Schütz Lisa, Lobsien Donald, Fritzsch Dominik, Tiepolt Solveig, Werner Peter, Schroeter Matthias L, Berrouschot Jörg, Saur Dorothee, Hesse Swen, Jochimsen Thies, Rullmann Michael, Sattler Bernhard, Patt Marianne, Gertz Hermann-Josef, Villringer Arno, Claßen Joseph, Hoffmann Karl-Titus, Sabri Osama, Barthel Henryk
Department of Nuclear Medicine, Leipzig University Hospital, Liebigstr. 18, 04103, Leipzig, Germany.
Department of Neuroradiology, Leipzig University Hospital, 04103, Leipzig, Germany.
Eur J Nucl Med Mol Imaging. 2016 Nov;43(12):2236-2243. doi: 10.1007/s00259-016-3462-x. Epub 2016 Jul 19.
Established Alzheimer's disease (AD) biomarker concepts classify into amyloid pathology and neuronal injury biomarkers, while recent alternative concepts classify into diagnostic and progression AD biomarkers. However, combined amyloid positron emission tomography/magnetic resonance imaging (PET/MRI) offers the chance to obtain both biomarker category read-outs within one imaging session, with increased patient as well as referrer convenience. The aim of this pilot study was to investigate this matter for the first time.
100 subjects (age 70 ± 10 yrs, 46 female), n = 51 with clinically defined mild cognitive impairment (MCI), n = 44 with possible/probable AD dementia, and n = 5 with frontotemporal lobe degeneration, underwent simultaneous [F]florbetaben or [C]PIB PET/MRI (3 Tesla Siemens mMR). Brain amyloid load, mesial temporal lobe atrophy (MTLA) by means of the Scheltens scale, and other morphological brain pathologies were scored by respective experts. The patients/caregivers as well as the referrers were asked to assess on a five-point scale the convenience related to the one-stop-shop PET and MRI approach.
In three subjects, MRI revealed temporal lobe abnormalities other than MTLA. According to the National Institute on Aging-Alzheimer's Association classification, the combined amyloid-beta PET/MRI evaluation resulted in 31 %, 45 %, and 24 % of the MCI subjects being categorized as "MCI-unlikely due to AD", "MCI due to AD-intermediate likelihood", and "MCI due to AD-high likelihood", respectively. 50 % of the probable AD dementia patients were categorized as "High level of evidence of AD pathophysiological process", and 56 % of the possible AD dementia patients as "Possible AD dementia - with evidence of AD pathophysiological process". With regard to the International Working Group 2 classification, 36 subjects had both positive diagnostic and progression biomarkers. The patient/caregiver survey revealed a gain of convenience in 88 % of responders as compared to a theoretically separate PET and MR imaging. In the referrer survey, an influence of the combined amyloid-beta PET/MRI on the final diagnosis was reported by 82 % of responders, with a referrer acceptance score of 3.7 ± 1.0 on a 5-point scale.
Simultaneous amyloid PET/MRI is feasible and provides imaging biomarkers of all categories which are able to supplement the clinical diagnosis of MCI due to AD and that of AD dementia. Further, patient and referrer convenience is improved by this one-stop-shop imaging approach.
已确立的阿尔茨海默病（AD）生物标志物概念分为淀粉样蛋白病理学和神经元损伤生物标志物，而最近的替代概念则分为AD诊断和进展生物标志物。然而，联合淀粉样蛋白正电子发射断层扫描/磁共振成像（PET/MRI）提供了在一次成像检查中获得两类生物标志物读数的机会，提高了患者及转诊医生的便利性。本初步研究的目的是首次对此进行调查。
100名受试者（年龄70±10岁，46名女性），n = 51例临床诊断为轻度认知障碍（MCI），n = 44例可能/很可能患有AD痴呆，n = 5例患有额颞叶变性，接受了同时进行的[F]氟比他班或[C]PIB PET/MRI（3特斯拉西门子mMR）检查。由相关专家对脑淀粉样蛋白负荷、采用Scheltens量表评估的内侧颞叶萎缩（MTLA）以及其他脑形态学病变进行评分。要求患者/护理人员以及转诊医生采用五点量表评估与一站式PET和MRI检查方法相关的便利性。
在3名受试者中，MRI显示除MTLA外的颞叶异常。根据美国国立衰老研究所-阿尔茨海默病协会的分类，联合淀粉样β蛋白PET/MRI评估结果显示，MCI受试者中分别有31%、45%和24%被归类为“因AD不太可能为MCI”、“因AD中度可能为MCI”和“因AD高度可能为MCI”。50%的很可能患有AD痴呆的患者被归类为“AD病理生理过程的高证据水平”，56%的可能患有AD痴呆的患者被归类为“可能患有AD痴呆 - 有AD病理生理过程的证据”。根据国际工作组2的分类，36名受试者同时具有阳性诊断和进展生物标志物。患者/护理人员调查显示，与理论上单独的PET和MR成像相比，88%的受访者表示便利性有所提高。在转诊医生调查中，82%的受访者报告联合淀粉样β蛋白PET/MRI对最终诊断有影响，转诊医生接受度评分为3.7±1.0（五点量表）。
同时进行淀粉样蛋白PET/MRI是可行的，可提供所有类别的成像生物标志物，能够补充因AD导致的MCI以及AD痴呆的临床诊断。此外，这种一站式成像方法提高了患者和转诊医生的便利性。
