Smith Ruben, Schöll Michael, Widner Håkan, van Westen Danielle, Svenningsson Per, Hägerström Douglas, Ohlsson Tomas, Jögi Jonas, Nilsson Christer, Hansson Oskar
From the Departments of Neurology (R.S., H.W., C.N.), Clinical Neurophysiology (D.H.), Radiation Physics (T.O.), and Clinical Physiology and Nuclear Medicine (J.J.), Skåne University Hospital (D.v.W.), Lund; Clinical Memory Research Unit (R.S., M.S., C.N., O.H.), Department of Clinical Sciences (D.v.W.), and Department of Diagnostic Radiology (D.v.W.), Lund University, Malmö; Wallenberg Centre for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry (M.S.), University of Gothenburg; Department of Clinical Neuroscience (P.S.), CMM L8:01, Stockholm; and Memory Clinic (O.H.), Skåne University Hospital, Malmö, Sweden.
Neurology. 2017 Aug 22;89(8):845-853. doi: 10.1212/WNL.0000000000004264. Epub 2017 Jul 28.
To study the usefulness of F-AV-1451 PET in patients with corticobasal syndrome (CBS).
We recruited 8 patients with CBS, 17 controls, 31 patients with Alzheimer disease (AD), and 11 patients with progressive supranuclear palsy (PSP) from the Swedish BioFINDER study. All patients underwent clinical assessment, F-AV-1451 PET, MRI, and quantification of β-amyloid pathology. A subset of participants also underwent F-FDG-PET.
In the 8 patients with CBS, 6 had imaging findings compatible with the corticobasal degeneration pathology and 2 with typical AD pathology. In the 6 patients with CBS without typical AD pathology, there were substantial retentions of F-AV-1451 in the motor cortex, corticospinal tract, and basal ganglia contralateral to the most affected body side. These patients could be clearly distinguished from patients with AD dementia or PSP using F-AV-1451. However, cortical atrophy was more widespread than the cortical retention of F-AV1451 in these CBS cases, and cortical AV-1451 uptake did not correlate with cortical thickness or glucose hypometabolism. These results are in sharp contrast to AD dementia, where F-AV-1451 retention was more widespread than cortical atrophy, and correlated well with cortical thickness and hypometabolism.
Patients with CBS without typical AD pathology exhibited AV-1451 retention in the motor cortex, corticospinal tract, and basal ganglia contralateral to the affected body side, clearly different from controls and patients with AD dementia or PSP. However, cortical atrophy measured with MRI and decreased F-fluorodeoxyglucose uptake were more widespread than F-AV-1451 uptake and probably represent earlier, yet less specific, markers of CBS.
This study provides Class III evidence that F-AV-1451 PET distinguishes between CBS and AD or PSP.
研究F-AV-1451正电子发射断层扫描（PET）在皮质基底节综合征（CBS）患者中的应用价值。
我们从瑞典生物标志物研究中招募了8例CBS患者、17例对照者、31例阿尔茨海默病（AD）患者和11例进行性核上性麻痹（PSP）患者。所有患者均接受了临床评估、F-AV-1451 PET、磁共振成像（MRI）以及β淀粉样蛋白病理学定量分析。部分参与者还接受了F-氟代脱氧葡萄糖（F-FDG）PET检查。
在8例CBS患者中，6例的影像学表现符合皮质基底节变性病理学特征，2例符合典型AD病理学特征。在6例无典型AD病理学特征的CBS患者中，F-AV-1451在运动皮质、皮质脊髓束以及与受影响最严重身体侧对侧的基底节中有大量滞留。使用F-AV-1451可将这些患者与AD痴呆或PSP患者明显区分开来。然而，在这些CBS病例中，皮质萎缩比F-AV-1451在皮质的滞留更为广泛，且皮质AV-1451摄取与皮质厚度或葡萄糖代谢减低无关。这些结果与AD痴呆形成鲜明对比，在AD痴呆中，F-AV-1451滞留比皮质萎缩更为广泛，且与皮质厚度和代谢减低密切相关。
无典型AD病理学特征的CBS患者在运动皮质、皮质脊髓束以及与受影响身体侧对侧的基底节中表现出AV-1451滞留，这与对照者以及AD痴呆或PSP患者明显不同。然而，MRI测量的皮质萎缩和F-氟代脱氧葡萄糖摄取减少比F-AV-1451摄取更为广泛，可能代表了CBS更早但特异性较低的标志物。
本研究提供了III类证据，表明F-AV-1451 PET可区分CBS与AD或PSP。
