Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy.
Semin Nucl Med. 2021 May;51(3):286-295. doi: 10.1053/j.semnuclmed.2020.12.006. Epub 2020 Dec 20.
Cerebrovascular disease is a significant cause of cognitive impairment leading to a reduction or loss of functioning, including social and occupational. The connection cause-effect between cerebrovascular disease and cerebral infarction was originally theorized by the studies from Newcastle-Upon-Tyne, England, in the 1960s, where vascular dementia (VaD) was defined as a disease originated from several infarctions that overcome a determined threshold. It differs from Alzheimer's disease (AD), although there are various overlaps in risk factors, symptomatology, the similarity of vascular lesions, and treatment benefits. Nevertheless, AD is one-half of all cases of dementia. Cognitive impairment and dementia (VCID) has recently been proposed to include different entities such as VaD, Vascular cognitive impairment, subcortical (ischemic) VaD, and vascular cognitive disorders. VaD is the most common cause of dementia after AD. Neuroimaging is an essential part of the workup of patients with cognitive decline and in those with suspected VCID it should be used to assess the extent, location, and type of vascular lesions. Computed tomography (CT) or structural magnetic resonance imaging (MRI) are usually used for the diagnosis of vascular diseases of the brain. However, images obtained from new hybrid devices could help the neurologist in the differential diagnosis between various neuropathological entities related to VCID. Single-photon emission computed tomography (SPECT) combined with CT or MRI and positron emission tomography (PET) combined with CT or MRI represent the future of neuroimaging tools as morphological and functional data can be provided simultaneously. New prospects have been developed such as hybrid PET/SPECT/CT, a high-performance prototype able to produce high-quality images but for now suitable only for small animals. Nowadays, PET/CT and PET/MRI are good performance and high-quality instruments, even if the magnetic field of MRI represents a limitation that affects the PET electronics and positron detection ability. SPECT/MRI delineates as a potential and tempting device. It could give us both functional and anatomical details, with the advantage of lack of extra ionizing radiation and high soft-tissue contrast, important features, and considerable auxiliary for differential diagnosis in the variegate word of vascular cognitive impairment. The aim of this review is to summarize the newest viewpoints in hybrid imaging in the diagnosis of VaD and to highlight pros and cons of each methodic.
脑血管病是导致认知功能障碍的主要原因，可导致功能（包括社交和职业功能）下降或丧失。20 世纪 60 年代，英国纽卡斯尔的研究最初提出了脑血管病与脑梗死之间的因果关系，当时血管性痴呆（VaD）被定义为起源于多个超过一定阈值的梗死的疾病。它与阿尔茨海默病（AD）不同，尽管危险因素、症状、血管病变的相似性和治疗获益方面存在各种重叠。然而，AD 占所有痴呆病例的一半。认知障碍和痴呆（VCID）最近被提议包括不同的实体，如 VaD、血管性认知障碍、皮质下（缺血性）VaD 和血管性认知障碍。VaD 是 AD 之后最常见的痴呆原因。神经影像学是评估认知能力下降患者和疑似 VCID 患者的重要组成部分，应用于评估血管病变的程度、位置和类型。计算机断层扫描（CT）或结构磁共振成像（MRI）通常用于诊断脑血管疾病。然而，来自新型混合设备的图像可以帮助神经病学家对与 VCID 相关的各种神经病理学实体进行鉴别诊断。单光子发射计算机断层扫描（SPECT）结合 CT 或 MRI 和正电子发射断层扫描（PET）结合 CT 或 MRI 代表了神经影像学工具的未来，因为可以同时提供形态和功能数据。已经开发了新的前景，如混合 PET/SPECT/CT，这是一种能够产生高质量图像的高性能原型，但目前仅适用于小动物。如今，PET/CT 和 PET/MRI 是性能良好、高质量的仪器，尽管 MRI 的磁场对 PET 电子设备和正电子探测能力有影响，但仍是一种限制。SPECT/MRI 描绘了一种有潜力和诱人的设备。它可以为我们提供功能和解剖细节，具有无额外电离辐射和高软组织对比度的优点，这是血管性认知障碍多样化世界中鉴别诊断的重要特征和相当大的辅助手段。本综述的目的是总结混合成像在 VaD 诊断中的最新观点，并突出每种方法的优缺点。
