Department of Neurology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China.
Int J Clin Pract. 2012 Feb;66(2):185-98. doi: 10.1111/j.1742-1241.2011.02845.x.
In recent years, the role of PET imaging in the prediction of mild cognitive impairment (MCI) to Alzheimer's disease (AD) conversion has been the subject of many longitudinal studies. The purpose of this study was to perform a meta-analysis to estimate the diagnostic accuracy of (18) F-fluoro-2-deoxyglucose-positron emission tomography (FDG-PET) and (11) C-Pittsburgh Compound B-positron emission tomography (PIB-PET) for prediction of short-term conversion to AD in patients with MCI. The MEDLINE and EMBASE databases were systematically searched for relevant studies. Methodological quality of the included studies was assessed. Sensitivities and specificities of PET in individual studies were calculated and meta-analysis was undertaken with a random-effects model. A summary receiver operating characteristic (SROC) curve was constructed with the Moses-Shapiro-Littenberg method. Heterogeneity was tested, and the presence of publication bias was assessed. Potential sources for heterogeneity were explored by assessing whether or not certain covariates significantly influenced the relative diagnostic odds ratio (DOR). Pooled estimates of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), DOR and the SROC curve of each PET imaging were determined. A total of 13 research studies (seven FDG-PET and six PIB-PET) met inclusion criteria and had sufficient data for statistical analysis. FDG-PET pooled estimates had 78.7% sensitivity (95% CI, 68.7-86.6%),74.0% specificity (95% CI, 67.0-80.3%), 18.1 LR+(95% CI, 7.3-45.0) and 0.32 LR-(95% CI, 0.16-0.61); and PIB-PET pooled estimates had 93.5% sensitivity (95%CI, 71.3-99.9%), 56.2% specificity (95% CI, 47.2-64.8%), 2.01 LR+ (95% CI, 1.57-2.58) and 0.17 LR-(95% CI, 0.08-0.36). Overall DOR was 17.3 (95% CI, 5.08-59.2) for FDG-PET and 12.8 (95% CI, 5.35-30.54) for PIB-PET. Area under the SROC curve was 0.88 ± 0.05 for FDG-PET and 0.85 ± 0.04 for PIB-PET. The data from FDG-PET research studies had high heterogeneity and funnel plot suggested a publication bias. The diagnostic accuracy determined for both FDG-PET and PIB-PET in this meta-analysis suggests that they are potentially valuable techniques for prediction of progression in patients with MCI. Both have their advantages and their combined use is a promising option for prediction purposes depending on availability and experience.
近年来，正电子发射断层扫描（PET）成像在预测轻度认知障碍（MCI）向阿尔茨海默病（AD）转化中的作用一直是许多纵向研究的主题。本研究旨在进行荟萃分析，以评估（18）F-氟-2-脱氧葡萄糖正电子发射断层扫描（FDG-PET）和（11）C-匹兹堡化合物 B 正电子发射断层扫描（PIB-PET）对预测 MCI 患者短期向 AD 转化的诊断准确性。系统地检索了 MEDLINE 和 EMBASE 数据库以获取相关研究。评估了纳入研究的方法学质量。计算了 PET 在个别研究中的敏感性和特异性，并采用随机效应模型进行荟萃分析。采用 Moses-Shapiro-Littenberg 方法构建了汇总受试者工作特征（SROC）曲线。对异质性进行了检验，并评估了发表偏倚的存在。通过评估某些协变量是否显著影响相对诊断比值比（DOR），探讨了异质性的潜在来源。确定了每种 PET 成像的敏感性、特异性、阳性似然比（LR+）、阴性似然比（LR-）、DOR 和 SROC 曲线的汇总估计值。共有 13 项研究（7 项 FDG-PET 和 6 项 PIB-PET）符合纳入标准，并有足够的数据进行统计分析。FDG-PET 汇总估计值的敏感性为 78.7%（95%CI，68.7-86.6%），特异性为 74.0%（95%CI，67.0-80.3%），18.1 LR+（95%CI，7.3-45.0）和 0.32 LR-（95%CI，0.16-0.61）；PIB-PET 汇总估计值的敏感性为 93.5%（95%CI，71.3-99.9%），特异性为 56.2%（95%CI，47.2-64.8%），2.01 LR+（95%CI，1.57-2.58）和 0.17 LR-（95%CI，0.08-0.36）。FDG-PET 的总体 DOR 为 17.3（95%CI，5.08-59.2），PIB-PET 的总体 DOR 为 12.8（95%CI，5.35-30.54）。FDG-PET 的 SROC 曲线下面积为 0.88±0.05，PIB-PET 的 SROC 曲线下面积为 0.85±0.04。FDG-PET 研究的数据存在高度异质性，漏斗图提示存在发表偏倚。本荟萃分析确定的 FDG-PET 和 PIB-PET 的诊断准确性表明，它们可能是预测 MCI 患者进展的有价值的技术。两者都有各自的优势，根据可用性和经验，联合使用是一种有前途的预测选择。
