Vemuri P, Wiste H J, Weigand S D, Shaw L M, Trojanowski J Q, Weiner M W, Knopman D S, Petersen R C, Jack C R
Aging and Dementia Imaging Research Laboratory, Department of Radiology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Neurology. 2009 Jul 28;73(4):287-93. doi: 10.1212/WNL.0b013e3181af79e5.
To assess the correlations of both MRI and CSF biomarkers with clinical diagnosis and with cognitive performance in cognitively normal (CN) subjects and patients with amnestic mild cognitive impairment (aMCI) and Alzheimer disease (AD).
This is a cross-sectional study with data from the Alzheimer's Disease Neuroimaging Initiative, which consists of CN subjects, subjects with aMCI, and subjects with AD with both CSF and MRI. Baseline CSF (t-tau, Abeta(1-42), and p-tau(181P)) and MRI scans were obtained in 399 subjects (109 CN, 192 aMCI, 98 AD). Structural Abnormality Index (STAND) scores, which reflect the degree of AD-like anatomic features on MRI, were computed for each subject.
We found no significant correlation between CSF biomarkers and cognitive scores in any of the 3 clinical groups individually. Conversely, STAND scores correlated with both Clinical Dementia Rating-sum of boxes and Mini-Mental State Examination in aMCI and AD (p < or = 0.01). While STAND and all CSF biomarkers were predictors of clinical group membership (CN, aMCI, or AD) univariately (p < 0.001), STAND was more predictive than CSF both univariately and in combined models.
CSF and MRI biomarkers independently contribute to intergroup diagnostic discrimination and the combination of CSF and MRI provides better prediction than either source of data alone. However, MRI provides greater power to effect cross-sectional groupwise discrimination and better correlation with general cognition and functional status cross-sectionally. We therefore conclude that although MRI and CSF provide complementary information, MRI reflects clinically defined disease stage better than the CSF biomarkers tested.
评估磁共振成像（MRI）和脑脊液生物标志物与认知正常（CN）受试者、遗忘型轻度认知障碍（aMCI）患者及阿尔茨海默病（AD）患者的临床诊断及认知表现之间的相关性。
这是一项横断面研究，数据来自阿尔茨海默病神经影像学倡议组织，研究对象包括认知正常受试者、aMCI受试者以及同时进行了脑脊液和MRI检查的AD受试者。对399名受试者（109名认知正常者、192名aMCI患者、98名AD患者）进行了基线脑脊液（总tau蛋白、β淀粉样蛋白1-42、磷酸化tau蛋白181P）检测及MRI扫描。计算了反映MRI上AD样解剖特征程度的结构异常指数（STAND）得分。
我们发现，在任何一个临床组中，脑脊液生物标志物与认知得分之间均无显著相关性。相反，在aMCI和AD组中，STAND得分与临床痴呆评定量表-方框总和及简易精神状态检查均相关（p≤0.01）。虽然STAND和所有脑脊液生物标志物单变量分析时均为临床分组（认知正常、aMCI或AD）的预测指标（p<0.001），但无论是单变量分析还是在联合模型中，STAND的预测能力均优于脑脊液生物标志物。
脑脊液和MRI生物标志物独立地有助于组间诊断鉴别，脑脊液和MRI联合使用比单独任何一种数据来源提供更好的预测效果。然而，MRI在进行横断面组间鉴别方面具有更强的能力，并且与横断面的总体认知和功能状态具有更好的相关性。因此，我们得出结论，虽然MRI和脑脊液提供互补信息，但MRI比所检测的脑脊液生物标志物能更好地反映临床定义的疾病阶段。
