; 3.23{\pm}0.48$ for caudate, putamen, whole striatum, respectively) had no significant difference with those of essential tremor; ET ($3.31{\pm}0.64,\; 3.06{\pm}0.61,\; 3.14{\pm}0.63$) and Alzheimer's disease; AD (3.33 $\pm$0.60, 3.29$\pm$0.79, 3.31$\pm$0.70), but were higher than those of Parkinson's disease; PD (1.92$\pm$0.74, 1.39$\pm$0.68, 1.64$\pm$0.68), multiple system atrophy; MSA (2.36$\pm$1.07, 2.16$\pm$0.91, 2.26$\pm$0.96), and dementia with Lewy body; DLB (1.95$\pm$0.72, 1.64$\pm$0.65, 1.79$\pm$0.66)(p<0.005). PD had statisticalIy lower values of PER and higher values of ASI than those of NC (p<0.005). And PD had significantIy lower value of PCR, higher ASI and lower BP in the putamen and whole striatum than MSA (p<0.05). Conclusion: Dopamine transporter image of $^{123}I-FP-CIT$ SPECT was a good value in differential diagnosis of parkinsonism.

목적: 본 연구는 $^{123}I-FP-CIT$ SPECT을 사용하여 파킨슨증을 구성하는 각 질환군별 차이를 평가하는 것이었다 방법: 본태성진전(64.9$\pm$8.4세, 남:녀 =20:59), 알츠하이머병(69.2$\pm$10.0세, 남:녀=4.4), 파킨슨병(66.4$\pm$9.5세, 남:녀=45:82), 레이소체치매(74.6$\pm$8.4세, 남:녀 =1:8), 그리고 다계통위축증(59.7$\pm$6.7세, 남:녀 = 8:6)을 진단받은 환자 237명과 정상군 18명(60.4$\pm$10.2세, 남:녀=9:9)의 $^{123}I-FP-CIT$ SPECT 영상을 분석하였다. 도파민운반체의 표준뇌지도로 검사자의 영상을 공간정규화한 후, 관심영역을 이용하여 미상핵, 피각의 특이영역 계수와 후두엽의 비특이 영역계수를 측정하여 결합잠재능(binding potential; BP)를 계산하였다. 선조체의 특이영역 계수 및 BP는 미상핵과 피각의계수를 가중평균(weighted mean)하여 구하였다. 그리고 피각과 미상핵의 BP간 비(BP ratio of putamen to caudate;PCR)와 선조체, 미상핵, 그리고 피각의 좌우 비대칭 비(asymmetric index; ASI)를 구하였다. 경과 영상을 시행한 파킨슨병(59.3$\pm$11.2세, 남 녀 = 2:3)에서는 연간 BP 감소를 구하였다. 결과 정상군의 BP는 본태성진전이나 알츠하이머병과는 차이가 없었고, 파킨슨병, 다계통위축증, 그리고 레이소체치매보다는 유의하게 높은 값이었다(p<0.005). 정상군의 PCR은 파킨슨병보다는 통계적으로 높았고, ASI는 낮았다(p<0.005), 파킨슨병은 다경색위축증보다 유의하게 PCR값과 피각 및 선조체의 BP는 낮았으며, ASI는 높았다(p<0.05). 그러나 본태성진전과 알츠하이머병 그리고 파킨슨병과 레이소체치매 간에는 모든 변수에서 유의한 차이를 보이지 않았다. 결론: 도파민 운반체 방사성추적자인 $^{123}I-FP-CIT$와 SPECT 영상을 이용하여 파킨슨증에서 질환군에 따른 차이를 평가 할 수 있었다. $^{123}I-FP-CIT$ SPECT를 이용한 도파민 운반체 영상은 파킨슨증의 감별에 유용할 것이다.

Keywords

References

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