Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237, Groupement d'Intérêt Public Cyceron, Caen, France.
Department of Nuclear Medicine, University of Navarra, Clinica Universidad de Navarra, Pamplona, Spain.
Lancet Neurol. 2020 Nov;19(11):951-962. doi: 10.1016/S1474-4422(20)30314-8.
Various biomarkers are available to support the diagnosis of neurodegenerative diseases in clinical and research settings. Among the molecular imaging biomarkers, amyloid-PET, which assesses brain amyloid deposition, and F-fluorodeoxyglucose (F-FDG) PET, which assesses glucose metabolism, provide valuable and complementary information. However, uncertainty remains regarding the optimal timepoint, combination, and an order in which these PET biomarkers should be used in diagnostic evaluations because conclusive evidence is missing. Following an expert panel discussion, we reached an agreement on the specific use of the individual biomarkers, based on available evidence and clinical expertise. We propose a diagnostic algorithm with optimal timepoints for these PET biomarkers, also taking into account evidence from other biomarkers, for early and differential diagnosis of neurodegenerative diseases that can lead to dementia. We propose three main diagnostic pathways with distinct biomarker sequences, in which amyloid-PET and F-FDG-PET are placed at different positions in the order of diagnostic evaluations, depending on clinical presentation. We hope that this algorithm can support diagnostic decision making in specialist clinical settings with access to these biomarkers and might stimulate further research towards optimal diagnostic strategies.
各种生物标志物可用于支持神经退行性疾病在临床和研究环境中的诊断。在分子影像学生物标志物中，评估脑淀粉样蛋白沉积的淀粉样蛋白-PET 和评估葡萄糖代谢的 F-氟脱氧葡萄糖（F-FDG）PET 提供了有价值且互补的信息。然而，由于缺乏确凿的证据，这些 PET 生物标志物在诊断评估中应何时使用、如何联合使用以及使用顺序仍存在不确定性。在专家小组讨论后，我们根据现有证据和临床专业知识，就个别生物标志物的具体用途达成了一致意见。我们提出了一个包含这些 PET 生物标志物最佳检测时间点的诊断算法，同时还考虑了来自其他生物标志物的证据，以便对可能导致痴呆的神经退行性疾病进行早期和鉴别诊断。我们提出了三条主要的诊断途径，具有不同的生物标志物序列，根据临床表现，在诊断评估顺序中，淀粉样蛋白-PET 和 F-FDG-PET 分别处于不同的位置。我们希望该算法能够为具有这些生物标志物的专科临床环境中的诊断决策提供支持，并可能激发对最佳诊断策略的进一步研究。
