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18F－FDG PET在记忆障碍患者中诊断阿尔茨海默病的效能
张焱
张晨鹏
黄干
王成
辛玫
邵泓达
王悦
万良荣
邱菊
徐群
李霞
刘建军
作者及单位信息
·
DOI： 10.3760/cma.j.cn321828-20240201-00051
Diagnostic efficiency of 18F-FDG PET for Alzheimer′s disease in patients with memory impairment
Zhang Yan
Zhang Chenpeng
Huang Gan
Wang Cheng
Xin Mei
Shao Hongda
Wang Yue
Wan Liangrong
Qiu Ju
Xu Qun
Li Xia
Liu Jianjun
Authors Info & Affiliations
Zhang Yan
Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Zhang Chenpeng
Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Huang Gan
Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Wang Cheng
Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Xin Mei
Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Shao Hongda
Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Wang Yue
Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Wan Liangrong
Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Qiu Ju
Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Xu Qun
Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Li Xia
Department of Geriatric Psychiatry, Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University; Alzheimer′s Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai 200030, China
Liu Jianjun
Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
·
DOI： 10.3760/cma.j.cn321828-20240201-00051
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摘要

目的研究 18F－FDG PET显像诊断记忆障碍患者中阿尔茨海默病(AD)的效能。

方法回顾性收集2019年8月至2023年9月上海交通大学医学院附属仁济医院96例初始诊断为记忆障碍的患者[男40例、女56例，年龄69.0(62.8，74.0)岁]。以 18F－AV45＋ 18F－PI－2620 PET/CT＋MRI显像结果为AD诊断的淀粉样蛋白、tau、神经变性(ATN)标准，应用视觉评估[颞、顶叶均代谢减低或后扣带回(PCC)代谢减低]和软件半定量分析[PET－SCORE和NeuroQ软件SUV比值(SUVR)]评价 18F－FDG PET显像在AD患者中的诊断效能。用 χ 2检验比较视觉评估和半定量参数的诊断效能，并对PET－SCORE与认知量表评分进行Pearson相关分析。

结果96例患者中，最终临床诊断为AD 61例，非AD 35例。 18F－FDG PET显像颞、顶叶视觉评估的诊断灵敏度最高[91.80%(56/61)]，与PET－SCORE[40.98%(25/61); χ 2＝29.03， P<0.001]、PCC视觉评估[77.05%(47/61); χ 2＝5.82， P＝0.016]差异有统计学意义；而PET－SCORE的诊断特异性最高[100%(35/35)]，与视觉评估的特异性[颞、顶叶均代谢减低：17.14%(6/35), χ 2＝27.03， P<0.001；PCC代谢减低：54.29%(19/35), χ 2＝14.06， P<0.001]差异有统计学意义。PET－SCORE与患者简易精神状态检查量表(MMSE)、蒙特利尔认知评价量表(MoCA)、日常生活活动能力量表(ADL)评分之间存在相关性( r值：－0.38、－0.36、0.31，均 P<0.01)。

结论在初始诊断为记忆障碍的患者中， 18F－FDG PET图像视觉评估具有较高的AD诊断灵敏度，半定量分析PET－SCORE具有较高的特异性。PET－SCORE与反映患者认知下降严重程度的量表评分相关。

记忆障碍;阿尔茨海默病;正电子发射断层显像术;体层摄影术，X线计算机;氟脱氧葡萄糖F18;乙二醇类;吡啶类;磁共振成像
ABSTRACT

ObjectiveTo assess the diagnostic efficiency of 18F-FDG PET for Alzheimer′s disease (AD) in patients with memory impairment.

MethodsA retrospective analysis was conducted on 96 patients (40 males, 56 females, age: 69.0(62.8, 74.0) years) initially diagnosed with memory impairment in Renji Hospital, School of Medicine, Shanghai Jiao Tong University between August 2019 and September 2023. The amyloid-tau-neurodegeneration (ATN) criteria, based on 18F-AV45+ 18F-PI-2620 PET/CT+ MRI imaging results, were used as the diagnostic standard for AD. Visual analysis (temporoparietal or posterior cingulate cortex (PCC) hypometabolism) and semi-quantitative analysis methods (PET-SCORE and NeuroQ software analysis (SUV ratio, SUVR)) were applied to evaluate the diagnostic efficiency of 18F-FDG PET imaging for AD. Diagnostic efficiencies of visual assessment and semi-quantitative parameters were compared by χ 2 test. Additionally, Pearson correlation analysis was performed to examine the relationship between results of PET-SCORE and cognitive scales.

ResultsOf the 96 patients initially diagnosed with memory impairment, 61 were clinically diagnosed with AD, while 35 were non-AD patients. Visual assessment of temporoparietal hypometabolism showed the highest sensitivity (91.80%, 56/61), which was significantly different from the sensitivities of PET-SCORE (40.98%(25/61); χ 2=29.03, P<0.001) and visual assessment of PCC hypometabolism (77.05%(47/61); χ 2=5.82, P=0.016). While semi-quantitative assessment using PET-SCORE demonstrated the highest specificity (100%, 35/35), which was significantly different from the specificities of visual assessment methods (temporoparietal hypometabolism: 17.14%(6/35), χ 2=27.03, P<0.001; PCC hypometabolism: 54.29%(19/35), χ 2=14.06, P<0.001). PET-SCORE exhibited statistically significant correlations with Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Activities of Daily Living (ADL) scores ( r values: -0.38, -0.36, 0.31, all P<0.01).

ConclusionsAmong patients initially diagnosed with memory impairment, visual assessment in 18F-FDG PET imaging analysis demonstrates higher sensitivity, while semi-quantitative analysis using PET-SCORE exhibits higher specificity. PET-SCORE shows statistically significant correlation with the severity of cognitive decline.

Memory disorders;Alzheimer disease;Positron-emission tomography;Tomography, X-ray computed;Fluorodeoxyglucose F18;Ethylene glycols;Pyridines;Magnetic resonance imaging
Liu Jianjun, Email: mocdef.3ab61jraelcun
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引用本文

张焱,张晨鹏,黄干,等. 18F－FDG PET在记忆障碍患者中诊断阿尔茨海默病的效能 [J]. 中华核医学与分子影像杂志,2024,44(12)：712-717.

DOI:10.3760/cma.j.cn321828-20240201-00051

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阿尔茨海默病(Alzheimer′s disease, AD)是引起老年人认知障碍的常见神经系统退行性疾病之一。在中国有1 507万年龄超过60岁者患有痴呆，其中AD占比最多(约983万)，其次是血管性痴呆(vascular dementia, VD)和额颞叶痴呆(frontotemporal dementia, FTD) [ 1 ]。在临床实践中，AD与其他疾病的准确鉴别至关重要。2018年美国国立老化研究所与阿尔茨海默协会(National Institute on Aging－Alzheimer′s Association, NIA－AA)提出淀粉样蛋白、tau、神经变性(amyloid－tau－neurodegeneration, ATN)诊断框架： 18F－AV45是被美国食品与药品监督管理局(Food and Drug Administration, FDA)批准的第1个β－淀粉样蛋白(β－amyloid, Aβ)PET显像剂，可用来表征"A"；"T"可用第2代tau PET显像剂 18F－PI－2620表征；MRI或CT显示大脑皮质萎缩、海马高度下降或颞角扩大可以表征"N" [ 1 , 2 , 3 , 4 ]。
然而，由于Aβ PET和tau PET目前在国内尚未进入商品化阶段，临床应用ATN框架对怀疑AD患者进行鉴别诊断受到限制。 18F－FDG PET显像是目前临床应用最广泛的分子影像技术，在FDG PET用于AD的相关研究中，多以主观量表作为判断AD的标准 [ 5 , 6 ]。本研究以分子影像ATN诊断框架作为判断AD的标准，在初始诊断为记忆障碍患者中评估 18F－FDG PET显像诊断AD的效能，探讨 18F－FDG PET显像在AD患者中应用价值。
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备注信息
A
刘建军，Email: mocdef.3ab61jraelcun
B

张焱：研究实施，数据采集与分析、论文撰写；张晨鹏、黄干、王成：研究实施，数据采集；辛枚、邵泓达、王悦、万良荣、邱菊、徐群、李霞：数据分析、技术支持；刘建军：研究设计与指导、论文修改、经费支持

C
所有作者声明无利益冲突
D
国家重点研发计划 (2023YFC3603200)
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