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Parkinson病(Parkinson disease:PD)はα-synuclein蛋白蓄積によるLewy小体形成により中脳黒質を中心とした神経変性を呈する疾患で,臨床症状として運動緩慢や筋強剛,安静時振戦をはじめとした左右差を伴うparkinsonismを呈し,進行期には姿勢保持障害が出現する1)。一方で,進行性核上性麻痺(progressive supranuclear palsy:PSP)は異常リン酸化tau蛋白が脳幹や基底核を中心に蓄積し,Richardson症候群(以下,PSP-RS)と呼ばれる典型例では初期から姿勢保持障害の強いparkinsonismや眼球上下転障害など特徴的な症状を呈する2)。しかし,Parkinson病型PSP(以下,PSP-P)では運動症状がPDに類似しており,両者の鑑別が困難な場合が多い3)。PSP-Pは臨床経過とともにPSP-RSに類似した症候に進展しPDと比較すると予後は不良であり2),これらの鑑別が臨床上の課題である。今回我々はPSP-PおよびPD症例における核医学画像の鑑別に有用な所見の検討を行った。
We retrospectively collected the image data of patients admitted to our hospital from January 2017 to June 2019 and consistent with Movement Disorder Society diagnostic criteria of progressive supranuclear palsy-parkinsonism(PSP-P)or Parkinson’s disease(PD). All included patients underwent both 123I-MIBG myocardial scintigraphy and 123I-FP-CIT SPECT. Patients whose images were taken more than a year before the hospitalization were excluded. These images were statistically compared between the two groups. We also performed receiver operating characteristic curve analysis. Image data of 11 PSP-P patients and 25 PD patients were collected. Significant differences were found in the early and delayed heart-to-mediastinum ratio and washout ratio of 123I-MIBG myocardial scintigraphy. The areas under the curve were 0.9236, 0.9600, and 0.8764, respectively. 123I-MIBG myocardial scintigraphy possibly differentiates PSP-P from PD.
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