Kim Yejin, Rosenberg Paul, Oh Esther
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Dement Geriatr Cogn Disord. 2018;46(3-4):154-167. doi: 10.1159/000492151. Epub 2018 Sep 10.
Molecular imaging of brain amyloid for the diagnosis of Alzheimer's disease (AD) using positron emission tomography (PET) has been approved for use in clinical practice by the Food and Drug Administration (FDA) since 2012. However, the clinical utility and diagnostic impact of amyloid PET imaging remain controversial. We conducted a review of the recent studies investigating clinical utility of amyloid PET imaging with focus on changes in diagnosis, diagnostic confidence, and patient management.
A total of 16 studies were included in the final analysis. Overall rate of changes in diagnosis after amyloid PET ranged from 9 to 68% (pooled estimate of 31%, 95% CI 23-39%). All studies reported overall increase in diagnostic confidence or diagnostic certainty after amyloid PET. Changes in patient management ranged from 37 to 87%; the most common type of change in management reported was either the initiation or discontinuation of planned AD medications. Key Messages: Amyloid PET imaging led to moderate to significant changes in diagnosis, diagnostic confidence, and subsequent patient management. It may be most useful in patients with high level of diagnostic uncertainty even after the completing the standard workup.
自2012年以来，使用正电子发射断层扫描（PET）对大脑淀粉样蛋白进行分子成像以诊断阿尔茨海默病（AD）已获美国食品药品监督管理局（FDA）批准用于临床实践。然而，淀粉样蛋白PET成像的临床效用和诊断影响仍存在争议。我们对近期研究进行了综述，这些研究调查了淀粉样蛋白PET成像的临床效用，重点关注诊断、诊断信心和患者管理方面的变化。
最终分析共纳入16项研究。淀粉样蛋白PET检查后诊断改变的总体发生率为9%至68%（合并估计值为31%，95%可信区间为23% - 39%）。所有研究均报告淀粉样蛋白PET检查后诊断信心或诊断确定性总体增加。患者管理方面的改变范围为37%至87%；报告的最常见管理改变类型是开始或停止计划中的AD药物治疗。关键信息：淀粉样蛋白PET成像在诊断、诊断信心和后续患者管理方面导致了中度至显著的变化。即使在完成标准检查后，对于诊断不确定性高的患者，它可能最有用。
