Staffen W, Bergmann J, Schönauer U, Zauner H, Kronbichler M, Golaszewski S, Ladurner G
Christian-Doppler-Clinic, Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Eur J Nucl Med Mol Imaging. 2009 May;36(5):801-10. doi: 10.1007/s00259-008-1028-2. Epub 2009 Jan 10.
Comparative evaluation of regional brain perfusion measured by HMPAO-SPECT of patients with mild cognitive impairment (MCI), dementia of Alzheimer's type (DAT) and depression with cognitive impairment (DCI).
A total of 736 patients were investigated because of suspected cognitive dysfunction. After exclusion of patients with other forms of dementia than DAT or relevant accompanying disorders, SPECT data from 149 MCI, 131 DAT and 127 DCI patients, and 123 controls without any cognitive impairment, were analysed. Relative cerebral blood flow of 34 anatomical regions was assessed with automated analysis software (BRASS).
Calculation of global forebrain perfusion discriminated demented from nondemented patients. Compared to controls DCI patients showed hypoperfusion of the thalamus, lentiform nucleus and medial temporal cortex. MCI patients differed significantly from controls concerning perfusion in both hemispheric temporal and parietal areas, and in the (right hemispheric) posterior part of the cingulate gyrus. MCI and DCI patients differed in the parietal, temporal superior and right hemispheric cingulate gyrus posterior cortices. Global forebrain and regional perfusion was more extensively reduced in DAT patients and discriminated them from controls, and MCI and DCI patients. Frontal perfusion disturbance was only present in DAT patients.
Automated analysis of HMPAO-SPECT data from MCI patients showed significant perfusion deficits in regions also involved in DAT patients, but ROC analysis demonstrated only moderate sensitivity and specificity for differentiating DAT patients from controls and DCI patients. Frontal hypoperfusion seems to correspond with conversion from MCI to DAT. Finally, the results in DCI patients again raise the question of depression as an early symptom of neurodegeneration.
通过锝-99m六甲基丙烯胺肟单光子发射计算机断层扫描（HMPAO-SPECT）对轻度认知障碍（MCI）、阿尔茨海默病型痴呆（DAT）和伴有认知障碍的抑郁症（DCI）患者的局部脑灌注进行比较评估。
共有736例因疑似认知功能障碍而接受调查的患者。在排除患有除DAT以外的其他形式痴呆或相关伴随疾病的患者后，对149例MCI患者、131例DAT患者、127例DCI患者以及123例无任何认知障碍的对照者的SPECT数据进行分析。使用自动分析软件（BRASS）评估34个解剖区域的相对脑血流量。
全脑前叶灌注的计算可区分痴呆患者与非痴呆患者。与对照组相比，DCI患者的丘脑、豆状核和颞叶内侧皮质存在灌注不足。MCI患者在双侧颞叶和顶叶区域以及（右侧半球）扣带回后部的灌注与对照组有显著差异。MCI和DCI患者在顶叶、颞叶上部和右侧半球扣带回后部皮质存在差异。DAT患者的全脑前叶和局部灌注减少更为广泛，可将其与对照组、MCI和DCI患者区分开来。额叶灌注障碍仅出现在DAT患者中。
对MCI患者的HMPAO-SPECT数据进行自动分析显示，在DAT患者中受累的区域也存在明显的灌注缺陷，但ROC分析表明，在区分DAT患者与对照组和DCI患者时，其敏感性和特异性仅为中等。额叶灌注不足似乎与MCI向DAT的转化有关。最后，DCI患者的结果再次引发了关于抑郁症是否为神经退行性变早期症状的问题。
