Department of Neurology, General Hospital of the Peoples' Liberation Army, 28 Fu Xing Road, Haidian District, Beijing 100853, China.
J Clin Neurosci. 2012 Oct;19(10):1354-7. doi: 10.1016/j.jocn.2011.11.035. Epub 2012 Jul 12.
18F-fluorodeoxyglucose-positron emission tomography/CT (18F-FDG PET/CT) scanning may be a useful tool for early diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD), as it may reveal lowered cellular glucose transport and metabolism in the cortex, cerebellum and basal ganglia. The aim of the present study was to compare the findings from PET/CT, MRI and electroencephalography (EEG) for patients with sCJD, to explore whether typical sites or reliable patterns of regional metabolic change could be found and to evaluate the results of diagnostic imaging in the light of clinical symptomatology. Five patients with biopsy-confirmed sCJD and nine with probable sCJD (aged 36-68 years) were evaluated using PET/CT, diffusion-weighted (DW)-MRI and EEG. In 13 of the 14 patients (92.86%), PET/CT imaging detected extra regions with abnormalities in addition to the hyperintense areas shown with DW-MRI. Two patients with no abnormal DW-MRI findings in the basal ganglia had bilateral extrapyramidal signs accompanied by basal ganglia hypometabolism on PET. Eight patients (57.14%) had decreased FDG uptake in the thalamic nuclei on PET scans; however, DW-MRI did not identify corresponding hyperintense changes in the thalamic nuclei. In 11 patients (78.57%), DW-MRI revealed more regions with abnormalities than EEG, and 10 patients (71.43%) had DW-MRI abnormalities in the thalamic nuclei and basal ganglia that EEG was unable to detect. There was a high level of correspondence among the PET/CT, DW-MRI and EEG results, with PET revealing more abnormal regions than the other imaging modalities. In the absence of neuropathological findings, FDG-PET could improve the accuracy of sCJD diagnosis when combined with DW-MRI and EEG, particularly for differentiating sCJD from paraneoplastic syndromes. Our results suggest that PET/CT is able to detect sCJD at an earlier stage and with greater sensitivity than DW-MRI.
18F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）扫描可能是散发性克雅氏病（sCJD）早期诊断的有用工具，因为它可能显示皮质、小脑和基底节的细胞葡萄糖转运和代谢降低。本研究的目的是比较 PET/CT、磁共振成像（MRI）和脑电图（EEG）在 sCJD 患者中的发现，探讨是否可以找到典型的部位或可靠的区域性代谢变化模式，并根据临床症状评估诊断成像的结果。对 5 例经活检证实的 sCJD 患者和 9 例可能的 sCJD 患者（年龄 36-68 岁）进行了 PET/CT、弥散加权（DW）-MRI 和 EEG 检查。在 14 例患者中的 13 例（92.86%）中，PET/CT 成像除了 DW-MRI 显示的高信号区域外，还检测到额外的异常区域。2 例基底节无异常 DW-MRI 发现的患者伴有双侧锥体外系体征，PET 显示基底节代谢低下。8 例（57.14%）患者的丘脑核 PET 扫描摄取 FDG 减少；然而，DW-MRI 没有发现相应的丘脑核高信号改变。在 11 例患者（78.57%）中，DW-MRI 显示异常区域多于 EEG，10 例（71.43%）患者的 DW-MRI 异常位于丘脑核和基底节，而 EEG 无法检测到。PET/CT、DW-MRI 和 EEG 结果之间有很高的一致性，PET 显示的异常区域多于其他成像方式。在没有神经病理学发现的情况下，FDG-PET 结合 DW-MRI 和 EEG 可以提高 sCJD 诊断的准确性，特别是用于区分 sCJD 与副肿瘤综合征。我们的结果表明，与 DW-MRI 相比，PET/CT 能够更早、更敏感地检测 sCJD。
