使用脑灌注单光子发射计算机断层扫描（SPECT），验证扣带回岛叶征及其优化比率以鉴别路易体痴呆和阿尔茨海默病。
Validation of the cingulate island sign with optimized ratios for discriminating dementia with Lewy bodies from Alzheimer's disease using brain perfusion SPECT.
作者信息
Imabayashi Etsuko, Soma Tsutomu, Sone Daichi, Tsukamoto Tadashi, Kimura Yukio, Sato Noriko, Murata Miho, Matsuda Hiroshi
机构信息
Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan.
QMS Group, Quality Assurance Department, FUJIFILM RI Pharma Co., Ltd., 14-1 Kyobashi 2-Chome, Chuo-Ku, Tokyo, 104-0031, Japan.
出版信息
Ann Nucl Med. 2017 Aug;31(7):536-543. doi: 10.1007/s12149-017-1181-4. Epub 2017 May 25.
OBJECTIVE
Dementia with Lewy bodies (DLB) is often cited as the second most common dementia after Alzheimer's disease (AD). It is clinically important to distinguish DLB from AD because specific side effects of antipsychotic drugs are limited to DLB. The relative preservation of cingulate glucose metabolism in the posterior cingulate gyri versus that in the precuni, known as the cingulate island sign (CIS), in patients with DLB compared with AD is supposed to be highly specific for diagnosing DLB. In a previous study, using brain perfusion SPECT, the largest value (0.873) for the area under the receiver operating characteristic (ROC) curve (AUC) for differentiating DLB from AD was obtained with the ratio of the posterior cingulate gyri from an early Alzheimer's disease-specific hypoperfusion volume of interest (VOI) versus the medial occipital lobe. Two purposes of this study are as follows: one is optimization of VOI setting for calculating CIS values and the other is to evaluate their accuracy and simultaneously to retest the method described in our previous paper.
METHODS
We conducted a retest of this SPECT method with another cohort of 13 patients with DLB and 13 patients with AD. Furthermore, we optimized VOIs using contrast images obtained from group comparisons of DLB and normal controls; the same 18 patients with DLB and 18 normal controls examined in our previous study. We obtained DLB-specific VOIs from areas where brain perfusion was significantly decreased in DLB. As the numerators of these ratios, early Alzheimer's disease-specific VOIs were used after subtracting DLB-specific VOIs. The DLB-specific VOIs were used as the denominator.
RESULTS
In retest, the obtained AUC was 0.858 and the accuracy, sensitivity, and specificity were 84.6, 84.6, and 84.6%, respectively. The ROC curve analysis with these optimized VOIs yielded a higher AUC of 0.882; and the accuracy, sensitivity, and specificity of these new CIS ratios were 84.6, 92.3, and 76.9%, respectively, with a threshold value of 0.281.
CONCLUSION
Optimized CISs using brain perfusion SPECT are clinically useful for differentiating DLB from AD.
目的
路易体痴呆（DLB）常被认为是仅次于阿尔茨海默病（AD）的第二常见痴呆类型。区分DLB与AD具有重要临床意义，因为抗精神病药物的特定副作用仅限于DLB。与AD患者相比，DLB患者后扣带回皮质葡萄糖代谢相对于楔前叶相对保留，即扣带回岛征（CIS），被认为对诊断DLB具有高度特异性。在先前的一项研究中，使用脑灌注单光子发射计算机断层扫描（SPECT），通过早期阿尔茨海默病特异性低灌注感兴趣区（VOI）的后扣带回与枕叶内侧的比值，获得了区分DLB与AD的受试者工作特征（ROC）曲线下面积（AUC）的最大值（0.873）。本研究有两个目的：一是优化用于计算CIS值的VOI设置，二是评估其准确性，并同时重新测试我们先前论文中描述的方法。
方法
我们对另一组13例DLB患者和13例AD患者进行了该SPECT方法的重新测试。此外，我们使用从DLB与正常对照的组间比较获得的对比图像优化VOI；与我们先前研究中检查的18例DLB患者和18例正常对照相同。我们从DLB中脑灌注显著降低的区域获得了DLB特异性VOI。作为这些比值的分子，在减去DLB特异性VOI后使用早期阿尔茨海默病特异性VOI。DLB特异性VOI用作分母。
结果
在重新测试中，获得的AUC为0.858，准确性、敏感性和特异性分别为84.6%、84.6%和84.6%。使用这些优化后的VOI进行的ROC曲线分析产生了更高的AUC，为0.882；这些新的CIS比值的准确性、敏感性和特异性分别为84.6%、92.3%和76.9%阈值为（0.281）。
结论
使用脑灌注SPECT优化的CIS在临床上有助于区分DLB与AD。
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