Sonni Ida, Ratib Osman, Boccardi Marina, Picco Agnese, Herholz Karl, Nobili Flavio, Varrone Andrea
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, CA, USA; Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospital of Geneva, Geneva, Switzerland.
Neurobiol Aging. 2017 Apr;52:228-242. doi: 10.1016/j.neurobiolaging.2016.04.026.
The use of biomarkers (BMs) for accurate diagnosis of Alzheimer's disease (AD) has been proposed by recent diagnostic criteria; however, their maturity is not sufficient to grant implementation in the clinical routine. A proper diagnostic process requires not only confirmation of the disease but also the exclusion of similar disorders entering differential diagnosis, like dementia with Lewy bodies (DLB). This review is aimed at evaluating the clinical validity of I-ioflupane brain single photon emission tomography and I-MIBG cardiac scintigraphy as imaging BMs for DLB. For this purpose, we used an adapted version of the 5-phase oncology framework for BMs development. A review of the literature was conducted using homogenous search criteria with other BMs addressed in parallel reviews. Results of our literature search showed that the rationale for the use of both BMs in the differential diagnosis of DLB and AD is strong (phase 1) and that they allow a good discrimination ability (phase 2), but studies investigating BMs distribution antemortem and postmortem on pathology are lacking. Moreover, thresholds for test positivity have not been defined for I-MIBG. The 2 BMs have not been yet assessed in early phases of DLB and AD (phase 3). No phase 4 and phase 5 studies have so far been carried out. This review highlights the priorities to address in future investigations to enable the proper use of I-ioflupane and I-MIBG for the differential diagnosis of dementia.
近期的诊断标准提出使用生物标志物（BMs）来准确诊断阿尔茨海默病（AD）；然而，它们的成熟度尚不足以在临床常规中应用。一个恰当的诊断过程不仅需要确诊疾病，还需要排除进入鉴别诊断的类似疾病，如路易体痴呆（DLB）。本综述旨在评估123I-碘番酸脑单光子发射断层扫描和123I-间碘苄胍心脏闪烁扫描作为DLB成像生物标志物的临床有效性。为此，我们采用了适用于生物标志物开发的五阶段肿瘤学框架。使用与平行综述中涉及的其他生物标志物相同的搜索标准对文献进行了检索。我们的文献检索结果表明，在DLB和AD的鉴别诊断中使用这两种生物标志物的理论依据充分（第1阶段），并且它们具有良好的鉴别能力（第2阶段），但缺乏在生前和死后对病理情况下生物标志物分布进行研究的相关内容。此外，尚未确定123I-间碘苄胍检测阳性的阈值。这两种生物标志物尚未在DLB和AD的早期阶段进行评估（第3阶段）。到目前为止，尚未开展第4阶段和第5阶段的研究。本综述强调了未来研究中需要解决的重点问题，以便能够恰当地使用123I-碘番酸和123I-间碘苄胍进行痴呆的鉴别诊断。
