[The clinical application value of brain 18F-FDG PET/CT in the diagnostics of Parkinsonian syndromes].

Objective: To analyze the PET/CT imaging features of fluoride 18F-fluorodeoxyglucose (18F-FDG) in patients with various types of Parkinson's syndrome (PS), and to establish a "diagnostic tree" model of 18F-FDG PET/CT for PS. Methods: Data of patients with Parkinson's disease (PD), patients with multiple system atrophy cerebellar type (MSA-C), and patients with multiple system atrophy Parkinson's type (MSA-P)admitted to the Neurology Department of Huashan Hospital affiliated to Fudan University from January 2019 to December 2021. 18F-FDG PET/CT examination was conducted in all patients. Clinical and follow-up data was collected to determine clinical diagnosis. The specific patterns of brain glucose metabolism in patients with various types of Parkinsonism were observed and their utility in the differential diagnosis of the disease was analyzed. 18F-FDG PET/CT imaging"diagnostic tree"model was established and its value in the differential diagnosis of Parkinsonism was verified. Results: A total of 320 patients, 187 males and 133 females, aged (62±9) years, were enrolled in our study, including 80 PD, 90 PSP, 114 MSA-C and 36 MSA-P patients. The differential diagnostic features of cerebral glucose metabolism of Parkinsonism were as follows: the metabolism of putamen increased in PD patients, the metabolism of caudate nucleus, thalamus, midbrain, and frontal lobe decreased in PSP patients, the metabolism of cerebellum decreased in MSA-C patients, and the metabolism of putamen and cerebellum decreased in MSA-P patients. The sensitivity and specificity of the"diagnostic tree"model are 88.75% and 91.25% for PD diagnosis, 54.44% and 96.96% for PSP diagnosis, 87.72% and 86.41% for MSA-C diagnosis, and 55.56% and 91.55% for MSA-P diagnosis, respectively. It could correctly classify 75%(240/320) of patients. Conclusions: Characteristic metabolism patterns of brain in 18F-FDG PET/CT imaging is significant for the differential diagnosis of PD, PSP, MSA-C and MSA-P. The"diagnostic tree"model is valuable for clinical diagnosis.目的： 分析各种类型帕金森综合征（PS）患者的氟［18F］-氟代脱氧葡萄糖（18F-FDG）PET/CT影像特征，建立PS的18F-FDG PET/CT“诊断树”模型。 方法： 回顾性收集2019年1月至2021年12月就诊于复旦大学附属华山医院神经内科的帕金森病（PD）患者、进行性核上性麻痹（PSP）患者、多系统萎缩-小脑型（MSA-C）患者、多系统萎缩-帕金森型（MSA-P）患者，进行18F-FDG PET/CT检查；所有患者完善临床资料采集和随访，确定患者的临床诊断；分析各种类型PS患者脑葡萄糖代谢的特异性改变模式以及在疾病鉴别诊断中的价值；建立18F-FDG PET/CT显像“诊断树”模型并验证其对PS的鉴别诊断价值。 结果： 共纳入320例患者，男性187例，女性133例，年龄（62±9）岁，包括80例PD、90例PSP、114例MSA-C、36例MSA-P。有鉴别诊断意义的脑区葡萄糖代谢特点如下：PD的壳核代谢增高；PSP尾状核、丘脑、中脑、额叶代谢减低；MSA-C小脑代谢减低；MSA-P壳核代谢减低、小脑代谢减低。建立“诊断树”模型，对PD诊断的灵敏度为88.75%，特异度为91.25%；对PSP诊断的灵敏度为54.44%，特异度为96.96%；对MSA-C诊断的灵敏度为87.72%，特异度为86.41%；对MSA-P诊断的灵敏度为55.56%，特异度为91.55%。“诊断树”模型可正确分类75%（240/320）的患者。 结论： PD、PSP、MSA-C、MSA-P的18F-FDG PET/CT显像呈现不同的脑区葡萄糖代谢改变特点，对鉴别诊断有重要价值，“诊断树”模型有助于进行临床诊断。.