Brooks David J
Translational and Clinical Research Institute, University of Newcastle upon Tyne, UK; Department of Nuclear Medicine, PET Centre, Aarhus University, Denmark; Department of Brain Sciences, Imperial College London, UK.
Semin Nucl Med. 2021 May;51(3):303-308. doi: 10.1053/j.semnuclmed.2020.12.001. Epub 2020 Dec 20.
Imaging has made an immense contribution toward supporting the diagnosis of dementias, detecting preclinical and prodromal pathology, and allowing disease progression to be objectively tracked. This has led to consensus guidelines for the use of imaging in dementias to be published and a future task will be to validate these guidelines. Additionally, there needs to be standardised approaches over the use of binary thresholds when assigning an abnormality status. Other medical unmet needs include the need for specific imaging markers of (1) linear tau tangles, TDP-43 and alpha synuclein aggregates; (2) microglial phenotypes that throw light on the activity of these inflammatory cells; (3) activity of intracellular processes which normally act to clear misfolded proteins; (4) epigenetic activity which regulates gene expression. Future imaging studies are predicted to be active in all these areas. Finally, as safer and more effective immunotherapy and other protective strategies against the pathologies of dementias are developed and trialed, imaging will play a major future role in determining the efficacy of neuroprotective treatments and their mechanism of action to be examined.
影像学在支持痴呆症诊断、检测临床前和前驱期病理以及客观追踪疾病进展方面做出了巨大贡献。这促使痴呆症影像学应用的共识指南得以发布，未来的一项任务将是验证这些指南。此外，在确定异常状态时，需要对二元阈值的使用采用标准化方法。其他尚未满足的医学需求包括需要特定的影像学标志物来检测：（1）线性tau缠结、TDP - 43和α突触核蛋白聚集体；（2）能揭示这些炎症细胞活性的小胶质细胞表型；（3）通常用于清除错误折叠蛋白的细胞内过程的活性；（4）调节基因表达的表观遗传活性。预计未来的影像学研究将在所有这些领域积极开展。最后，随着更安全、更有效的免疫疗法和其他针对痴呆症病理的保护策略的开发和试验，影像学在确定神经保护治疗的疗效及其作用机制方面将发挥重要的未来作用。
