Triviño-Ibáñez Eva María, Sánchez-Vañó Raquel, Sopena-Novales Pablo, Romero-Fábrega Juan Carlos, Rodríguez-Fernández Antonio, Carnero Pardo Cristóbal, Martínez Lozano María Dolores, Gómez-Río Manuel
Department of Nuclear Medicine, Virgen de las Nieves University Hospital.
IBS, Granada Bio-Health Research Institute, Granada.
Medicine (Baltimore). 2019 Jul;98(29):e16509. doi: 10.1097/MD.0000000000016509.
To evaluate the use of amyloid-positron emission tomography (PET) in routine clinical practice, in a selected population with cognitive impairment that meets appropriate use criteria (AUC).A multicenter, observational, prospective case-series study of 211patients from 2 level-3 hospitals who fulfilled clinical AUC for amyloid-PET scan in a naturalistic setting. Certainty degree was evaluated using a 5-point Likert scale: 0 (very low probability); 1 (low probability); 2 (intermediate probability); 3 (high probability); and 4 (practically sure), before and after amyloid PET. The treatment plan was considered as cognition-specific or noncognition-specific.Amyloid-PET was positive in 118 patients (55.9%) and negative in 93 patients (44.1%). Diagnostic prescan confidence according amyloid-PET results showed that in both, negative and positive-PET subgroup, the most frequent category was intermediate probability (45.7% and 55.1%, respectively). After the amyloid-PET, the diagnostic confidence showed a very different distribution, that was, in the negative-PET group the most frequent categories are very unlikely (70.7%) and unlikely (29.3%), while in the positive-PET group were very probable (57.6%) and practically sure (39%). Only in 14/211 patients (6.6%) the result of the amyloid-PET did not influence the diagnostic confidence, while in 194 patients (93.4%), the diagnostic confidence improved significantly after amyloid-PET results. The therapeutic intention was modified in 93 patients (44.1%). Specific treatment for Alzheimer disease was started, before amyloid-PET, in 80 patients (37.9%).This naturalistic study provides evidence that the implementation of amyloid-PET is associated with a significant improvement in diagnostic confidence and has a high impact on the therapeutic management of patients with mild cognitive impairment fulfilled clinical AUC.
为评估淀粉样蛋白正电子发射断层扫描（PET）在常规临床实践中的应用情况，选取了符合适当使用标准（AUC）的认知障碍患者群体。这是一项来自2家三级医院的211例患者的多中心、观察性、前瞻性病例系列研究，这些患者在自然环境中满足淀粉样蛋白PET扫描的临床AUC标准。在淀粉样蛋白PET检查前后，使用5点李克特量表评估确定性程度：0（极低概率）；1（低概率）；2（中等概率）；3（高概率）；4（几乎确定）。治疗计划被视为针对认知或不针对认知。118例患者（55.9%）的淀粉样蛋白PET呈阳性，93例患者（44.1%）呈阴性。根据淀粉样蛋白PET结果的扫描前诊断信心显示，在PET阴性和阳性亚组中，最常见的类别都是中等概率（分别为45.7%和55.1%）。淀粉样蛋白PET检查后，诊断信心呈现出非常不同的分布，即PET阴性组中最常见的类别是极不可能（70.7%）和不太可能（29.3%），而PET阳性组中是很可能（57.6%）和几乎确定（39%）。仅14/211例患者（6.6%）的淀粉样蛋白PET结果未影响诊断信心，而194例患者（93.4%）在淀粉样蛋白PET结果出来后诊断信心显著提高。93例患者（44.1%）的治疗意向发生了改变。在淀粉样蛋白PET检查前，80例患者（37.9%）开始了针对阿尔茨海默病的特异性治疗。这项自然研究提供了证据，表明淀粉样蛋白PET的实施与诊断信心的显著提高相关，并且对符合临床AUC的轻度认知障碍患者的治疗管理有很大影响。
