Department of Nuclear Medicine, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
LANE - Laboratory of Alzheimer's Neuroimaging & Epidemiology, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy.
Eur J Nucl Med Mol Imaging. 2018 Jul;45(9):1497-1508. doi: 10.1007/s00259-018-4039-7. Epub 2018 Apr 27.
We aim to report the quality of accuracy studies investigating the utility of [F]fluorodeoxyglucose (FDG)-PET in supporting the diagnosis of prodromal Alzheimer's Disease (AD), frontotemporal lobar degeneration (FTLD) and prodromal dementia with Lewy bodies (DLB) in mild cognitive impairment (MCI) subjects, and the corresponding recommendations made by a panel of experts.
Seven panellist, four from the European Association of Nuclear Medicine, and three from the European Academy of Neurology, produced recommendations taking into consideration the incremental value of FDG-PET, as added on clinical-neuropsychological examination, to ascertain the aetiology of MCI (AD, FTLD or DLB). A literature search using harmonized population, intervention, comparison, and outcome (PICO) strings was performed, and an evidence assessment consistent with the European Federation of Neurological Societies guidance was provided. The consensual recommendation was achieved based on Delphi rounds.
Fifty-four papers reported the comparison of interest. The selected papers allowed the identification of FDG patterns that characterized MCI due to AD, FTLD and DLB. While clinical outcome studies supporting the diagnosis of MCI due to AD showed varying accuracies (ranging from 58 to 100%) and varying areas under the receiver-operator characteristic curves (0.66 to 0.97), no respective data were identified for MCI due to FTLD or for MCI due to DLB. However, the high negative predictive value of FDG-PET and the existence of different disease-specific patterns of hypometabolism support the consensus recommendations for the clinical use of this imaging technique in MCI subjects.
FDG-PET has clinical utility on a fair level of evidence in detecting MCI due to AD. Although promising also in detecting MCI due to FTLD and MCI due to DLB, more research is needed to ultimately judge the clinical utility of FDG-PET in these entities.
我们旨在报告一项旨在评估 [F]氟脱氧葡萄糖（FDG）-PET 在支持轻度认知障碍（MCI）患者前驱阿尔茨海默病（AD）、额颞叶变性（FTLD）和前驱路易体痴呆（DLB）诊断中的效用准确性研究的质量，以及专家组提出的相应建议。
7 名小组成员，其中 4 名来自欧洲核医学协会，3 名来自欧洲神经病学会，根据 FDG-PET 在临床神经心理学检查基础上增加的附加价值，制定了关于确定 MCI（AD、FTLD 或 DLB）病因的建议。使用协调一致的人群、干预、比较和结局（PICO）字符串进行文献检索，并提供符合欧洲神经病学会联合会指南的证据评估。基于德尔菲（Delphi）回合达成共识建议。
54 篇论文报告了相关比较。所选论文可识别出 AD、FTLD 和 DLB 所致 MCI 的 FDG 模式。虽然支持 AD 所致 MCI 诊断的临床结局研究显示出不同的准确性（范围为 58%至 100%）和不同的受试者工作特征曲线下面积（0.66 至 0.97），但未发现 FTLD 或 DLB 所致 MCI 的相应数据。然而，FDG-PET 的高阴性预测值和存在不同的特定疾病代谢低下模式支持在 MCI 患者中使用该影像学技术的临床共识建议。
FDG-PET 在检测 AD 所致 MCI 方面具有一定水平的临床效用证据。虽然在检测 FTLD 和 DLB 所致 MCI 方面也有一定的应用前景，但需要进一步研究，以最终判断 FDG-PET 在这些疾病实体中的临床效用。
