IRCCS Centro San Giovanni di Dio FBF, via Pilastroni 1, Brescia, Italy.
Nat Rev Neurol. 2010 Feb;6(2):67-77. doi: 10.1038/nrneurol.2009.215.
Structural imaging based on magnetic resonance is an integral part of the clinical assessment of patients with suspected Alzheimer dementia. Prospective data on the natural history of change in structural markers from preclinical to overt stages of Alzheimer disease are radically changing how the disease is conceptualized, and will influence its future diagnosis and treatment. Atrophy of medial temporal structures is now considered to be a valid diagnostic marker at the mild cognitive impairment stage. Structural imaging is also included in diagnostic criteria for the most prevalent non-Alzheimer dementias, reflecting its value in differential diagnosis. In addition, rates of whole-brain and hippocampal atrophy are sensitive markers of neurodegeneration, and are increasingly used as outcome measures in trials of potentially disease-modifying therapies. Large multicenter studies are currently investigating the value of other imaging and nonimaging markers as adjuncts to clinical assessment in diagnosis and monitoring of progression. The utility of structural imaging and other markers will be increased by standardization of acquisition and analysis methods, and by development of robust algorithms for automated assessment.
基于磁共振的结构成像已成为疑似阿尔茨海默病患者临床评估的一个重要组成部分。关于从疾病前期到明显阶段的结构标志物的自然变化的前瞻性数据正在从根本上改变人们对该疾病的认识方式，并将影响其未来的诊断和治疗。内侧颞叶结构萎缩现在被认为是轻度认知障碍阶段的一个有效诊断标志物。结构成像也被纳入最常见的非阿尔茨海默病痴呆症的诊断标准，反映了其在鉴别诊断中的价值。此外，全脑和海马萎缩的速度是神经退行性变的敏感标志物，并且越来越多地用作潜在的疾病修饰治疗试验的结果测量指标。目前，大型多中心研究正在研究其他成像和非成像标志物作为临床评估的辅助手段，用于诊断和监测疾病进展的价值。通过标准化的采集和分析方法以及用于自动评估的稳健算法，结构成像和其他标志物的效用将得到提高。
