Garibotto Valentina, Herholz Karl, Boccardi Marina, Picco Agnese, Varrone Andrea, Nordberg Agneta, Nobili Flavio, Ratib Osman
Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospitals of Geneva, Geneva University, Geneva, Switzerland.
Wolfson Molecular Imaging Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Neurobiol Aging. 2017 Apr;52:183-195. doi: 10.1016/j.neurobiolaging.2016.03.033.
The use of Alzheimer's disease (AD) biomarkers is supported in diagnostic criteria, but their maturity for clinical routine is still debated. Here, we evaluate brain fluorodeoxyglucose positron emission tomography (FDG PET), a measure of cerebral glucose metabolism, as a biomarker to identify clinical and prodromal AD according to the framework suggested for biomarkers in oncology, using homogenous criteria with other biomarkers addressed in parallel reviews. FDG PET has fully achieved phase 1 (rational for use) and most of phase 2 (ability to discriminate AD subjects from healthy controls or other forms of dementia) aims. Phase 3 aims (early detection ability) are partly achieved. Phase 4 studies (routine use in prodromal patients) are ongoing, and only preliminary results can be extrapolated from retrospective observations. Phase 5 studies (quantify impact and costs) have not been performed. The results of this study show that specific efforts are needed to complete phase 3 evidence, in particular comparing and combining FDG PET with other biomarkers, and to properly design phase 4 prospective studies as a basis for phase 5 evaluations.
阿尔茨海默病（AD）生物标志物在诊断标准中得到了支持，但其在临床常规应用中的成熟度仍存在争议。在此，我们根据肿瘤学生物标志物建议的框架，使用与平行综述中涉及的其他生物标志物相同的标准，评估脑氟代脱氧葡萄糖正电子发射断层扫描（FDG PET），一种脑葡萄糖代谢的测量方法，作为识别临床和前驱AD的生物标志物。FDG PET已完全实现了第1阶段（使用的合理性）和大部分第2阶段（将AD患者与健康对照或其他形式的痴呆区分开来的能力）的目标。第3阶段的目标（早期检测能力）部分实现。第4阶段的研究（在前驱患者中的常规应用）正在进行中，目前只能从回顾性观察中推断出初步结果。第5阶段的研究（量化影响和成本）尚未开展。本研究结果表明，需要做出具体努力来完成第3阶段的证据，特别是将FDG PET与其他生物标志物进行比较和结合，并妥善设计第4阶段的前瞻性研究，作为第5阶段评估的基础。
