Farid Karim, Hong Young T, Aigbirhio Franklin I, Fryer Tim D, Menon David K, Warburton Elizabeth A, Baron Jean-Claude
APHP, Hotel-Dieu Hospital, Department of Nuclear Medicine, Paris, France; Dept of Nuclear Medicine, Martinique University Hospital, Fort-de-France, French West Indies.
Wolfson Brain Imaging Centre, Dept of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
PLoS One. 2015 Oct 6;10(10):e0139926. doi: 10.1371/journal.pone.0139926. eCollection 2015.
Although late-phase (>35min post-administration) 11C-PiB-PET has good sensitivity in cerebral amyloid angiopathy (CAA), its specificity is poor due to frequently high uptake in healthy aged subjects. By detecting perfusion-like abnormalities, early-phase 11C-PiB-PET might add diagnostic value. Early-frame (1-6min) 11C-PiB-PET was obtained in 11 non-demented patients with probable CAA-related symptomatic lobar intracerebral haemorrhage (70±7yrs), 9 age-matched healthy controls (HCs) and 10 HCs <55yrs. There was a significant decrease in early-phase atrophy-corrected whole-cortex SUV relative to cerebellar vermis (SUVR) in the CAA vs age-matched HC group. None of the age-matched controls fell below the lower 95% confidence limit derived from the young HCs, while 6/11 CAA patients did (sensitivity = 55%, specificity = 100%). Combining both early- and late-phase 11C-PiB data did not change the sensitivity and specificity of late-phase PiB, but combined early- and late-phase positivity entails a very high suspicion of underlying Aβ-related clinical disorder, i.e., CAA or Alzheimer disease (AD). In order to clarify this ambiguity, we then show that the occipital/posterior cingulate ratio is markedly lower in CAA than in AD (N = 7). These pilot data suggest that early-phase 11C-PiB-PET may not only add to late-phase PiB-PET with respect to the unclear situation of late-phase positivity, but also help differentiate CAA from AD.
尽管晚期（给药后>35分钟）11C-PiB-PET在脑淀粉样血管病（CAA）中具有良好的敏感性，但由于在健康老年人中摄取通常较高，其特异性较差。通过检测类似灌注的异常情况，早期11C-PiB-PET可能会增加诊断价值。对11例可能患有CAA相关症状性脑叶脑出血的非痴呆患者（70±7岁）、9例年龄匹配的健康对照者（HCs）和10例年龄<55岁的HCs进行了早期帧（1-6分钟）11C-PiB-PET检查。与年龄匹配的HC组相比，CAA组早期萎缩校正后的全皮质标准化摄取值（SUV）相对于小脑蚓部（SUVR）显著降低。年龄匹配的对照组中没有一个低于年轻HCs得出的95%置信下限，而11例CAA患者中有6例低于该下限（敏感性=55%，特异性=100%）。结合早期和晚期11C-PiB数据并没有改变晚期PiB的敏感性和特异性，但早期和晚期均为阳性则高度怀疑存在潜在的与Aβ相关的临床疾病，即CAA或阿尔茨海默病（AD）。为了澄清这种模糊性，我们随后表明，CAA患者枕叶/后扣带回比值明显低于AD患者（N=7）。这些初步数据表明，早期11C-PiB-PET不仅可以在晚期PiB-PET晚期阳性情况不明确方面提供补充，还有助于区分CAA和AD。
