Dickstein D L, Pullman M Y, Fernandez C, Short J A, Kostakoglu L, Knesaurek K, Soleimani L, Jordan B D, Gordon W A, Dams-O'Connor K, Delman B N, Wong E, Tang C Y, DeKosky S T, Stone J R, Cantu R C, Sano M, Hof P R, Gandy S
Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Transl Psychiatry. 2016 Sep 27;6(9):e900. doi: 10.1038/tp.2016.175.
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder most commonly associated with repetitive traumatic brain injury (TBI) and characterized by the presence of neurofibrillary tangles of tau protein, known as a tauopathy. Currently, the diagnosis of CTE can only be definitively established postmortem. However, a new positron emission tomography (PET) ligand, [F]T807/AV1451, may provide the antemortem detection of tau aggregates, and thus various tauopathies, including CTE. Our goal was to examine [F]T807/AV1451 retention in athletes with neuropsychiatric symptoms associated with a history of multiple concussions. Here we report a 39-year-old retired National Football League player who suffered 22 concussions and manifested progressive neuropsychiatric symptoms. Emotional lability and irritability were the chief complaints. Serial neuropsychological exams revealed a decline in executive functioning, processing speed and fine motor skills. Naming was below average but other cognitive functions were preserved. Structural analysis of longitudinally acquired magenetic resonance imaging scans revealed cortical thinning in the left frontal and lateral temporal areas, as well as volume loss in the basal ganglia. PET with [F]florbetapir was negative for amyloidosis. The [F]T807/AV1451 PET showed multifocal areas of retention at the cortical gray matter-white matter junction, a distribution considered pathognomonic for CTE. [F]T807/AV1451 standard uptake value (SUV) analysis showed increased uptake (SUVr⩾1.1) in bilateral cingulate, occipital, and orbitofrontal cortices, and several temporal areas. Although definitive identification of the neuropathological underpinnings basis for [F]T807/AV1451 retention requires postmortem correlation, our data suggest that [F]T807/AV1451 tauopathy imaging may be a promising tool to detect and diagnose CTE-related tauopathy in living subjects.
慢性创伤性脑病（CTE）是一种神经退行性疾病，最常与重复性创伤性脑损伤（TBI）相关，其特征是存在tau蛋白神经原纤维缠结，这是一种tau蛋白病。目前，CTE的诊断只能在死后才能明确确立。然而，一种新的正电子发射断层扫描（PET）配体[F]T807/AV1451，可能能够在生前检测到tau蛋白聚集体，从而检测包括CTE在内的各种tau蛋白病。我们的目标是研究[F]T807/AV1451在有多次脑震荡病史且伴有神经精神症状的运动员中的滞留情况。在此，我们报告一名39岁的退役美国国家橄榄球联盟球员，他曾遭受22次脑震荡，并出现了进行性神经精神症状。情绪不稳定和易怒是主要症状。系列神经心理学检查显示执行功能、处理速度和精细运动技能下降。命名能力低于平均水平，但其他认知功能保留。对纵向获取的磁共振成像扫描进行结构分析，发现左侧额叶和颞叶外侧皮质变薄，以及基底神经节体积减小。[F]florbetapir PET检查显示淀粉样变性为阴性。[F]T807/AV1451 PET显示皮质灰质-白质交界处有多个滞留区域，这种分布被认为是CTE的特征性表现。[F]T807/AV1451标准摄取值（SUV）分析显示双侧扣带回、枕叶和眶额皮质以及几个颞叶区域摄取增加（SUVr⩾1.1）。虽然明确确定[F]T807/AV1451滞留的神经病理学基础需要死后进行相关性研究，但我们的数据表明，[F]T807/AV1451 tau蛋白病成像可能是一种有前景的工具，用于在活体受试者中检测和诊断与CTE相关的tau蛋白病。
