Kemp Paul M, Hoffmann Sandra A, Holmes Clive, Bolt Livia, Ward Tony, Holmes Robin B, Fleming John S
Department of Nuclear Medicine, Southampton University Hospitals Trust, Southampton, UK.
Nucl Med Commun. 2005 Dec;26(12):1099-106. doi: 10.1097/00006231-200512000-00009.
To assess the role of 99mTc-hexamethylpropyleneamine oxime single-photon emission computed tomography (99mTc-HMPAO SPECT) imaging of the precuneus and medial temporal lobe in the individual patient with mild Alzheimer's disease and dementia with Lewy bodies (DLB) using statistical parametric mapping and visual image interpretation.
Thirty-four patients with mild late-onset Alzheimer's disease, 20 patients with early-onset Alzheimer's disease, 15 patients with DLB and 31 healthy controls were studied. All patients fulfilled appropriate clinical criteria; the DLB patients also had evidence of dopaminergic presynaptic terminal loss on 123I-N-omega-fluoropropyl-2beta-carbomethoxy-3beta-(4-iodophenyl)-tropane imaging. 99mTc-HMPAO SPECT brain scans were acquired on a multidetector gamma camera and images were assessed separately by visual interpretation and with SPM99.
Statistical parametric maps were significantly more accurate than visual image interpretation in all disease categories. In patients with mild late-onset Alzheimer's disease, statistical parametric mapping demonstrated significant hypoperfusion to the precuneus in 59% and to the medial temporal lobe in 53%. Seventy-six per cent of these patients had a defect in either location. No controls had precuneal or medial temporal lobe hypoperfusion (specificity, 100%). Statistical parametric mapping also demonstrated 73% of patients with DLB to have precuneal abnormalities, but only 6% had medial temporal lobe involvement.
These findings illustrate the capability of statistical parametric mapping to demonstrate reliable abnormalities in the majority, but not all, patients with either mild Alzheimer's disease or DLB. Precuneal hypoperfusion is not specific to Alzheimer's disease and is equally likely to be found in DLB. In this study, medial temporal hypoperfusion was significantly more common in Alzheimer's disease than in DLB. Statistical parametric maps appear to be considerably more reliable than simple visual interpretation of 99mTc-HMPAO images for these regions.
采用统计参数映射和视觉图像解读方法，评估99m锝-六甲基丙烯胺肟单光子发射计算机断层扫描（99mTc-HMPAO SPECT）对轻度阿尔茨海默病和路易体痴呆（DLB）患者楔前叶和内侧颞叶的成像作用。
对34例轻度晚发型阿尔茨海默病患者、20例早发型阿尔茨海默病患者、15例DLB患者和31名健康对照者进行研究。所有患者均符合相应的临床标准；DLB患者在123I-N-ω-氟丙基-2β-甲氧基羰基-3β-（4-碘苯基）-托烷成像上也有多巴胺能突触前终末丢失的证据。使用多探测器伽马相机进行99mTc-HMPAO SPECT脑扫描，并分别通过视觉解读和SPM99对图像进行评估。
在所有疾病类别中，统计参数映射比视觉图像解读显著更准确。在轻度晚发型阿尔茨海默病患者中，统计参数映射显示59%的患者楔前叶有显著灌注不足，53%的患者内侧颞叶有显著灌注不足。这些患者中有76%在上述任一部位存在缺损。无对照者有楔前叶或内侧颞叶灌注不足（特异性为100%）。统计参数映射还显示73%的DLB患者有楔前叶异常，但只有6%的患者内侧颞叶受累。
这些发现表明，统计参数映射能够在大多数（但并非全部）轻度阿尔茨海默病或DLB患者中显示出可靠的异常。楔前叶灌注不足并非阿尔茨海默病所特有，在DLB中同样可能出现。在本研究中，内侧颞叶灌注不足在阿尔茨海默病中比在DLB中更为常见。对于这些区域，统计参数映射似乎比99mTc-HMPAO图像的简单视觉解读可靠得多。
