McConathy Jonathan, Sheline Yvette I
Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
Departments of Psychiatry, Radiology, and Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
Biol Psychiatry. 2015 Apr 15;77(8):685-92. doi: 10.1016/j.biopsych.2014.08.024. Epub 2014 Sep 16.
In evaluating disease changes, it is critical to have measurements that are sensitive, specific, and reliable. Cognitive decline, particularly in the context of Alzheimer's disease, is an area that has attracted numerous recent studies, and the proposed biomarkers used in these investigations need to be validated. In this review, we highlight studies with important implications about the role of imaging biomarkers in cognitive decline and dementia as well as in distinguishing preclinical dementia before evidence of cognitive decline. Structural changes determined on cross-sectional and longitudinal magnetic resonance imaging provide early prediction of dementia, particularly when combined with other measures. Molecular imaging using positron emission tomography and single photon emission computed tomography tracers quantify the presence or activity of receptors, transporters, enzymes, metabolic pathways, and proteins. The newest developments in molecular imaging are described, and methods are compared. Distinguishing features of imaging biomarkers among dementias and the spectrum of preclinical Alzheimer's disease, mild cognitive impairment, and Alzheimer's disease are described. Appropriate use criteria for positron emission tomography with amyloid tracers are delineated. Although these efforts are still in the early phase of development, there is great promise for further development in structural magnetic resonance imaging and positron emission tomography technologies.
在评估疾病变化时，拥有敏感、特异且可靠的测量方法至关重要。认知衰退，尤其是在阿尔茨海默病的背景下，是一个最近吸引了众多研究的领域，这些研究中使用的拟议生物标志物需要得到验证。在本综述中，我们重点介绍了关于成像生物标志物在认知衰退和痴呆中的作用以及在认知衰退证据出现之前区分临床前痴呆方面具有重要意义的研究。横断面和纵向磁共振成像所确定的结构变化可提供痴呆的早期预测，尤其是与其他测量方法结合使用时。使用正电子发射断层扫描和单光子发射计算机断层扫描示踪剂的分子成像可对受体、转运体、酶、代谢途径和蛋白质的存在或活性进行量化。本文描述了分子成像的最新进展，并对各种方法进行了比较。阐述了痴呆以及临床前阿尔茨海默病、轻度认知障碍和阿尔茨海默病范围内成像生物标志物的区别特征。划定了使用淀粉样蛋白示踪剂进行正电子发射断层扫描的适当使用标准。尽管这些努力仍处于发展的早期阶段，但结构磁共振成像和正电子发射断层扫描技术有很大的进一步发展前景。
