【摘要】 目的 探讨¹⁸F-FDG PET在帕金森病（PD）和以帕金森综合征为主要表现的多系统萎缩（MSA-P）诊断与鉴别诊断中的价值。方法 纳入2019年5月至2022年12月吉林大学第一医院收治的96例帕金森病患者（PD组）和52例MSA-P患者（MSA-P组），均行18F-FDG PET显像，并采用CortexID Suite软件对图像数据进行分析，获得感兴趣区26个脑区的Z值（Z-score），通过与正常对照数据库对比，最终获得帕金森病和MSA-P患者大脑葡萄糖代谢模式；采用受试者工作特征（ROC）曲线并计算曲线下面积（AUC）评价18F-FDG PET对帕金森病和MSA-P的诊断与鉴别诊断效能，Kappa检验评价18F-FDG PET与“金标准”的诊断一致性。结果 （1）代谢模式：与正常对照数据库相比，PD组脑桥（t=2.851,P=0.005）、小脑（t=2.295,P=0.024）及颞叶内侧（t=5.850,P=0.000）呈现显著高代谢，枕叶外侧（t=-7.116,P=0.000）、顶叶上部（t=-13.466,P=0.000）、顶叶下部（t=-21.838,P=0.000）、楔前叶（t=-7.121,P=0.000）、感觉运动区（t=-6.931,P=0.000）及前额叶外侧（t=-6.778,P=0.000）则呈现显著低代谢；而MSA-P组脑桥（t=-8.364,P=0.000）、小脑（t=-9.900,P=0.000）、顶叶上部（t=-4.830,P=0.000）及顶叶下部（t=-11.287,P=0.000）呈显著低代谢，初级视觉皮质呈高代谢（t=5.579,P=0.000）。（2）诊断与鉴别诊断：与MSA-P组相比，PD组感觉运动区（t=-2.695,P=0.008）、楔前叶（t=-4.516,P=0.000）、顶叶上部（t=-4.611,P=0.000）、顶叶下部（t=-5.903,P=0.000）、枕叶外侧（t=-5.088,P=0.000）及初级视觉皮质（t=-3.218,P=0.002）Z-score较低，颞叶内侧（t=3.718,P=0.002）、小脑（t=9.880,P=0.000）及脑桥（t=9.520,P=0.000）Z-score较高。ROC曲线显示，小脑（Z=3.595,P=0.000;Z=2.942,P=0.003;Z=2.942,P=0.003;Z=3.519,P=0.000）、脑桥（Z=3.363,P=0.001;Z=3.237,P=0.000;Z=2.376,P=0.018;Z=3.012,P=0.003）、6个脑区联合（Z=4.354,P=0.000;Z=4.242,P=0.000;Z=3.711,P=0.000;Z=4.233,P=0.000）AUC均大于楔前叶、顶叶上部、顶叶下部、枕叶外侧，且6个脑区联合AUC大于脑桥（Z=1.986,P=0.047）;Kappa检验显示18F-FDG PET诊断两种疾病与“金标准”的一致性均较高（均κ=0.678,P=0.000）。结论 基于18F-FDG PET可以获得帕金森病和MSA-P的特征性大脑葡萄糖代谢模式，对帕金森病和MSA-P具有较好的诊断与鉴别诊断效能。更多还原

【Abstract】 Objective To investigate the value of ¹⁸F-FDG PET in the diagnosis and differential diagnosis of Parkinson’s disease（PD） and multiple system atrophy with parkinsonism-predominant（MSA-P）.Methods Total 96 patients with PD and 52 patients with MSA-P from The First Hospital of Jilin University from May 2019 to December 2022 were included, and ¹⁸F-FDG PET data were collected from all patients and ¹⁸F-FDG PET data was analyzed using CortexID Suite software. The diagnostic and differential diagnostic efficacy of PD and MSA-P of ¹⁸F-FDG PET was evaluated using the receiver operating characteristic（ROC） curve and area under the curve（AUC）. The Z-scores of 26 brain regions were obtained, and the brain glucose metabolism patterns of patients with PD and MSA-P were finally obtained by comparing with the normal control database. The consistency between18F-FDG PET and "gold standard" diagnosis was evaluated using the Kappa test.Results 1) Metabolic pattern: compared with the normal control database, the PD group showed significantly hypermetabolism in pons（t = 2.851, P = 0.005）,cerebellum（t = 2.295, P = 0.024） and mesial temporal（t = 5.850, P = 0.000）, and significantly hypometabolism in lateral occipital（t =-7.116, P = 0.000）, superior parietal（t =-13.466, P = 0.000）, inferior parietal（t =-21.838, P = 0.000）, precuneus（t =-7.121, P = 0.000）, sensorimotor（t =-6.931, P = 0.000） and lateral prefrontal（t =-6.778, P = 0.000）; while the MSA-P group showed significant hypometabolism in pons（t =-8.364, P = 0.000）, cerebellum（t =-9.900, P = 0.000）, superior parietal（t =-4.830, P = 0.000） and inferior parietal（t =-11.287, P = 0.000）, and hypermetabolism in the primary visual（t = 5.579, P = 0.000）.2) Diagnosis and differential diagnosis: compared with the MSA-P group, the PD group had lower Z-score in sensorimotor（t =-0.646, P = 0.008）, precuneus（t =-4.516, P = 0.000）, superior parietal（t =-4.611, P =0.000）, inferior parietal（t =-5.903, P = 0.000）, lateral occipital（t =-5.088, P = 0.000） and primary visual（t =-3.218, P = 0.002）, while the Z-scores in mesial temporal（t = 3.718, P = 0.002）, cerebellum（t = 9.880, P =0.000） and pons（t = 9.520, P = 0.000） were higher. The ROC curve was drew for the differential diagnostic efficacy of ¹⁸F-FDG PET through the six brain regions with statistical difference and P = 0.000 between the2 groups, the result showed that the AUC of cerebellum（Z = 3.595, P = 0.000; Z = 2.942, P = 0.003; Z =2.942, P = 0.003; Z = 3.519, P = 0.000）, pons（Z = 3.363, P = 0.001; Z = 3.237, P = 0.000; Z = 2.376, P =0.018; Z = 3.012, P = 0.003） and the combination of the six brain regions（Z = 4.354, P = 0.000; Z = 4.242,P = 0.000; Z = 3.711, P = 0.000; Z = 4.233, P = 0.000） were bigger than the AUC of precuneus, superior parietal, inferior parietal and lateral occipital; the AUC of the combination of the six brain regions was bigger than pons（Z = 1.986, P = 0.047）. Kappa test indicated that the diagnosis of the ¹⁸F-FDG PET had good agreement with the diagnosis of the "gold standard" in the two diseases（κ = 0.678, P = 0.000, for all）.C onclusionsThe characteristic brain glucose metabolism patterns of PD and MSA-P can be obtained by ¹⁸F-FDG PET.¹⁸F-FDG PET has good diagnostic and differential diagnostic efficacy for PD and MSA-P.更多还原