From the Memory and Aging Center, Department of Neurology (A.B., G.T., G.M., Y.C., L.I., J.K., A.M.S., M.G.-T., B.L.M., A.L.B., H.J.R., G.D.R.), and Department of Radiology and Biomedical Imaging (G.D.R.), University of California San Francisco; Frontotemporal Disorders Unit (B.C.D.), Department of Neurology, Massachusetts General Hospital, Boston; and Harvard Medical School, Charleston; Department of Neurology (B.F.B., D.S.K.), Mayo Clinic, Rochester, MN; Molecular Biophysics and Integrated Bioimaging Division (W.J.J., G.D.R.), Lawrence Berkeley National Laboratory, CA; and Helen Wills Neuroscience Institute (G.D.R.), University of California Berkeley.
Neurology. 2020 Jul 14;95(2):e140-e154. doi: 10.1212/WNL.0000000000009760. Epub 2020 Jun 26.
To compare the sensitivity of structural MRI and F-fludeoxyglucose PET (FDG-PET) to detect longitudinal changes in frontotemporal dementia (FTD).
Thirty patients with behavioral variant FTD (bvFTD), 7 with nonfluent/agrammatic variant primary progressive aphasia (nfvPPA), 16 with semantic variant primary progressive aphasia (svPPA), and 43 cognitively normal controls underwent 2-4 MRI and FDG-PET scans (total scans/visit = 270) as part of the Frontotemporal Lobar Degeneration Neuroimaging Initiative study. Linear mixed-effects models were carried out voxel-wise and in regions of interest to identify areas showing decreased volume or metabolism over time in patients as compared to controls.
At baseline, patients with bvFTD showed bilateral temporal, dorsolateral, and medial prefrontal atrophy/hypometabolism that extended with time into adjacent structures and parietal lobe. In nfvPPA, baseline atrophy/hypometabolism in supplementary motor cortex extended with time into left greater than right precentral, dorsolateral, and dorsomedial prefrontal cortex. In svPPA, baseline atrophy/hypometabolism encompassed the anterior temporal and medial prefrontal cortex and longitudinal changes were found in temporal, orbitofrontal, and lateral parietal cortex. Across syndromes, there was substantial overlap in the brain regions showing volume and metabolism loss. Even though the pattern of metabolic decline was more extensive, metabolic changes were also more variable and sample size estimates were similar or higher for FDG-PET compared to MRI.
Our findings demonstrated the sensitivity of FDG-PET and structural MRI for tracking disease progression in FTD. Both modalities showed highly overlapping patterns of longitudinal change and comparable sample size estimates to detect longitudinal changes in future clinical trials.
比较结构磁共振成像（MRI）和 F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）检测额颞叶痴呆（FTD）纵向变化的敏感性。
30 例行为变异型额颞叶痴呆（bvFTD）患者、7 例非流利/语法障碍型原发性进行性失语（nfvPPA）患者、16 例语义变异型原发性进行性失语（svPPA）患者和 43 例认知正常对照者作为额颞叶变性神经影像学倡议研究的一部分，接受了 2-4 次 MRI 和 FDG-PET 扫描（总扫描/就诊次数为 270 次）。采用线性混合效应模型对患者与对照组进行了基于体素和感兴趣区的分析，以识别出在时间上表现出体积或代谢减少的区域。
在基线时，bvFTD 患者双侧颞叶、背外侧和内侧前额叶萎缩/代谢低下，随着时间的推移，这些区域扩展到相邻结构和顶叶。在 nfvPPA 中，补充运动皮质的基线萎缩/代谢低下随着时间的推移扩展到左侧大于右侧中央前回、背外侧和背内侧前额叶皮质。在 svPPA 中，基线萎缩/代谢低下范围包括前颞叶和内侧前额叶皮质，并且在颞叶、眶额和外侧顶叶皮质中发现了纵向变化。在各个综合征中，表现出体积和代谢损失的脑区有很大的重叠。尽管代谢下降的模式更为广泛，但代谢变化也更为多变，FDG-PET 的样本量估计与 MRI 相似或更高。
我们的研究结果表明，FDG-PET 和结构 MRI 均可用于检测 FTD 疾病进展。两种方法都显示出高度重叠的纵向变化模式，并且在未来的临床试验中具有相似或更高的检测纵向变化的样本量估计。
