Department of Nuclear Medicine, University Hospital of Munich, LMU, Munich, Germany.
Department of Radiology, Kindai University, Osaka, Japan.
J Alzheimers Dis. 2020;74(1):101-112. doi: 10.3233/JAD-190818.
Amyloid-β (Aβ) accumulation in brain of patients with suspected Alzheimer's disease (AD) can be assessed by positron emission tomography (PET) in vivo. While visual classification prevails in the clinical routine, semiquantitative PET analyses may enable more reliable evaluation of cases with a visually uncertain, borderline Aβ accumulation.
We evaluated different analysis approaches (visual/semiquantitative) to find the most accurate and sensitive interpretation of Aβ-PET for predicting risk of progression from mild cognitive impairment (MCI) to AD.
Based on standard uptake value (SUV) ratios of a cortical-composite volume of interest of 18F-AV45-PET from MCI subjects (n = 396, ADNI database), we compared three different reference region (cerebellar grey matter, CBL; brainstem, BST; white matter, WM) normalizations and the visual read by receiver operator characteristics for calculating a hazard ratio (HR) for progression to Alzheimer's disease dementia (ADD).
During a mean follow-up time of 45.6±13.0 months, 28% of the MCI cases (110/396) converted to ADD. Among the tested methods, the WM reference showed best discriminatory power and progression-risk stratification (HRWM of 4.4 [2.6-7.6]), but the combined results of the visual and semiquantitative analysis with all three reference regions showed an even higher discriminatory power.
A multi-analytical composite of visual and semiquantitative reference tissue analyses of 18F-AV45-PET gave improved risk stratification for progression from MCI to ADD relative to performance of single read-outs. This optimized approach is of special interest for prospective treatment trials, which demand a high accuracy.
疑似阿尔茨海默病（AD）患者脑内淀粉样蛋白-β（Aβ）的积累可以通过正电子发射断层扫描（PET）进行体内评估。虽然在临床常规中采用视觉分类，但半定量 PET 分析可能使具有不确定、边界 Aβ 积累的病例评估更加可靠。
我们评估了不同的分析方法（视觉/半定量），以找到最准确和敏感的 18F-AV45-PET 分析方法来预测从轻度认知障碍（MCI）到 AD 的进展风险。
基于 18F-AV45-PET 皮质复合感兴趣区的标准摄取值（SUV）比值（ADNI 数据库中 396 名 MCI 受试者），我们比较了三种不同的参考区域（小脑灰质、CBL；脑干、BST；脑白质、WM）归一化方法和视觉读片的接受者操作特征，以计算进展为阿尔茨海默病痴呆（ADD）的风险比（HR）。
在平均 45.6±13.0 个月的随访期间，396 例 MCI 病例中有 28%（110/396）转化为 ADD。在测试的方法中，WM 参考显示出最好的区分能力和进展风险分层（WM HR 为 4.4 [2.6-7.6]），但视觉和半定量分析与所有三种参考区域的综合结果显示出更高的区分能力。
与单一读片相比，18F-AV45-PET 的视觉和半定量参考组织分析的多分析组合为从 MCI 到 ADD 的进展提供了更好的风险分层。这种优化方法对于需要高精度的前瞻性治疗试验特别感兴趣。
