留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

脑淀粉样血管病与阿尔茨海默病18F-FDG PET/CT代谢改变图型对比研究

贾琛皓 吴美其 郭瑞杰 倪俊 崔瑞雪

贾琛皓, 吴美其, 郭瑞杰, 倪俊, 崔瑞雪. 脑淀粉样血管病与阿尔茨海默病18F-FDG PET/CT代谢改变图型对比研究[J]. 协和医学杂志, 2022, 13(2): 263-269. doi: 10.12290/xhyxzz.2021-0693
引用本文: 贾琛皓, 吴美其, 郭瑞杰, 倪俊, 崔瑞雪. 脑淀粉样血管病与阿尔茨海默病18F-FDG PET/CT代谢改变图型对比研究[J]. 协和医学杂志, 2022, 13(2): 263-269. doi: 10.12290/xhyxzz.2021-0693
JIA Chenhao, WU Meiqi, GUO Ruijie, NI Jun, CUI Ruixue. Comparative Study of 18F-FDG PET/CT Metabolic Alteration Patterns in Cerebral Amyloid Angiopathy and Alzheimer's Disease[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(2): 263-269. doi: 10.12290/xhyxzz.2021-0693
Citation: JIA Chenhao, WU Meiqi, GUO Ruijie, NI Jun, CUI Ruixue. Comparative Study of 18F-FDG PET/CT Metabolic Alteration Patterns in Cerebral Amyloid Angiopathy and Alzheimer's Disease[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(2): 263-269. doi: 10.12290/xhyxzz.2021-0693

脑淀粉样血管病与阿尔茨海默病18F-FDG PET/CT代谢改变图型对比研究

doi: 10.12290/xhyxzz.2021-0693
基金项目: 

国家重点研发计划 2018YFC1315200

中国医学科学院医学与健康科技创新工程 2018-I2M-3-001

详细信息
    通讯作者:

    崔瑞雪,E-mail:mmdhmm@126.com

    贾琛皓、吴美其对本文同等贡献

    贾琛皓、吴美其对本文同等贡献

  • 中图分类号: R741;R817.4

Comparative Study of 18F-FDG PET/CT Metabolic Alteration Patterns in Cerebral Amyloid Angiopathy and Alzheimer's Disease

Funds: 

National Key Research and Development Project of China 2018YFC1315200

CAMS Innovation Fund for Medical Sciences 2018-I2M-3-001

More Information
  • 摘要:   目的  比较脑淀粉样血管病(cerebral amyloid angiopathy,CAA)与阿尔茨海默病(Alzheimer's disease,AD)患者的脑代谢差异,评价18F-脱氧葡萄糖(fluorodeoxy glucose,FDG)正电子发射断层显像/计算机体层成像(positron emission tomography/computed tomography, PET/CT)脑显像对CAA和AD的鉴别价值。  方法  回顾性纳入2020年12月至2021年6月北京协和医院符合修订Boston标准的很可能CAA患者以及年龄与其相近的AD患者。随机纳入同期行18F-FDG PET/CT检查且认知功能正常的人群为对照。对3组18F-FDG PET/CT图像进行视觉分析和定量分析。  结果  共入选符合纳入和排除标准的10例很可能CAA患者(CAA组)、10例AD患者(AD组)以及11例认知功能正常的对照人群(对照组)。视觉分析结果显示,相较对照组,AD组典型表现为双侧基本对称的颞顶叶代谢减低,以颞叶内侧、后扣带回代谢减低最为显著;CAA组皮层代谢减低区呈无特定规律分布,代谢减低或缺损区与出血区域相关。基于体素的脑代谢图像定量分析结果显示,相较对照组,AD组后扣带回、海马旁回、顶叶、颞叶内侧的代谢显著减低(P < 0.01);CAA组广泛白质区以及尾状核头、胼胝体、前扣带回、颞叶外侧皮层等处代谢显著减低(P < 0.01)。基于脑区的定量分析显示,CAA组枕叶/后扣带回(occipital/posterior cingulate, O/PC)相对脑桥的18F-FDG标准摄取值比值(standardized uptake value ratio,SUVr)明显低于AD组(0.91±0.05比1.07±0.08,P < 0.001);O/PC SUVr鉴别很可能CAA、AD的曲线下面积为0.98(95%CI:0.93~1.00),最佳临界值为0.96,灵敏度为100%,特异度为90%。  结论  CAA与AD患者的18F-FDG PET/CT显像呈明显不同的代谢降低图型;O/PC SUVr或可作为二者鉴别诊断的敏感指标。
    作者贡献:贾琛皓、吴美其负责研究设计、数据分析、论文撰写与修订;郭瑞杰负责影像资料收集;倪俊负责临床资料收集、数据分析;崔瑞雪负责指导研究设计、数据审核及论文审校。
    利益冲突:所有作者均声明不存在利益冲突
  • 图  1  75岁女性AD患者,进行性记忆力下降4年余,伴精神、行为异常,MMSE评分19分,18F-FDG PET/CT示后扣带回、双侧颞叶内侧代谢对称性减低(A、B,箭头),18F-AV45 PET/CT示大脑皮质Aβ弥漫沉积(C),头颅SWI未发现皮层或皮层下明确微出血灶(D);58岁男性很可能CAA患者,进行性反应力、记忆力下降5年余,双下肢乏力、行走变慢3年余,MMSE评分29分,18F-FDG PET/CT示后扣带回代谢保留、双侧颞叶内侧代谢略低(E、F,箭头),余皮层呈无规律、不均匀、不对称多处代谢减低,18F-AV45 PET/CT示大脑皮质Aβ弥漫沉积(G),头颅SWI示双侧大脑半球皮层及皮层下多发微出血灶(H)

    AD:阿尔茨海默病;CAA:脑淀粉样血管病;18F-FDG:18F-脱氧葡萄糖;PET/CT:正电子发射断层显像/计算机体层成像;MMSE:简易精神状态检查量表;SWI:磁敏感加权成像

    图  2  AD和很可能CAA患者基于体素的脑代谢改变图像

    A. AD患者颞叶内侧(红箭头)、后扣带回(蓝箭头)和顶叶背外侧皮层(白箭头)代谢减低;B.很可能CAA患者广泛白质区、尾状核头(红箭头)、胼胝体(蓝箭头)、前扣带回(蓝箭头)、颞叶外侧皮层(白箭头)代谢减低
    AD、CAA:同图 1

    图  3  O/PC SUVr鉴别AD与很可能CAA的ROC曲线图

    AD、CAA: 同图 1;O/PC: 枕叶/后扣带回;SUVr: 标准摄取值比值;ROC: 操作者工作特征

  • [1] Boulouis G, Charidimou A, Greenberg SM. Sporadic Cerebral Amyloid Angiopathy: Pathophysiology, Neuroimag-ing Features, and Clinical Implications[J]. Semin Neurol, 2016, 36: 233-243. doi:  10.1055/s-0036-1581993
    [2] Charidimou A, Boulouis G, Gurol ME, et al. Emerging concepts in sporadic cerebral amyloid angiopathy[J]. Brain, 2017, 140: 1829-1850. doi:  10.1093/brain/awx047
    [3] Akers C, Acosta LMY, Considine C, et al. Atypical Clinical Manifestations of Cerebral Amyloid Angiopathy[J]. Curr Neurol Neurosci Rep, 2019, 19: 64. doi:  10.1007/s11910-019-0981-4
    [4] Linn J, Halpin A, Demaerel P, et al. Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy[J]. Neurology, 2010, 74: 1346-1350. doi:  10.1212/WNL.0b013e3181dad605
    [5] Greenberg SM, Charidimou A. Diagnosis of Cerebral Amy-loid Angiopathy: Evolution of the Boston Criteria[J]. Stroke, 2018, 49: 491-497. doi:  10.1161/STROKEAHA.117.016990
    [6] Charidimou A, Farid K, Baron JC. Amyloid-PET in sporadic cerebral amyloid angiopathy: A diagnostic accuracy meta-analysis[J]. Neurology, 2017, 89: 1490-1498. doi:  10.1212/WNL.0000000000004539
    [7] Charidimou A, Farid K, Tsai HH, et al. Amyloid-PET burden and regional distribution in cerebral amyloid angiopathy: a systematic review and meta-analysis of biomarker performance[J]. J Neurol Neurosurg Psychiatry, 2018, 89: 410-417. doi:  10.1136/jnnp-2017-316851
    [8] Farid K, Charidimou A, Baron JC. Amyloid positron emis-sion tomography in sporadic cerebral amyloid angiopathy: A systematic critical update[J]. Neuroimage Clin, 2017, 15: 247-263. doi:  10.1016/j.nicl.2017.05.002
    [9] Planton M, Saint-Aubert L, Raposo N, et al. Florbetapir Regional Distribution in Cerebral Amyloid Angiopathy and Alzheimer's Disease: A PET Study[J]. J Alzheimers Dis, 2020, 73: 1607-1614. doi:  10.3233/JAD-190625
    [10] Mosconi L, Tsui WH, Herholz K, et al. Multicenter standardized 18F-FDG PET diagnosis of mild cognitive impair-ment, Alzheimer's disease, and other dementias[J]. J Nucl Med, 2008, 49: 390-398. doi:  10.2967/jnumed.107.045385
    [11] Smailagic N, Vacante M, Hyde C, et al. 18F-FDG PET for the early diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI)[J]. Cochrane Database Syst Rev, 2015, 1: Cd010632.
    [12] Kantarci K, Boeve BF, Przybelski SA, et al. FDG PET metabolic signatures distinguishing prodromal DLB and prod-romal AD[J]. Neuroimage Clin, 2021, 31: 102754. doi:  10.1016/j.nicl.2021.102754
    [13] Arbizu J, Festari C, Altomare D, et al. Clinical utility of FDG-PET for the clinical diagnosis in MCI[J]. Eur J Nucl Med Mol Imaging, 2018, 45: 1497-1508. doi:  10.1007/s00259-018-4039-7
    [14] Bergeret S, Queneau M, Rodallec M, et al. Brain Glucose Metabolism in Cerebral Amyloid Angiopathy: An FDG-PET Study[J]. Stroke, 2021, 52: 1478-1482. doi:  10.1161/STROKEAHA.120.032905
    [15] Dubois B, Feldman HH, Jacova C, et al. Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria[J]. Lancet Neurol, 2014, 13: 614-629. doi:  10.1016/S1474-4422(14)70090-0
    [16] Bergeret S, Queneau M, Rodallec M, et al. [(18) F]FDG PET may differentiate cerebral amyloid angiopathy from Alzheimer's disease[J]. Eur J Neurol, 2021, 28: 1511-1519. doi:  10.1111/ene.14743
    [17] Scheltens P, De Strooper B, Kivipelto M, et al. Alzheimer's disease[J]. Lancet, 2021, 397: 1577-1590. doi:  10.1016/S0140-6736(20)32205-4
    [18] Gatti L, Tinelli F, Scelzo E, et al. Understanding the Pathophysiology of Cerebral Amyloid Angiopathy[J]. Int J Mol Sci, 2020, 21: 3435. doi:  10.3390/ijms21103435
    [19] Viswanathan A, Greenberg SM. Cerebral amyloid angiopathy in the elderly[J]. Ann Neurol, 2011, 70: 871-880. doi:  10.1002/ana.22516
    [20] Vinters HV, Gilbert JJ. Cerebral amyloid angiopathy: incidence and complications in the aging brain. Ⅱ. The distribution of amyloid vascular changes[J]. Stroke, 1983, 14: 924-928. doi:  10.1161/01.STR.14.6.924
    [21] Keage HA, Carare RO, Friedland RP, et al. Population studies of sporadic cerebral amyloid angiopathy and dementia: a systematic review[J]. BMC Neurol, 2009, 9: 3. doi:  10.1186/1471-2377-9-3
    [22] Samuraki M, Matsunari I, Yoshita M, et al. Cerebral Amyloid Angiopathy-Related Microbleeds Correlate with Glucose Metabolism and Brain Volume in Alzheimer's Disease[J]. J Alzheimers Dis, 2015, 48: 517-528. doi:  10.3233/JAD-150274
    [23] Farid K, Hong YT, Aigbirhio FI, et al. Early-Phase 11C-PiB PET in Amyloid Angiopathy-Related Symptomatic Cerebral Hemorrhage: Potential Diagnostic Value?[J]. PLoS One, 2015, 10: e0139926. doi:  10.1371/journal.pone.0139926
    [24] Frisoni GB, Boccardi M, Barkhof F, et al. Strategic roadmap for an early diagnosis of Alzheimer's disease based on biomarkers[J]. Lancet Neurol, 2017, 16: 661-676. doi:  10.1016/S1474-4422(17)30159-X
    [25] Tomonaga M. Cerebral amyloid angiopathy in the elderly[J]. J Am Geriatr Soc, 1981, 29: 151-157. doi:  10.1111/j.1532-5415.1981.tb01757.x
  • 加载中
图(3)
计量
  • 文章访问数:  954
  • HTML全文浏览量:  178
  • PDF下载量:  133
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-10-16
  • 录用日期:  2021-11-19
  • 刊出日期:  2022-03-30

目录

    /

    返回文章
    返回

    【温馨提醒】近日,《协和医学杂志》编辑部接到作者反映,有多名不法人员冒充期刊编辑发送见刊通知,鼓动作者添加微信,从而骗取版面费的行为。特提醒您,本刊与作者联系的方式均为邮件通知或电话,稿件进度通知邮箱为:mjpumch@126.com,编辑部电话为:010-69154261,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!