Walker Zuzana, Jaros Evelyn, Walker Rodney W H, Lee Lean, Costa Durval C, Livingston Gill, Ince Paul G, Perry Robert, McKeith Ian, Katona Cornelius L E
University College London and Royal Free Hospitals, London, UK.
J Neurol Neurosurg Psychiatry. 2007 Nov;78(11):1176-81. doi: 10.1136/jnnp.2006.110122. Epub 2007 Mar 12.
Dementia with Lewy bodies (DLB) is a common form of dementia. The presence of Alzheimer's disease (AD) pathology modifies the clinical features of DLB, making it harder to distinguish DLB from AD clinically during life. Clinical diagnostic criteria for DLB applied at presentation can fail to identify up to 50% of cases. Our aim was to determine, in a series of patients with dementia in whom autopsy confirmation of diagnosis was available, whether functional imaging of the nigrostriatal pathway improves the accuracy of diagnosis compared with diagnosis by means of clinical criteria alone.
A single photon emission computed tomography (SPECT) scan was carried out with a dopaminergic presynaptic ligand [123I]-2beta-carbometoxy-3beta-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT; ioflupane) on a group of patients with a clinical diagnosis of DLB or other dementia. An abnormal scan was defined as one in which right and left posterior putamen binding, measured semiquantitatively, was more than 2 SDs below the mean of the controls.
Over a 10 year period it was possible to collect 20 patients who had been followed from the time of first assessment and time of scan through to death and subsequent detailed neuropathological autopsy. Eight patients fulfilled neuropathological diagnostic criteria for DLB. Nine patients had AD, mostly with coexisting cerebrovascular disease. Three patients had other diagnoses. The sensitivity of an initial clinical diagnosis of DLB was 75% and specificity was 42%. The sensitivity of the FP-CIT scan for the diagnosis of DLB was 88% and specificity was 100%.
FP-CIT SPECT scans substantially enhanced the accuracy of diagnosis of DLB by comparison with clinical criteria alone.
路易体痴呆（DLB）是一种常见的痴呆形式。阿尔茨海默病（AD）病理改变会影响DLB的临床特征，使得生前临床上难以将DLB与AD区分开来。初诊时应用的DLB临床诊断标准可能无法识别高达50%的病例。我们的目的是在一系列有尸检确诊的痴呆患者中，确定黑质纹状体通路的功能成像与仅依靠临床标准诊断相比，是否能提高诊断的准确性。
对一组临床诊断为DLB或其他痴呆的患者，使用多巴胺能突触前配体[123I]-2β-甲氧基羰基-3β-（4-碘苯基）-N-（3-氟丙基）去甲托烷（FP-CIT；碘氟烷）进行单光子发射计算机断层扫描（SPECT）。异常扫描定义为半定量测量的左右后壳核结合低于对照组平均值2个标准差以上。
在10年期间，共收集到20例患者，这些患者从首次评估和扫描时起一直随访至死亡及随后的详细神经病理学尸检。8例患者符合DLB的神经病理学诊断标准。9例患者患有AD，大多合并脑血管疾病。3例患者有其他诊断。DLB初始临床诊断的敏感性为75%，特异性为42%。FP-CIT扫描诊断DLB的敏感性为88%，特异性为100%。
与仅依靠临床标准相比，FP-CIT SPECT扫描显著提高了DLB诊断的准确性。
