Patwardhan Meenal B, McCrory Douglas C, Matchar David B, Samsa Gregory P, Rutschmann Olivier T
Duke Center for Clinical Health Policy Research, 2200 W Main St, Suite 220, Durham, NC 27705, USA.
Radiology. 2004 Apr;231(1):73-80. doi: 10.1148/radiol.2311021620. Epub 2004 Feb 27.
To assess the operating characteristics of positron emission tomography (PET) by using fluorine 18 fluorodeoxyglucose (FDG) in the diagnosis of Alzheimer disease.
Articles published between 1989 and 2003 were identified in the MEDLINE, CINAHL, and HealthSTAR databases. Articles were selected if FDG PET was performed with a dedicated scanner and the resolution was specified, if standard criteria were used for the diagnosis of Alzheimer disease, if at least 12 human subjects with Alzheimer disease were enrolled in the study, if clinical diagnosis or histopathologic findings were used as the reference standard, and if sufficient data were provided to construct a 2 x 2 table. Two reviewers independently abstracted data regarding the operating characteristics (sensitivity and specificity) of PET and evaluated the study quality. A meta-analysis was performed by constructing a summary receiver operating characteristic curve and by combining the sensitivity and specificity values by using a random-effects model.
Fifteen articles that met the inclusion criteria showed heterogeneity in sensitivity and specificity estimates that were not related to quality features with no plausible explanations. The summary sensitivity of PET was 86% (95% CI: 76%, 93%), and the summary specificity was 86% (95% CI: 72%, 93%).
The specificity and sensitivity of FDG PET are limited by both study design and patient characteristics. Therefore, the clinical value of these parameters is uncertain; future research on the use of PET in the diagnosis of Alzheimer disease needs to focus on current limitations to be of practical relevance in clinical settings.
通过使用氟-18氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）评估其在阿尔茨海默病诊断中的操作特性。
在MEDLINE、CINAHL和HealthSTAR数据库中检索1989年至2003年发表的文章。入选标准为：使用专用扫描仪进行FDG PET检查且明确分辨率；采用标准标准诊断阿尔茨海默病；研究纳入至少12名阿尔茨海默病患者；以临床诊断或组织病理学结果作为参考标准；提供足够数据以构建2×2列联表。两名审阅者独立提取关于PET操作特性（敏感性和特异性）的数据并评估研究质量。通过构建汇总接受者操作特征曲线并使用随机效应模型合并敏感性和特异性值进行荟萃分析。
15篇符合纳入标准的文章在敏感性和特异性估计方面存在异质性，与质量特征无关且无合理的解释。PET的汇总敏感性为86%（95%CI：76%，93%），汇总特异性为86%（95%CI：72%，93%）。
FDG PET的特异性和敏感性受到研究设计和患者特征的限制。因此，这些参数的临床价值尚不确定；未来关于PET在阿尔茨海默病诊断中应用的研究需要关注当前的局限性，以便在临床环境中具有实际相关性。
