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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

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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

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