Alzheimers Res Ther. 2013 Jul 8;5(Suppl 1):S4. doi: 10.1186/alzrt200.
The Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4) was held 3 to 4 May 2012 in Montreal, Quebec, Canada. A group of neuroimaging experts were assigned the task of reviewing and summarizing the literature on clinical and research applications of different neuroimaging modalities in cognitive disorders. This paper summarizes the literature and recommendations made to the conference regarding the role of several emerging neuroimaging modalities in cognitive disorders. Functional magnetic resonance imaging (MRI), magnetic resonance spectroscopy, and diffusion tensor imaging are discussed in detail within this paper. Other emergent neuroimaging modalities such as positron emission tomography with novel ligands, high-field MRI, arterial spin labeling MRI and noncerebral blood flow single-photon emission computerized tomography are only discussed briefly. Neuroimaging modalities that were recommended at the CCCDTD4 for both clinical and research applications such as amyloid and flurodeoxyglucose positron emission tomography, computerized tomography and structural MRI are discussed in a separate paper by the same authors. A literature search was conducted using the PubMed database including articles in English that involved human subjects and covered the period from the last CCCDTD publication (CCCDTD3; January 2006) until April 2012. Search terms included the name of the specific modality, dementia, Alzheimer's disease, and mild cognitive impairment. A separate search used the same parameters but was restricted to review articles to identify recent evidence-based reviews. Case studies and small case series were not included. Papers representing current evidence were selected, reviewed, and summarized, and the results were presented at the CCCDTD4 meeting with recommendations regarding the utility of various neuroimaging modalities in cognitive disorders. The evidence was graded according to the Oxford Centre for Evidence Based Medicine guidelines. Due to the limitations of current evidence, the neuroimaging modalities discussed in this paper were not recommended for clinical investigation of patients presenting with cognitive impairment. However, in the research setting, each modality provides a unique contribution to the understanding of basic mechanisms and neuropathological markers of cognitive disorders, to the identification of markers for early detection and for the risk of conversion to dementia in the at-risk populations, to the differentiation between different types of cognitive disorders, and to the identification of treatment targets and indicators of treatment response. In conclusion, for all of the neuroimaging modalities discussed in this paper, further studies are needed to establish diagnostic utility such as validity, reliability, and predictive and prognostic value. More multicenter studies are therefore needed with standardized image acquisition, experimental protocols, definition of the clinical population studied, larger numbers of participants, and longer duration of follow-up to allow generalizability of the results to the individual patient.
第四届加拿大痴呆症诊断和治疗共识会议（CCCDTD4）于 2012 年 5 月 3 日至 4 日在加拿大魁北克省蒙特利尔市举行。一组神经影像学专家的任务是审查和总结不同神经影像学方式在认知障碍的临床和研究应用方面的文献。本文总结了会议上关于几种新兴神经影像学方式在认知障碍中的作用的文献和建议。本文详细讨论了功能磁共振成像（fMRI）、磁共振波谱和弥散张量成像。本文还简要讨论了其他新兴的神经影像学方式，如使用新型配体的正电子发射断层扫描、高磁场磁共振成像、动脉自旋标记磁共振成像和非脑血流单光子发射计算机断层扫描。在 CCCDTD4 会议上推荐用于临床和研究应用的神经影像学方式，如淀粉样蛋白和氟脱氧葡萄糖正电子发射断层扫描、计算机断层扫描和结构磁共振成像，由同一作者在另一篇论文中进行了讨论。使用 PubMed 数据库进行了文献检索，包括涉及人类受试者的英文文章，并涵盖了最后一次 CCCDTD 出版物（CCCDTD3；2006 年 1 月）至 2012 年 4 月的时间段。搜索词包括特定方式的名称、痴呆症、阿尔茨海默病和轻度认知障碍。使用相同参数进行了单独搜索，但仅限于综述文章，以确定最近的基于证据的综述。未包括病例研究和小病例系列。选择、审查和总结了代表当前证据的论文，并在 CCCDTD4 会议上提出了关于各种神经影像学方式在认知障碍中的应用的建议。证据根据牛津循证医学中心的指南进行分级。由于现有证据的局限性，本文讨论的神经影像学方式不建议用于患有认知障碍的患者的临床研究。然而，在研究环境中，每种方式都为理解认知障碍的基本机制和神经病理学标志物、识别早期检测和高危人群向痴呆转化的标志物、区分不同类型的认知障碍以及识别治疗靶点和治疗反应指标提供了独特的贡献。总之，对于本文讨论的所有神经影像学方式，都需要进一步的研究来建立诊断效用，如有效性、可靠性以及预测和预后价值。因此，需要更多的多中心研究，包括标准化的图像采集、实验方案、所研究临床人群的定义、更多的参与者和更长的随访时间，以将研究结果推广到个体患者。
