From the Memory and Aging Center and Department of Neurology (P.S.-J., P.M.G., J.H., B.G., M.H., L.T.G., M.G.-T., W.W.S., A.L.B., H.J.R., J.H.K., B.L.M.,W.J.J., G.D.R.) and Department of Pathology and Laboratory Medicine (E.J.H.), University of California, San Francisco; University Hospital "Marqués de Valdecilla," IFIMAV and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.S.-J.), Santander, Spain; Helen Wills Neuroscience Institute (P.M.G., W.J.J., G.D.R.), University of California, Berkeley; Lawrence Berkeley National Laboratory (P.M.G., J.P.O., M.J., W.J.J., G.D.R.), Berkeley, CA; Center for Neurodegenerative Research (J.Q.T.), University of Pennsylvania, Philadelphia; and Department of Pathology and Laboratory Medicine (H.V.V.), University of California, Los Angeles.
Neurology. 2014 Jan 21;82(3):230-8. doi: 10.1212/WNL.0000000000000032. Epub 2013 Dec 18.
To evaluate the effect of amyloid imaging on clinical decision making.
We conducted a retrospective analysis of 140 cognitively impaired patients (mean age 65.0 years, 46% primary β-amyloid (Aβ) diagnosis, mean Mini-Mental State Examination 22.3) who underwent amyloid (Pittsburgh compound B [PiB]) PET as part of observational research studies and were evaluated clinically before and after the scan. One hundred thirty-four concurrently underwent fluorodeoxyglucose (FDG)-PET. We assessed for changes between the pre- and post-PET clinical diagnosis (from Aβ to non-Aβ diagnosis or vice versa) and Alzheimer disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using χ(2) and multivariate logistic regression. Postmortem diagnosis was available for 24 patients (17%).
Concordance between scan results and baseline diagnosis was high (PiB 84%, FDG 82%). The primary diagnosis changed after PET in 13/140 patients (9%) overall but in 5/13 (38%) patients considered pre-PET diagnostic dilemmas. When examined independently, discordant PiB and discordant FDG were both associated with diagnostic change (unadjusted p < 0.0001). However, when examined together in a multivariate logistic regression, only discordant PiB remained significant (adjusted p = 0.00013). Changes in treatment were associated with discordant PiB in patients with non-Aβ diagnoses (adjusted p = 0.028), while FDG had no effect on therapy. Both PiB (96%) and FDG (91%) showed high agreement with autopsy diagnosis.
PET had a moderate effect on clinical outcomes. Discordant PiB had a greater effect than discordant FDG, and influence on diagnosis was greater than on treatment. Prospective studies are needed to better characterize the clinical role of amyloid PET.
评估淀粉样蛋白成像对临床决策的影响。
我们对 140 例认知障碍患者（平均年龄 65.0 岁，46%为原发性β-淀粉样蛋白（Aβ）诊断，平均简易精神状态检查 22.3）进行了回顾性分析，这些患者作为观察性研究的一部分接受了淀粉样蛋白（匹兹堡化合物 B [PiB]）正电子发射断层扫描（PET）检查，并在扫描前后进行了临床评估。134 例患者同时接受了氟脱氧葡萄糖（FDG）-PET 检查。我们评估了 PET 前后临床诊断（从 Aβ到非 Aβ诊断或反之）和阿尔茨海默病治疗计划的变化。使用卡方检验和多变量逻辑回归评估 PiB/FDG 结果与管理变化之间的关系。对 24 例患者（17%）进行了尸检诊断。
扫描结果与基线诊断的一致性很高（PiB 84%，FDG 82%）。140 例患者中，总体有 13 例（9%）在 PET 后改变了主要诊断，但在 13 例（38%）被认为是 PET 前诊断难题的患者中，有 5 例改变了诊断。当单独检查时，不一致的 PiB 和不一致的 FDG 均与诊断改变相关（未调整 p<0.0001）。然而，当在多变量逻辑回归中一起检查时，只有不一致的 PiB 仍然具有统计学意义（调整后 p=0.00013）。在非 Aβ诊断的患者中，不一致的 PiB 与治疗改变相关（调整后 p=0.028），而 FDG 对治疗没有影响。PiB（96%）和 FDG（91%）与尸检诊断均具有较高的一致性。
PET 对临床结果有中等影响。不一致的 PiB 比不一致的 FDG 影响更大，对诊断的影响大于对治疗的影响。需要前瞻性研究来更好地描述淀粉样蛋白 PET 的临床作用。
