Shea Y F, Ha J, Lee S C, Chu L W
Division of Geriatrics, Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
The Alzheimer's Disease Research Network, SRT Ageing, The University of Hong Kong, Pokfulam, Hong Kong.
Hong Kong Med J. 2016 Aug;22(4):327-33. doi: 10.12809/hkmj154707. Epub 2016 Jun 17.
This study investigated the improvement in the accuracy of diagnosis of dementia subtypes among Chinese dementia patients who underwent [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography ((18)FDG PET) with or without carbon 11-labelled Pittsburgh compound B ((11)C-PIB).
This case series was performed in the Memory Clinic at Queen Mary Hospital, Hong Kong. We reviewed 109 subjects (56.9% were female) who received PET with or without (11)C-PIB between January 2007 and December 2014. Data including age, sex, education level, Mini-Mental State Examination score, Clinical Dementia Rating scale score, neuroimaging report, and pre-/post-imaging clinical diagnoses were collected from medical records. The agreement between the initial and post-PET with or without (11)C-PIB dementia diagnosis was analysed by the Cohen's kappa statistics.
The overall accuracy of initial clinical diagnosis of dementia subtype was 63.7%, and diagnosis was subsequently changed in 36.3% of subjects following PET with or without (11)C-PIB. The rate of accurate initial clinical diagnosis (compared with the final post-imaging diagnosis) was 81.5%, 44.4%, 14.3%, 28.6%, 55.6% and 0% for Alzheimer's disease, dementia with Lewy bodies, frontotemporal dementia, vascular dementia, other dementia, and mixed dementia, respectively. The agreement between the initial and final post-imaging dementia subtype diagnosis was only fair, with a Cohen's kappa of 0.25 (95% confidence interval, 0.05-0.45). For the 21 subjects who underwent (11)C-PIB PET imaging, 19% (n=4) of those with Alzheimer's disease (PIB positive) were initially diagnosed with non-Alzheimer's disease dementia.
In this study, PET with or without (11)C-PIB brain imaging helped improve the accuracy of diagnosis of dementia subtype in 36% of our patients with underlying Alzheimer's disease, dementia with Lewy bodies, vascular dementia, and frontotemporal dementia.
本研究调查了接受[18F]-2-氟-2-脱氧-D-葡萄糖正电子发射断层扫描（(18)FDG PET）且使用或未使用碳11标记的匹兹堡化合物B（(11)C-PIB）的中国痴呆患者中痴呆亚型诊断准确性的提高情况。
本病例系列研究在香港玛丽医院记忆门诊进行。我们回顾了2007年1月至2014年12月期间接受PET检查（使用或未使用(11)C-PIB）的109名受试者（56.9%为女性）。从病历中收集了包括年龄、性别、教育水平、简易精神状态检查表评分、临床痴呆评定量表评分、神经影像学报告以及影像检查前后的临床诊断等数据。使用Cohen's kappa统计分析初始诊断与PET检查（使用或未使用(11)C-PIB）后痴呆诊断之间的一致性。
痴呆亚型初始临床诊断的总体准确率为63.7%，在接受PET检查（使用或未使用(11)C-PIB）后，36.3%的受试者诊断结果发生了改变。阿尔茨海默病、路易体痴呆、额颞叶痴呆、血管性痴呆、其他痴呆和混合性痴呆的初始临床诊断准确率（与最终影像检查后诊断相比）分别为81.5%、44.4%、14.3%、28.6%、55.6%和0%。初始诊断与最终影像检查后痴呆亚型诊断之间的一致性仅为中等，Cohen's kappa值为0.25（95%置信区间，0.05 - 0.45）。对于21名接受(11)C-PIB PET成像的受试者，19%（n = 4）的阿尔茨海默病患者（PIB阳性）最初被诊断为非阿尔茨海默病痴呆。
在本研究中，PET检查（使用或未使用(11)C-PIB）脑部成像有助于提高36%的潜在阿尔茨海默病、路易体痴呆、血管性痴呆和额颞叶痴呆患者痴呆亚型的诊断准确性。
