Institute of Neuroscience, Newcastle University,Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL,UK.
Nuclear Medicine Department,Leazes Wing, Royal Victoria Infirmary,Richardson Road, Newcastle upon Tyne NE1 4LP,UK.
Psychol Med. 2019 Feb;49(3):396-402. doi: 10.1017/S0033291718000995. Epub 2018 Apr 25.
Dopaminergic imaging has high diagnostic accuracy for dementia with Lewy bodies (DLB) at the dementia stage. We report the first investigation of dopaminergic imaging at the prodromal stage.
We recruited 75 patients over 60 with mild cognitive impairment (MCI), 33 with probable MCI with Lewy body disease (MCI-LB), 15 with possible MCI-LB and 27 with MCI with Alzheimer's disease. All underwent detailed clinical, neurological and neuropsychological assessments and FP-CIT [123I-N-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)] dopaminergic imaging. FP-CIT scans were blindly rated by a consensus panel and classified as normal or abnormal.
The sensitivity of visually rated FP-CIT imaging to detect combined possible or probable MCI-LB was 54.2% [95% confidence interval (CI) 39.2-68.6], with a specificity of 89.0% (95% CI 70.8-97.6) and a likelihood ratio for MCI-LB of 4.9, indicating that FP-CIT may be a clinically important test in MCI where any characteristic symptoms of Lewy body (LB) disease are present. The sensitivity in probable MCI-LB was 61.0% (95% CI 42.5-77.4) and in possible MCI-LB was 40.0% (95% CI 16.4-67.7).
Dopaminergic imaging had high specificity at the pre-dementia stage and gave a clinically important increase in diagnostic confidence and so should be considered in all patients with MCI who have any of the diagnostic symptoms of DLB. As expected, the sensitivity was lower in MCI-LB than in established DLB, although over 50% still had an abnormal scan. Accurate diagnosis of LB disease is important to enable early optimal treatment for LB symptoms.
多巴胺能成像在痴呆路易体（DLB）的痴呆阶段具有较高的诊断准确性。我们报告了对前驱期进行多巴胺能成像的首次研究。
我们招募了 75 名 60 岁以上的轻度认知障碍（MCI）患者、33 名可能的 MCI 伴路易体病（MCI-LB）患者、15 名可能的 MCI-LB 患者和 27 名 MCI 伴阿尔茨海默病患者。所有患者均接受了详细的临床、神经学和神经心理学评估以及 FP-CIT[123I-N-氟丙基-2β-羧基-3β-（4-碘苯基）]多巴胺能成像。FP-CIT 扫描由共识小组进行盲法评分，并分为正常或异常。
视觉评分的 FP-CIT 成像对检测合并的可能或确诊 MCI-LB 的敏感性为 54.2%（95%置信区间 [CI] 39.2-68.6），特异性为 89.0%（95%CI 70.8-97.6），MCI-LB 的似然比为 4.9，表明 FP-CIT 可能是 MCI 中具有重要临床意义的检测手段，因为 MCI 中存在任何路易体（LB）疾病的特征性症状。在确诊的 MCI-LB 中的敏感性为 61.0%（95%CI 42.5-77.4），在可能的 MCI-LB 中的敏感性为 40.0%（95%CI 16.4-67.7）。
多巴胺能成像在痴呆前阶段具有较高的特异性，并显著提高了诊断信心，因此应考虑在所有有 DLB 诊断症状的 MCI 患者中进行此项检测。正如预期的那样，MCI-LB 的敏感性低于已确诊的 DLB，但仍有超过 50%的患者扫描结果异常。准确诊断 LB 疾病对于早期治疗 LB 症状非常重要。
