Dougall Nadine J, Bruggink Sjoerd, Ebmeier Klaus P
Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Kennedy Tower, Edinburgh EH10 5HF, United Kingdom.
Am J Geriatr Psychiatry. 2004 Nov-Dec;12(6):554-70. doi: 10.1176/appi.ajgp.12.6.554.
The authors sought to determine the diagnostic accuracy of 99mTc-HMPAO-SPECT in discriminating between Alzheimer disease (AD) and other dementias.
Articles published between 1985 and 2002 were retrieved systematically from MEDLINE and EMBASE, cross-referencing with personal collections and 13 narrative reviews. Of 301 studies identified, 48 survived exclusion criteria and contained extractable data. Two authors independently assessed and graded the methodology of all included studies. Diagnostic comparison groups included vascular dementia (VD; 13 studies), fronto-temporal dementia (FTD; 7 studies), normal healthy volunteers (27 studies), and non-dementia patients (13 studies). Where statistically justified, groups were pooled in a metaanalysis; summary receiver operating curves were constructed; and heterogeneity across studies examined by regression of the diagnostic odds ratio.
The pooled weighted sensitivity of 99mTc-HMPAO-SPECT in discriminating clinically defined AD from VD was 71.3%; its specificity was 75.9%. The pooled weighted sensitivity and specificity for AD versus FTD were 71.5% and 78.2%, respectively. Variation in outcome across studies was not found to be attributable to any single factor.
Pathological verification studies suggest that clinical criteria may be more sensitive in detecting AD than brain SPECT (81% versus 74%). However, SPECT studies provide a higher specificity against other types of dementia than clinical criteria (91% versus 70%). SPECT may, therefore, be helpful in the differential diagnosis of AD. Clinical follow-up studies are urgently required to establish its predictive validity with regard to natural history and treatment response.
作者试图确定99mTc-HMPAO单光子发射计算机断层扫描（SPECT）在区分阿尔茨海默病（AD）和其他痴呆症方面的诊断准确性。
系统检索1985年至2002年间发表在医学文献数据库（MEDLINE）和荷兰医学文摘数据库（EMBASE）上的文章，并与个人收藏及13篇叙述性综述进行交叉引用。在检索到的301项研究中，48项符合排除标准并包含可提取的数据。两位作者独立评估并对所有纳入研究的方法进行分级。诊断比较组包括血管性痴呆（VD；13项研究）、额颞叶痴呆（FTD；7项研究）、正常健康志愿者（27项研究）和非痴呆患者（13项研究）。在统计学合理的情况下，将各研究组进行汇总荟萃分析；构建汇总的受试者工作特征曲线；并通过诊断比值比的回归分析研究间的异质性。
99mTc-HMPAO-SPECT鉴别临床诊断的AD与VD的汇总加权灵敏度为71.3%；特异性为75.9%。AD与FTD鉴别诊断的汇总加权灵敏度和特异性分别为71.5%和78.2%。未发现研究结果的差异可归因于任何单一因素。
病理验证研究表明，临床标准在检测AD方面可能比脑SPECT更敏感（81%对74%）。然而，SPECT研究针对其他类型痴呆症的特异性高于临床标准（91%对70%）。因此，SPECT可能有助于AD的鉴别诊断。迫切需要进行临床随访研究以确定其在自然病程和治疗反应方面的预测效度。
