-
帕金森病(Parkinson's disease,PD)是一种神经退行性疾病,好发于中老年人,其发病率仅次于阿尔茨海默病。PD的临床特点主要表现为静止性震颤、运动迟缓和肌肉强直[1],使用左旋多巴制剂对症治疗具有确切效果、出现嗅觉减退或心脏交感神经支配等症状对诊断PD也具有一定的参考价值[2],然而,单纯依靠患者的临床症状和对左旋多巴制剂疗效等进行PD严重程度的评估缺乏客观标准。11C-2β-甲氧甲酰-3β-(4-氟苯基)托烷[11C-2-β-carbo-methoxy-3-β-(4-fluorophenyl) tropane,11C-CFT]是靶向多巴胺转运体(dopamine transporter,DAT)的分子显像剂,通过PET显像可特异性地探测脑内DAT的分布,直接反映多巴胺能神经元的功能状态,了解PD黑质-纹状体病变的程度和范围[3]。本研究通过对PD患者行11C-CFT DAT PET/CT脑显像,探讨显像特点,分析其在PD诊断中的临床价值。
-
11C-CFT PET/CT显像结果显示,正常对照组:11C-CFT特异性地分布于健康受检者的新纹状体区,形态大小对称,放射性分布均匀,呈“八”字形(图1A),而在大脑皮层、小脑、丘脑等部位放射性分布极低;PD组:双侧尾状核放射性分布呈稍降低但尚均匀,双侧壳核放射性分布呈不同程度的降低或稀疏缺损。其中,早期PD组患者双侧壳核放射性分布呈不对称性降低或缺损(图1B);晚期PD组患者双侧壳核放射性分布呈较对称性稀疏缺损(图1C)。
-
PD组患者和正常对照组受检者在性别和年龄之间的差异均无统计学意义(χ2=1.072、t=0.435,P=0.949、0.468)。由表1可知,PD组尾状核、壳核及新纹状体的11C-CFT摄取值较正常对照组均明显降低,分别降低至正常对照组的76.8%、49.6%、62.6%,且以壳核11C-CFT摄取值降低最明显,差异均有统计学意义(均P<0.05)。与早期PD组相比,晚期PD组尾状核及新纹状体的11C-CFT摄取值均明显降低,分别降低至早期PD组的79.3%、82.2%,且差异均有统计学意义(均P<0.05)。与正常对照组相比,PD组尾状核、壳核不对称指数增高,以壳核增高更明显且差异有统计学意义(P=0.030)。晚期PD组与早期PD组比较,尾状核、壳核不对称指数的差异均有统计学意义(均P<0.05)。与正常对照组相比,PD组壳核与尾状核摄取值的比值的差异有统计学意义(P<0.001)。
组别 尾状核摄取值 壳核
摄取值新纹状体
摄取值尾状核不对称指数 壳核不对称指数 壳核与尾状核摄取值的比值 正常对照组(n=8) 5.82±1.38 6.47±1.47 12.29±2.75 0.07±0.11 0.06±0.08 1.13±0.13 PD组
(n=41)4.47±1.43a 3.21±1.16a 7.69±2.42a 0.09±0.07 0.14±0.09a 0.74±0.21a 早期PD组
(n=19)5.03±1.10 3.47±0.76 8.50±1.77 0.06±0.06 0.18±0.10 0.69±0.09 晚期PD组
(n=22)3.99±1.53b 3.00±1.41 6.99±2.71b 0.11±0.08b 0.11±0.07b 0.77±0.28 注:a表示与正常对照组相比,差异均有统计学意义(t=2.439、6.944、4.818、2.184、4.929,P=0.019、0.001、0.001、0.030、<0.001);b表示与早期PD组相比,差异均有统计学意义(t=2.454、2.070、2.251、2.858,P=0.019、0.045、0.029、0.007)。PD为帕金森病;CFT为2β-甲氧甲酰-3β-(4-氟苯基)托烷 表 1 PD组和正常对照组新纹状体及各亚区11C-CFT分布的比较(
±s)$\bar x $ Table 1. Comparison of 11C-CFT distribution in new striatum and subareas of Parkinson's disease group and normal control group (
±s)$\bar x $ -
由表2可知,PD组尾状核的11C-CFT摄取值与年龄、起病年龄、H-Y分级均呈负相关(均P<0.05),与壳核不对称指数呈正相关(P<0.05)。壳核的11C-CFT 摄取值与起病年龄、H-Y分级均呈负相关(均P<0.05),与病程、壳核与尾状核摄取值的比值均呈正相关(均P<0.05)。新纹状体的11C-CFT摄取值与年龄、起病年龄、H-Y分级均呈负相关(均P<0.01),与壳核不对称指数呈正相关(P<0.05)。
指标 尾状核 壳核 新纹状体 r值 P值 r值 P值 r值 P值 年龄 −0.537 <0.001 −0.262 0.098 −0.444 0.004 起病年龄 −0.581 <0.001 −0.353 0.024 −0.514 0.001 病程 0.195 0.222 0.322 0.040 0.271 0.087 H-Y分级 −0.380 0.014 −0.453 0.003 −0.426 0.006 尾状核不对称指数 −0.133 0.407 0.134 0.402 −0.014 0.930 壳核不对称指数 0.410 0.008 0.183 0.253 0.331 0.034 壳核与尾状核摄取值的比值 −0.279 0.078 0.396 0.010 0.026 0.874 注:PD为帕金森病;CFT为2β-甲氧甲酰-3β-(4-氟苯基)托烷;H-Y分级为Hoehn-Yahr分级 表 2 PD患者新纹状体及各亚区11C-CFT摄取值与临床指标的相关性
Table 2. Correlation between 11C-CFT uptake values and clinical indicators in new striatum and subareas of Parkinson's disease patients
帕金森患者脑多巴胺转运体11C-CFT PET/CT显像特点的分析
Characteristics of 11C-CFT PET/CT imaging of brain dopamine transporter in patients with Parkinson's disease
-
摘要:
目的 探讨帕金森病(PD)患者11C-2β-甲氧甲酰-3β-(4-氟苯基)托烷(CFT)脑多巴胺转运体(DAT)PET/CT显像的特点,分析其对PD的临床诊断价值。 方法 回顾性分析2018年8月至2021年2月于贵州医科大学附属医院行11C-CFT PET/CT脑显像且经临床确诊的41例原发性PD患者的临床资料和影像学资料,其中男性21例、女性20例,年龄34~81岁(57.6±12.2)岁。根据Hoehn-Yahr(H-Y)分级将PD患者分为早期PD组(19例)和晚期PD组(22例)。同时纳入与PD组患者年龄匹配的8名健康受检者作为正常对照组,其中男性4名、女性4名,年龄42~72(61.0±9.8)岁。通过勾画感兴趣区(ROI)得到双侧尾状核、壳核及小脑3个层面的11C-CFT摄取值,按相应公式计算双侧尾状核、壳核、新纹状体的11C-CFT摄取值和不对称指数、壳核与尾状核摄取值的比值。计量资料的比较采用两独立样本t检验;计数资料的比较采用卡方检验;采用Pearson相关性分析评价PD患者新纹状体及各亚区DAT分布与各临床指标之间的相关性。 结果 在11C-CFT PET/CT脑显像中,PD组双侧尾状核放射性分布呈稍降低但尚均匀,双侧壳核放射性分布呈不同程度的降低或稀疏缺损。其中,早期PD组患者双侧壳核放射性分布呈不对称性降低或缺损;晚期PD组患者双侧壳核放射性分布呈较对称性稀疏缺损。与正常对照组比较,PD组新纹状体11C-CFT摄取值减低,且差异有统计学意义(12.29±2.75 对 7.69±2.42,t=4.818,P<0.01);PD组不对称指数增高,且在壳核中表现最显著,差异有统计学意义(0.06±0.08 对 0.14±0.09,t=2.184,P<0.05);PD组壳核与尾状核摄取值的比值降低,且差异有统计学意义(1.13±0.13 对 0.74±0.21,t=4.929,P<0.01)。与早期PD组比较,晚期PD组在新纹状体的摄取值降低最明显,且差异有统计学意义(8.50±1.77 对 6.99±2.71,t=2.070,P<0.05),晚期PD组在尾状核、壳核不对称指数之间的差异均有统计学意义(0.06±0.06 对 0.11±0.08、0.18±0.10 对 0.11±0.07,t=2.251、2.858,均P<0.05)。PD患者新纹状体11C-CFT摄取值与年龄、起病年龄、H-Y分级均呈负相关(r=−0.444、−0.514、−0.426,均P<0.01),与壳核11C-CFT摄取不对称指数呈正相关(r=0.331,P<0.05)。PD患者尾状核11C-CFT摄取值与年龄、起病年龄、H-Y分级均呈负相关(r=−0.537、−0.581、−0.380,均P<0.05),与壳核不对称指数呈正相关(r=0.410,P<0.01);PD患者壳核11C-CFT摄取值与起病年龄、H-Y分级均呈负相关(r=−0.353、−0.453,均P<0.05),与病程、壳核与尾状核摄取值的比值均呈正相关(r=0.322、0.396,均P<0.05)。 结论 PD患者DAT在11C-CFT PET/CT脑显像上主要表现为双侧尾状核及壳核的放射性分布降低,11C-CFT PET/CT脑DAT显像有助于PD的诊断及其严重程度的评估。 -
关键词:
- 托烷类 /
- 帕金森病 /
- 多巴胺质膜转运蛋白质类 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机
Abstract:Objective To investigate the characteristics of 11C-2-carbomethoxy-3-(4-fluorophenyl) tropane (11C-CFT) brain dopamine transporter (DAT) PET/CT imaging and analyze its clinical diagnostic value in patients with Parkinson's disease (PD). Methods A retrospective analysis was performed on the clinical and images data of 41 patients with primary PD who underwent 11C-CFT PET/CT brain imaging in the Affiliated Hospital of Guizhou Medical University from August 2018 to February 2021. The patients included 21 males and 20 females aged 34–81(57.6±12.2) years. The patients were divided into early PD group (19 cases) and late PD group (22 cases) according to the Hoehn and Yahr (H-Y) grade. Moreover, eight healthy subjects matched with the PD group were included as the normal control group. The subjects including 4 males and 4 females aged 42–72 (61.0±9.8) years. The 11C-CFT uptake values of the bilateral caudate nucleus, putamen, and cerebellum were obtained by delineating the regions of interest. The 11C-CFT uptake values of the bilateral caudate nucleus, putamen, and new striatum; the asymmetry index and the ratio of the putamen to the caudate nucleus were calculated according to the corresponding formula. Two independent sample t-test was used to compare the measurement data. Chi square test was used to compare counting data, and Pearson correlation analysis was used to evaluate the correlation between DAT distribution in the new striatum and subareas of PD patients and clinical indicators. Results In 11C-CFT PET/CT brain imaging, the radioactivity distribution of the bilateral caudate nucleus in the PD group was slightly reduced but still uniform, and the radioactivity distribution of the bilateral putamen nucleus in the PD group was reduced or sparse. The radiation distribution of the bilateral putamen was asymmetrically reduced or defective in the early PD group and symmetrical and sparse in the late PD group. Compared with the normal control group, the 11C-CFT value of the new striatum in the PD group was significantly decreased, and the difference was statistically significant (12.29±2.75 vs.7.69±2.42, t=4.818, P<0.01). The asymmetry index increased in the PD group and was most obvious in the putamen, and the difference was statistically significant (0.06±0.08 vs. 0.14±0.09, t=2.184, P<0.05). The ratio of the 11C-CFT uptake value in the putamen to that in the caudate nucleus decreased in the PD group, and the difference was statistically significant (1.13±0.13 vs. 0.74±0.21, t=4.929, P<0.01). Compared with the early PD group, the late PD group had the most significant decrease in 11C-CFT uptake in the new striatum, and the difference was statistically significant(8.50±1.77 vs. 6.99±2.71, t=2.070, P<0.05). Significant differences were found in the asymmetry indexes between the caudate nucleus and putamen in the early PD group and the late PD group, and the differences were statistically significant (0.06±0.06 vs. 0.11±0.08, 0.18±0.10 vs. 0.11±0.07; t=2.251, 2.858; both P<0.05). In the PD patients, the 11C-CFT uptake index in the new striatum was negatively correlated with age, onset age, and H-Y grade (r=−0.444, −0.514, −0.426; all P<0.01), and positively correlated with the asymmetry index of 11C-CFT uptake in putamen (r=0.331, P<0.05). The 11C-CFT values of the caudate nucleus in the PD patients were negatively correlated with age, onset age, and H-Y grade (r=−0.537, −0.581, −0.380; all P<0.05) but positively correlated with the putamen asymmetry index (r=0.410, P<0.01). In the PD patients, the putamen 11C-CFT was negatively correlated with the onset age and H-Y grade (r=−0.353, −0.453; both P<0.05) and positively correlated with the course of disease and the ratio of the putamen to the caudate nucleus (r=0.322, 0.396; both P<0.05). Conclusions In 11C-CFT PET/CT brain DAT imaging, the patients with PD showed decreased radioactivity distribution in the bilateral caudate nucleus and putamen. 11C-CFT PET/CT brain DAT imaging is helpful for PD diagnosis and severity assessment. -
表 1 PD组和正常对照组新纹状体及各亚区11C-CFT分布的比较(
±s)$\bar x $ Table 1. Comparison of 11C-CFT distribution in new striatum and subareas of Parkinson's disease group and normal control group (
±s)$\bar x $ 组别 尾状核摄取值 壳核
摄取值新纹状体
摄取值尾状核不对称指数 壳核不对称指数 壳核与尾状核摄取值的比值 正常对照组(n=8) 5.82±1.38 6.47±1.47 12.29±2.75 0.07±0.11 0.06±0.08 1.13±0.13 PD组
(n=41)4.47±1.43a 3.21±1.16a 7.69±2.42a 0.09±0.07 0.14±0.09a 0.74±0.21a 早期PD组
(n=19)5.03±1.10 3.47±0.76 8.50±1.77 0.06±0.06 0.18±0.10 0.69±0.09 晚期PD组
(n=22)3.99±1.53b 3.00±1.41 6.99±2.71b 0.11±0.08b 0.11±0.07b 0.77±0.28 注:a表示与正常对照组相比,差异均有统计学意义(t=2.439、6.944、4.818、2.184、4.929,P=0.019、0.001、0.001、0.030、<0.001);b表示与早期PD组相比,差异均有统计学意义(t=2.454、2.070、2.251、2.858,P=0.019、0.045、0.029、0.007)。PD为帕金森病;CFT为2β-甲氧甲酰-3β-(4-氟苯基)托烷 表 2 PD患者新纹状体及各亚区11C-CFT摄取值与临床指标的相关性
Table 2. Correlation between 11C-CFT uptake values and clinical indicators in new striatum and subareas of Parkinson's disease patients
指标 尾状核 壳核 新纹状体 r值 P值 r值 P值 r值 P值 年龄 −0.537 <0.001 −0.262 0.098 −0.444 0.004 起病年龄 −0.581 <0.001 −0.353 0.024 −0.514 0.001 病程 0.195 0.222 0.322 0.040 0.271 0.087 H-Y分级 −0.380 0.014 −0.453 0.003 −0.426 0.006 尾状核不对称指数 −0.133 0.407 0.134 0.402 −0.014 0.930 壳核不对称指数 0.410 0.008 0.183 0.253 0.331 0.034 壳核与尾状核摄取值的比值 −0.279 0.078 0.396 0.010 0.026 0.874 注:PD为帕金森病;CFT为2β-甲氧甲酰-3β-(4-氟苯基)托烷;H-Y分级为Hoehn-Yahr分级 -
[1] McGregor MM, Nelson AB. Circuit mechanisms of Parkinson's disease[J]. Neuron, 2019, 101(6): 1042−1056. DOI: 10.1016/j.neuron.2019.03.004. [2] 李玲, 吴平, 邬剑军, 等. 多巴胺转运体PET显像对帕金森病和进行性核上性麻痹的鉴别诊断价值研究[J]. 中国临床神经科学, 2018, 26(3): 262−268. DOI: 10.3969/j.issn.1008-0678.2018.03.004.
Li L, Wu P, Wu JJ, et al. Dopamine transporter PET imaging in patients with progressive supranuclear palsy and Parkinson's disease[J]. Chin J Clin Neurosci, 2018, 26(3): 262−268. DOI: 10.3969/j.issn.1008-0678.2018.03.004.[3] 辛玫, 张晨鹏, 王成, 等. 震颤与非震颤帕金森病患者11C-CFT和18F-FDG PET/CT显像的代谢特点[J]. 中华核医学与分子影像杂志, 2019, 38(6): 344−348. DOI: 10.3760/cma.j.issn.2095-2848.2019.06.005.
Xin M, Zhang CP, Wang C, et al. Metabolic patterns of 11C-CFT and 18F-FDG PET/CT imaging in tremor and non-tremor Parkinson's[J]. Chin J Nucl Med Mol Imaging, 2019, 38(6): 344−348. DOI: 10.3760/cma.j.issn.2095-2848.2019.06.005.[4] Calne DB, Snow BJ, Lee C. Criteria for diagnosing Parkinson's disease[J]. Ann Neurol, 1992, 32(S1): S125−127. DOI: 10.1002/ana.410320721. [5] 冼文彪, 史新冲, 张祥松, 等. [11C]CFT脑多巴胺转运体PET显像对帕金森病诊断和严重程度评估的应用[J]. 中国神经精神疾病杂志, 2014, 40(8): 474−478. DOI: 10.3936/j.issn.1002-0152.2014.08.006.
Xian WB, Shi XC, Zhang XS, et al. Applicationof [11C]CFT dopamine transporter PET imaging in the diagnosis and severity assessment of Parkinson disease[J]. Chin J Nerv Ment Dis, 2014, 40(8): 474−478. DOI: 10.3936/j.issn.1002-0152.2014.08.006.[6] Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality[J]. Neurology, 1967, 17(5): 427−442. DOI: 10.1212/wnl.17.5.427. [7] 宁静, 杨晖, 李灿, 等. 11C-CFT PET/CT显像与帕金森病综合评定量表评分相关性分析[J]. 中华保健医学杂志, 2020, 22(1): 49−52. DOI: 10.3969/j.issn.1674-3245.2020.01.014.
Ning J, Yang H, Li C, et al. Correlation analysis between PET/CT imaging of 11C-CFT and UPDRS in Parkinson's disease[J]. Chin J Health Care Med, 2020, 22(1): 49−52. DOI: 10.3969/j.issn.1674-3245.2020.01.014.[8] 左传涛, 王坚, 黄喆慜, 等. 统计参数图和ROI联合应用在多巴胺转运蛋白PET显像分析中的价值[J]. 中华核医学杂志, 2008, 28(1): 7−10. DOI: 10.3760/cma.j.issn.2095-2848.2008.01.003.
Zuo CT, Wang J, Huang ZM, et al. The value of combining statistical parametric mapping and ROI methods in DAT imaging analysis[J]. Chin J Nucl Med Mol Imaging, 2008, 28(1): 7−10. DOI: 10.3760/cma.j.issn.2095-2848.2008.01.003.[9] 王营飞, 贺娟, 张学敏. 帕金森病的早期症状与诊断方法研究进展[J]. 医学综述, 2018, 24(12): 2441−2445. DOI: 10.3969/j.issn.1006-2084.2018.12.028.
Wang YF, He J, Zhang XM. Research advances in early symptoms and diagnostic methods of Parkinson's disease[J]. Med Recapitul, 2018, 24(12): 2441−2445. DOI: 10.3969/j.issn.1006-2084.2018.12.028.[10] Ishibashi K, Oda K, Ishiwata K, et al. Comparison of dopamine transporter decline in a patient with Parkinson's disease and normal aging effect[J]. J Neurol Sci, 2014, 339(1/2): 207−209. DOI: 10.1016/j.jns.2014.01.015. [11] Odekerken VJJ, van Laar T, Staal MJ, et al. Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial[J]. Lancet Neurol, 2013, 12(1): 37−44. DOI: 10.1016/S1474-4422(12)70264-8. [12] 杨晖, 李灿, 杜磊, 等. 对比年轻型与老年型帕金森病的多巴胺转运蛋白及D2受体PET显像[J]. 中国医学影像技术, 2018, 34(11): 1610−1614. DOI: 10.13929/j.1003-3289.201805160.
Yang H, Li C, Du L, et al. Comparison of dopamine transporter and D2 receptor imaging in young and late onset Parkinson disease[J]. Chin J Med Imaging Technol, 2018, 34(11): 1610−1614. DOI: 10.13929/j.1003-3289.201805160.[13] 沈杨, 张琦, 赵佳奇, 等. 阿尔兹海默病与帕金森病共性病理机制研究进展[J]. 中华中医药学刊, 2018, 36(2): 319−322. DOI: 10.13193/j.issn.1673-7717.2018.02.015.
Shen Y, Zhang Q, Zhao JQ, et al. Common pathological mechanism of Alzheimer's disease and Parkinson's disease[J]. Chin Arch Tradit Chin Med, 2018, 36(2): 319−322. DOI: 10.13193/j.issn.1673-7717.2018.02.015.[14] 袁晶, 王含, 万新华. 帕金森病相关认知功能障碍[J]. 中国现代神经疾病杂志, 2017, 17(6): 409−414. DOI: 10.3969/j.issn.1672-6731.2017.06.004.
Yuan J, Wang H, Wan XH. Cognitive impairment in Parkinson's disease[J]. Chin J Contemp Neurol Neurosurg, 2017, 17(6): 409−414. DOI: 10.3969/j.issn.1672-6731.2017.06.004.[15] Li XH, Zhang QZ, Qin YD, et al. Positron emission tomography/computed tomography dual imaging using 18-fluorine flurodeoxyglucose and 11C-labeled 2-β-carbomethoxy-3-β-(4-fluorophenyl) tropane for the severity assessment of Parkinson disease[J]. Medicine, 2020, 99(14): e19662. DOI: 10.1097/MD.0000000000019662. [16] 王坚, 蒋雨平, 项景德, 等. 18F-FP-β-CIT PET脑显像在早期诊断帕金森病中的意义[J]. 中华核医学杂志, 2003, 23(4): 216−218. DOI: 10.3760/cma.j.issn.2095-2848.2003.04.009.
Wang J, Jiang YP, Xiang JD, et al. The significance of 18F-FP-β-CIT dopamine transporter PET imaging in early diagnosis of Parkinson's disease[J]. Chin J Nucl Med Mol Imaging, 2003, 23(4): 216−218. DOI: 10.3760/cma.j.issn.2095-2848.2003.04.009.[17] McNeill A, Wu RM, Tzen KY, et al. Dopaminergic neuronal imaging in genetic Parkinson's disease: insights into pathogenesis[J/OL]. PLoS One, 2013, 8(7): e69190[2022-02-06]. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0069190. DOI: 10.1371/journal.pone.0069190. [18] Lin W, Zuo CT, Wu JJ, et al. Striatal asymmetry index and its correlation with the Hoehn & Yahr stage in Parkinson's disease[J]. Int J Neurosci, 2022, 132(2): 165−170. DOI: 10.1080/00207454.2020.1806265. [19] Nurmi E, Bergman J, Eskola O, et al. Progression of dopaminergic hypofunction in striatal subregions in Parkinson's disease using [18F]CFT PET[J]. Synapse, 2003, 48(3): 109−115. DOI: 10.1002/syn.10192. [20] El Fakhri G, Habert MO, Maksud P, et al. Quantitative simultaneous 99mTc-ECD/123I-FP-CIT SPECT in Parkinson's disease and multiple system atrophy[J]. Eur J Nucl Med Mol Imaging, 2006, 33(1): 87−92. DOI: 10.1007/s00259-005-1920-y. [21] Scherfler C, Seppi K, Donnemiller E, et al. Voxel-wise analysis of [123I]β-CIT SPECT differentiates the Parkinson variant of multiple system atrophy from idiopathic Parkinson's disease[J]. Brain, 2005, 128(7): 1605−1612. DOI: 10.1093/brain/awh485. [22] Rosano C, Metti AL, Rosso AL, et al. Influence of striatal dopamine, cerebral small vessel disease, and other risk factors on age-related parkinsonian motor signs[J]. J Gerontol A Biol Sci Med Sci, 2020, 75(4): 696−701. DOI: 10.1093/gerona/glz161. [23] Liu SY, Wu JJ, Zhao J, et al. Onset-related subtypes of Parkinson's disease differ in the patterns of striatal dopaminergic dysfunction: a positron emission tomography study[J]. Parkinsonism Relat Disord, 2015, 21(12): 1448−1453. DOI: 10.1016/j.parkreldis.2015.10.017. [24] 赵振凡, 陶俊, 许志强, 等. 11C-CFT脑多巴胺转运体PET显像对帕金森病进展及严重程度的评价[J]. 西部医学, 2017, 29(6): 782−785, 790. DOI: 10.3969/j.issn.1672-3511.2017.06.009.
Zhao ZF, Tao J, Xu ZQ, et al. Application of 11C-CFT dopamine transporter PET imaging in the assessment of progression and severity of Parkinson's disease[J]. Med J West China, 2017, 29(6): 782−785, 790. DOI: 10.3969/j.issn.1672-3511.2017.06.009.