aLaboratory for Cognitive Neurology, Department of Neurosciences, University of Leuven bNeurology Department, University Hospitals Leuven cAlzheimer Research Centre KU Leuven, Leuven Institute for Neuroscience and Disease, University of Leuven, dNuclear Medicine and Molecular Imaging, University Hospitals and University of Leuven, Leuven, Belgium.
Curr Opin Neurol. 2013 Dec;26(6):646-55. doi: 10.1097/WCO.0000000000000036.
This review evaluates the potential clinical utility of amyloid imaging.
Amyloid PET is a valid in-vivo marker of neuritic plaque load and correlates with amyloid plaque surface area. Abundant diffuse plaques, however, with scant neuritic plaques can also give rise to a positive scan, most often reported in association with Lewy body disease. Specificity of amyloid PET for discriminating Alzheimer's disease from healthy controls is higher than that of structural MRI. Sensitivity for discriminating Alzheimer's disease from healthy controls or from frontotemporal lobar degeneration is also higher than that of fluorodeoxyglucose-PET, with higher interreader reliability. Within a same center there is high concordance between dichotomization of cases based on amyloid PET versus cerebrospinal fluid Aβ42. In a tentative algorithm, we restrict clinical-diagnostic use to dementia with age of onset before 60 years, primary progressive aphasia and corticobasal syndrome, cases with objective cognitive deficits that could be due to a neurodegenerative cause but also have significant cerebrovascular or psychiatric comorbidity, and rapidly progressive dementia.
Empirical studies that evaluate how amyloid PET can change clinical-diagnostic thinking are starting to emerge. Key questions to be resolved are its role compared with cerebrospinal fluid markers and its impact on patient outcome.
本综述评估了淀粉样蛋白成像的潜在临床应用价值。
淀粉样蛋白 PET 是神经原纤维缠结负荷的有效活体标志物，与淀粉样斑块表面积相关。然而，大量弥漫性斑块，而神经原纤维缠结较少的斑块也可能导致阳性扫描，这种情况最常与路易体病有关。淀粉样蛋白 PET 区分阿尔茨海默病与健康对照组的特异性高于结构 MRI。与氟脱氧葡萄糖-PET 相比，其区分阿尔茨海默病与健康对照组或额颞叶变性的敏感性也更高，且具有更高的读者间可靠性。在同一中心内，基于淀粉样蛋白 PET 与脑脊液 Aβ42 对病例进行二分法的一致性很高。在一个试探性的算法中，我们将临床诊断用途限制在发病年龄在 60 岁之前的痴呆、原发性进行性失语症和皮质基底节综合征、有客观认知障碍的病例，这些病例可能是由于神经退行性疾病引起的，但也有明显的血管性或精神共病，以及快速进行性痴呆。
评估淀粉样蛋白 PET 如何改变临床诊断思维的实证研究开始出现。需要解决的关键问题是它与脑脊液标志物的比较及其对患者预后的影响。
