Kondo M, Tokuda T, Itsukage M, Kuriyama N, Matsushima S, Yamada K, Nakanishi H, Ishikawa M, Nakagawa M
Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Neuroradiol J. 2013 Feb;26(1):41-6. doi: 10.1177/197140091302600107. Epub 2013 Mar 8.
This study aimed to elucidate the incidence and distribution of the cortical retention of Pittsburgh compound B (PIB) in patients with idiopathic normal pressure hydrocephalus (iNPH) and clarify the differences from those in patients with Alzheimer's disease (AD). Ten patients with iNPH without any clinical signs indicative of AD were enrolled in this study. Cerebral retention of PIB in positron emission tomography (PET) in iNPH patients was compared with those in seven age-matched AD patients. The CSF levels of β-amyloid 1-42 peptide (Aβ42), which inversely decrease with cerebral amyloid burden, were also measured. Three of the ten patients with iNPH showed increased cortical PIB retention. Although the mean cortical SUV ratios were similar, the distribution of PIB retention differed widely between the patients with iNPH and AD. PIB retention was limited to the high-convexity parasagittal areas in iNPH patients, whereas it spread over the frontal and parietotemporal areas in AD. The coronal images of PIB-PET were more informative than conventional transverse images in evaluating the distribution pattern of cortical PIB retention. Two iNPH patients with higher cortical PIB retention had the lowest levels of CSF Aβ42, indicating that PIB retention in iNPH would not reflect a simple delay in PIB clearance but its binding to existing Aβ amyloid in the brain. Our results indicate that iNPH is one of the diseases exhibiting cortical PIB retention. The characteristic distribution of PIB retention in iNPH could be useful in the differential diagnosis between iNPH and AD.
本研究旨在阐明匹兹堡化合物B（PIB）在特发性正常压力脑积水（iNPH）患者大脑皮质中的滞留发生率及分布情况，并明确其与阿尔茨海默病（AD）患者的差异。本研究纳入了10例无任何提示AD临床症状的iNPH患者。将iNPH患者正电子发射断层扫描（PET）中PIB的脑内滞留情况与7例年龄匹配的AD患者进行比较。还测量了与脑淀粉样蛋白负荷呈负相关降低的脑脊液β淀粉样蛋白1-42肽（Aβ42）水平。10例iNPH患者中有3例显示大脑皮质PIB滞留增加。尽管平均皮质标准化摄取值（SUV）比率相似，但iNPH患者与AD患者PIB滞留的分布差异很大。iNPH患者的PIB滞留局限于高凸矢状旁区，而在AD患者中则分布于额叶和顶颞叶区域。在评估皮质PIB滞留的分布模式时，PIB-PET的冠状位图像比传统的横断位图像提供的信息更多。2例大脑皮质PIB滞留较高的iNPH患者脑脊液Aβ42水平最低，这表明iNPH中的PIB滞留并非反映PIB清除的简单延迟，而是其与脑内现有Aβ淀粉样蛋白的结合。我们的结果表明，iNPH是表现出大脑皮质PIB滞留的疾病之一。iNPH中PIB滞留的特征性分布可能有助于iNPH与AD的鉴别诊断。
