Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, 141 52, Stockholm, Sweden.
Center for Cognitive and Behavioral Disorders, IRCCS Mondino Foundation and Dept of Brain and Behavior, University of Pavia, 27100, Pavia, Italy.
Eur J Nucl Med Mol Imaging. 2021 Feb;48(2):612-622. doi: 10.1007/s00259-020-04969-7. Epub 2020 Jul 31.
To assess the clinical impact and incremental diagnostic value of F-fluorodeoxyglucose (FDG-PET) among memory clinic patients with uncertain diagnosis.
The study population consisted of 277 patients who, despite extensive baseline cognitive assessment, MRI, and CSF analyses, had an uncertain diagnosis of mild cognitive impairment (MCI) (n = 177) or dementia (n = 100). After baseline diagnosis, each patient underwent an FDG-PET, followed by a post-FDG-PET diagnosis formulation. We evaluated (i) the change in diagnosis (baseline vs. post-FDG-PET), (ii) the change in diagnostic accuracy when comparing each baseline and post-FDG-PET diagnosis to a long-term follow-up (3.6 ± 1.8 years) diagnosis used as reference, and (iii) comparative FDG-PET performance testing in MCI and dementia conditions.
FDG-PET led to a change in diagnosis in 86 of 277 (31%) patients, in particular in 57 of 177 (32%) MCI and in 29 of 100 (29%) dementia patients. Diagnostic change was greater than two-fold in the sub-sample of cases with dementia "of unclear etiology" (change in diagnosis in 20 of 32 (63%) patients). In the dementia group, after results of FDG-PET, diagnostic accuracy improved from 77 to 90% in Alzheimer's disease (AD) and from 85 to 94% in frontotemporal lobar degeneration (FTLD) patients (p < 0.01). FDG-PET performed better in dementia than in MCI (positive likelihood ratios >5 and < 5, respectively).
Within a selected clinical population, FDG-PET has a significant clinical impact, both in early and differential diagnosis of uncertain dementia. FDG-PET provides significant incremental value to detect AD and FTLD over a clinical diagnosis of uncertain dementia.
评估 F-氟代脱氧葡萄糖（FDG-PET）在认知诊所患者中对不确定诊断的临床影响和增量诊断价值。
研究人群包括 277 名患者，尽管进行了广泛的基线认知评估、MRI 和 CSF 分析，但他们的轻度认知障碍（MCI）（n=177）或痴呆（n=100）诊断仍不确定。在基线诊断后，每位患者都进行了 FDG-PET，然后制定了 FDG-PET 后诊断。我们评估了（i）诊断变化（基线与 FDG-PET 后），（ii）比较每个基线和 FDG-PET 后诊断与长期随访（3.6±1.8 年）诊断的诊断准确性变化，（iii）比较 MCI 和痴呆情况下的 FDG-PET 性能测试。
FDG-PET 导致 277 名患者中的 86 名（31%）患者的诊断发生变化，特别是在 177 名 MCI 患者中的 57 名（32%）和 100 名痴呆患者中的 29 名（29%）。在“病因不明”的痴呆亚组病例中，诊断变化大于两倍（20 名患者中的 32 名（63%）患者的诊断发生变化）。在痴呆组中，FDG-PET 后，阿尔茨海默病（AD）患者的诊断准确性从 77%提高到 90%，额颞叶变性（FTLD）患者从 85%提高到 94%（p<0.01）。FDG-PET 在痴呆中的表现优于 MCI（阳性似然比分别大于 5 和小于 5）。
在选定的临床人群中，FDG-PET 具有显著的临床影响，无论是在早期还是在不确定痴呆的鉴别诊断中。FDG-PET 在检测 AD 和 FTLD 方面提供了比不确定痴呆的临床诊断更有意义的增量价值。
