AP-HM-Hôpital de la Timone, Neurology and Neuropsychology Department, and Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.
Geriatric Department, CHRU de Nancy-Hôpital Brabois, Vandoeuvre-les-Nancy, France.
Alzheimers Dement. 2018 Mar;14(3):293-305. doi: 10.1016/j.jalz.2017.09.009. Epub 2017 Nov 4.
Although some studies have previously addressed the clinical impact of amyloid positron emission tomography (PET), none has specifically addressed its selective and hierarchical implementation in relation to cerebrospinal fluid analysis in a naturalistic setting.
This multicenter study was performed at French tertiary memory clinics in patients presenting with most complex clinical situations (i.e., early-onset, atypical clinical profiles, suspected mixed etiological conditions, unexpected rate of progression), for whom cerebrospinal fluid analysis was indicated but either not feasible or considered as noncontributory (ClinicalTrials.gov: NCT02681172).
Two hundred five patients were enrolled with evaluable florbetaben PET scans; 64.4% of scans were amyloid positive. PET results led to changed diagnosis and improved confidence in 66.8% and 81.5% of patients, respectively, and altered management in 80.0% of cases.
High-level improvement of diagnostic certainty and management is provided by selective and hierarchical implementation of florbetaben PET into current standard practices for the most complex dementia cases.
尽管先前有一些研究探讨了淀粉样蛋白正电子发射断层扫描(PET)的临床影响,但没有一项研究专门针对在自然环境中结合脑脊液分析,对其进行有选择性和分层的实施。
这项多中心研究在法国三级记忆诊所进行,入组的是具有最复杂临床情况的患者(即发病早、非典型临床特征、疑似混合病因、进展速度出乎意料),这些患者需要进行脑脊液分析,但由于各种原因无法进行或认为无意义(ClinicalTrials.gov:NCT02681172)。
共纳入 205 例可评估氟比他滨 PET 扫描的患者;64.4%的扫描结果为淀粉样蛋白阳性。PET 结果分别使 66.8%和 81.5%的患者改变了诊断和增加了诊断信心,80.0%的患者改变了治疗方案。
通过有选择性和分层的方式,将氟比他滨 PET 纳入最复杂的痴呆病例的现行标准实践中,可提供更高水平的诊断确定性和管理改善。