淀粉样蛋白PET与脑脊液检测在阿尔茨海默病诊断中的增量价值
Incremental value of amyloid-PET versus CSF in the diagnosis of Alzheimer's disease.
作者信息
Ramusino Matteo Cotta, Garibotto Valentina, Bacchin Ruggero, Altomare Daniele, Dodich Alessandra, Assal Frederic, Mendes Aline, Costa Alfredo, Tinazzi Michele, Morbelli Silvia D, Bauckneht Matteo, Picco Agnese, Dottorini Massimo E, Tranfaglia Cristina, Farotti Lucia, Salvadori Nicola, Moretti Davide, Savelli Giordano, Tarallo Anna, Nobili Flavio, Parapini Maura, Cavaliere Carlo, Salvatore Elena, Salvatore Marco, Boccardi Marina, Frisoni Giovanni B
机构信息
Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland.
Center for Cognitive and Behavioral Disorders, IRCCS Mondino Foundation and Dept of Brain and Behavior, University of Pavia, 27100, Pavia, Italy.
出版信息
Eur J Nucl Med Mol Imaging. 2020 Feb;47(2):270-280. doi: 10.1007/s00259-019-04466-6. Epub 2019 Aug 6.
PURPOSE
To compare the incremental diagnostic value of amyloid-PET and CSF (Aβ42, tau, and phospho-tau) in AD diagnosis in patients with mild cognitive impairment (MCI) or mild dementia, in order to improve the definition of diagnostic algorithm.
METHODS
Two independent dementia experts provided etiological diagnosis and relative diagnostic confidence in 71 patients on 3 rounds, based on (1) clinical, neuropsychological, and structural MRI information alone; (2) adding one biomarker (CSF amyloid and tau levels or amyloid-PET with a balanced randomized design); and (3) adding the other biomarker.
RESULTS
Among patients with a pre-biomarker diagnosis of AD, negative PET induced significantly more diagnostic changes than amyloid-negative CSF at both rounds 2 (CSF 67%, PET 100%, P = 0.028) and 3 (CSF 0%; PET 78%, P < 0.001); PET induced a diagnostic confidence increase significantly higher than CSF on both rounds 2 and 3.
CONCLUSIONS
Amyloid-PET should be prioritized over CSF biomarkers in the diagnostic workup of patients investigated for suspected AD, as it provides greater changes in diagnosis and diagnostic confidence.
TRIAL REGISTRATION
EudraCT no.: 2014-005389-31.
目的
比较淀粉样蛋白PET和脑脊液（Aβ42、tau蛋白和磷酸化tau蛋白）在轻度认知障碍（MCI）或轻度痴呆患者AD诊断中的增量诊断价值，以完善诊断算法的定义。
方法
两位独立的痴呆症专家基于以下信息对71例患者进行三轮病因诊断及相关诊断置信度评估：（1）仅依据临床、神经心理学和结构MRI信息；（2）添加一种生物标志物（脑脊液淀粉样蛋白和tau蛋白水平或采用平衡随机设计的淀粉样蛋白PET）；（3）添加另一种生物标志物。
结果
在生物标志物检查前诊断为AD的患者中，第二轮（脑脊液67%，PET 100%，P = 0.028）和第三轮（脑脊液0%；PET 78%，P < 0.001）时，PET阴性导致的诊断变化均显著多于淀粉样蛋白阴性的脑脊液；第二轮和第三轮中，PET导致的诊断置信度提升均显著高于脑脊液。
结论
在对疑似AD患者进行诊断检查时，淀粉样蛋白PET应优先于脑脊液生物标志物，因为它能带来更大的诊断变化和诊断置信度提升。
试验注册号
EudraCT编号：2014-005389-31。
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