Hanada Kazushi, Hosono Makoto, Kudo Takashi, Hitomi Yoshie, Yagyu Yukinobu, Kirime Eiji, Komeya Yoshihiro, Tsujii Noa, Hitomi Kazuhiko, Nishimura Yasumasa
Department of Neuropsychiatry, Kinki University School of Medicine, Osaka, Japan.
Nucl Med Commun. 2006 Jun;27(6):535-41. doi: 10.1097/00006231-200606000-00010.
Alzheimer's disease and major depression are representative diseases that present forgetfulness and a depressive mood. It is often difficult to make a differential diagnosis between the two in the initial phase.
To evaluate the differential diagnosis method using regional cerebral blood flow patterns with a three-dimensional stereotactic surface projection technique.
Twenty early-elderly patients with mild and moderate forgetfulness were studied. Among them, 10 were diagnosed as having major depression (the MD group) and the other 10 as having Alzheimer's disease (the AD group). All patients underwent cerebral perfusion single photon emission computed tomography (SPECT) with [(123)I]iodoamphetamine. A z-score was calculated for each pixel of the cerebral surface. Twenty-one circular regions of interest (ROIs) were placed on the z-score map. The significance of the statistical difference in ROI values between the two groups was determined by using the two-sided Mann-Whitney U-test.
The z-scores for the lateral parietal, lateral temporal, bilateral precuneus and bilateral posterior cingulate gyrus were significantly reduced in the AD group compared with those in the MD group. The z-scores for the lateral frontal, left thalamus and bilateral medial frontal regions were significantly lower in the MD group than in the AD group.
Our study demonstrated a difference in regional cerebral blood flow patterns between the early elderly with Alzheimer's disease and those with major depression. All patients were classified into the appropriate categories using discriminant analysis and z-scores of frontal and parietal regions. Brain perfusion SPECT was a useful tool for the differential diagnosis between Alzheimer's disease and major depression.
阿尔茨海默病和重度抑郁症是表现出健忘和抑郁情绪的代表性疾病。在疾病初期，通常很难对二者进行鉴别诊断。
采用三维立体定向表面投影技术，利用脑血流模式评估鉴别诊断方法。
对20例患有轻度和中度健忘的老年患者进行研究。其中，10例被诊断为重度抑郁症（MD组），另外10例被诊断为阿尔茨海默病（AD组）。所有患者均接受了用[（123）I]碘安非他明进行的脑灌注单光子发射计算机断层扫描（SPECT）。计算脑表面每个像素的z值。在z值图上放置21个感兴趣的圆形区域（ROI）。采用双侧曼-惠特尼U检验确定两组ROI值的统计学差异的显著性。
与MD组相比，AD组外侧顶叶、外侧颞叶、双侧楔前叶和双侧后扣带回的z值显著降低。MD组外侧额叶、左侧丘脑和双侧内侧额叶区域的z值显著低于AD组。
我们的研究表明，患有阿尔茨海默病的老年患者和患有重度抑郁症的老年患者在脑血流模式上存在差异。使用判别分析以及额叶和顶叶区域的z值，可将所有患者归入相应类别。脑灌注SPECT是阿尔茨海默病和重度抑郁症鉴别诊断的有用工具。
