1] Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK [2] INSERM U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France.
APHP, Hotel-Dieu Hospital, Department of Nuclear Medicine, Paris, France.
J Cereb Blood Flow Metab. 2014 May;34(5):753-8. doi: 10.1038/jcbfm.2014.43. Epub 2014 Mar 12.
By detecting β-amyloid (Aβ) in the wall of cortical arterioles, amyloid positron emission tomography (PET) imaging might help diagnose cerebral amyloid angiopathy (CAA) in patients with lobar intracerebral hemorrhage (l-ICH). No previous study has directly assessed the diagnostic value of (11)C-Pittsburgh compound B (PiB) PET in probable CAA-related l-ICH against healthy controls (HCs). (11)C-PiB-PET and magnetic resonance imaging (MRI) including T2* were obtained in 11 nondemented patients fulfilling the Boston criteria for probable CAA-related symptomatic l-ICH (sl-ICH) and 20 HCs without cognitive complaints or impairment. After optimal spatial normalization, cerebral spinal fluid (CSF)-corrected PiB distribution volume ratios (DVRs) were obtained. There was no significant difference in whole cortex or regional DVRs between CAA patients and age-matched HCs. The whole cortex DVR was above the 95% confidence limit in 4/9 HCs and 10/11 CAA patients (sensitivity=91%, specificity=55%). Region/frontal or occipital ratios did not have better discriminative value. Similar but less accurate results were found using visual analysis. In patients with sl-ICH, (11)C-PiB-PET has low specificity for CAA due to the frequent occurrence of high (11)C-PiB uptake in the healthy elderly reflecting incipient Alzheimer's disease (AD), which might also be present in suspected CAA. However, a negative PiB scan rules out CAA with excellent sensitivity, which has clinical implications for prognostication and selection of candidates for drug trials.
通过检测皮质小动脉壁中的β-淀粉样蛋白（Aβ），淀粉样蛋白正电子发射断层扫描（PET）成像可能有助于诊断伴有皮质下脑叶出血（l-ICH）的脑淀粉样血管病（CAA）。以前的研究尚未直接评估（11）C-Pittsburgh 化合物 B（PiB）PET 对可能与 CAA 相关的 l-ICH 相对于健康对照（HC）的诊断价值。11 名非痴呆患者符合波士顿标准的可能与 CAA 相关的症状性 l-ICH（sl-ICH）和 20 名无认知主诉或障碍的 HC 接受了（11）C-PiB-PET 和包括 T2*的磁共振成像（MRI）检查。在最佳空间归一化后，获得脑脊液（CSF）校正的 PiB 分布体积比（DVR）。CAA 患者和年龄匹配的 HC 之间整个皮质或区域 DVR 没有显著差异。整个皮质 DVR 在 4/9 名 HC 和 10/11 名 CAA 患者中高于 95%置信限（灵敏度=91%，特异性=55%）。区域/额叶或枕叶比值没有更好的区分价值。使用视觉分析也发现了类似但准确性较低的结果。在 sl-ICH 患者中，由于健康老年人中经常出现高（11）C-PiB 摄取，（11）C-PiB-PET 对 CAA 的特异性较低，这反映了阿尔茨海默病（AD）的早期发病，而 AD 也可能存在于疑似 CAA 中。然而，阴性 PiB 扫描可以排除 CAA，具有出色的敏感性，这对预后和药物试验候选者的选择具有临床意义。
