Monge Argilés J A, Blanco Cantó M A, Leiva Salinas C, Flors L, Muñoz Ruiz C, Sánchez Payá J, Gasparini Berenguer R, Leiva Santana C
Servicio de Neurología, Hospital General Universitario de Alicante, Alicante, España.
Servicio de Neurología, Hospital General Universitario de Alicante, Alicante, España.
Neurologia. 2014 Sep;29(7):397-401. doi: 10.1016/j.nrl.2013.06.002. Epub 2013 Aug 20.
The goals of this study were to compare the early diagnostic utility of Alzheimer disease biomarkers in the CSF with those in brain MRI in conditions found in our clinical practice, and to ascertain the diagnostic accuracy of both techniques used together.
Between 2008 and 2009, we included 30 patients with mild cognitive impairment (MCI) who were examined using 1.5 Tesla brain MRI and AD biomarker analysis in CSF. MRI studies were evaluated by 2 radiologists according to the Korf́s visual scale. CSF biomarkers were analysed using INNOTEST reagents for Aβ1-42, total-tau and phospho-tau181p. We evaluated clinical changes 2 years after inclusion.
By 2 years after inclusion, 15 of the original 30 patients (50%) had developed AD (NINCDS-ADRA criteria). The predictive utility of AD biomarkers in CSF (RR 2.7; 95% CI, 1.1-6.7; P<.01) was greater than that of MRI (RR 1.5; 95% CI 95%, 0.7-3.4; P<.2); using both techniques together yielded a sensitivity and a negative predictive value of 100%. Normal results on both complementary tests ruled out progression to AD (100%) within 2 years of inclusion.
Our results show that the diagnostic accuracy of biomarkers in CSF is higher than that of biomarkers in MRI. Combined use of both techniques is highly accurate for either early diagnosis or exclusion of AD in patients with MCI.
本研究的目的是比较在我们临床实践中发现的各种情况下，脑脊液中阿尔茨海默病生物标志物与脑磁共振成像（MRI）中生物标志物的早期诊断效用，并确定两种技术联合使用时的诊断准确性。
在2008年至2009年期间，我们纳入了30例轻度认知障碍（MCI）患者，对其进行了1.5特斯拉脑MRI检查和脑脊液中AD生物标志物分析。MRI研究由2名放射科医生根据科尔夫视觉量表进行评估。脑脊液生物标志物使用用于Aβ1-42、总tau蛋白和磷酸化tau181p的INNOTEST试剂进行分析。我们在纳入后2年评估临床变化。
纳入后2年时，最初的30例患者中有15例（50%）发展为AD（根据美国国立神经病学、语言障碍和卒中研究所-阿尔茨海默病及相关疾病协会（NINCDS-ADRA）标准）。脑脊液中AD生物标志物的预测效用（相对风险（RR）2.7；95%置信区间（CI），1.1 - 6.7；P <.01）大于MRI的预测效用（RR 1.5；95% CI 95%，0.7 - 3.4；P <.2）；两种技术联合使用时，敏感性和阴性预测值均为100%。两项补充检查结果均正常可排除在纳入后2年内进展为AD（100%）。
我们的结果表明，脑脊液中生物标志物的诊断准确性高于MRI中的生物标志物。两种技术联合使用对于早期诊断或排除MCI患者的AD具有很高的准确性。
