Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA.
Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA.
Adv Exp Med Biol. 2021;1281:93-112. doi: 10.1007/978-3-030-51140-1_7.
Frontotemporal lobar dementia (FTLD) is a clinically and pathologically complex disease. Advances in neuroimaging techniques have provided a specialized set of tools to investigate underlying pathophysiology and identify clinical biomarkers that aid in diagnosis, prognostication, monitoring, and identification of appropriate endpoints in clinical trials. In this chapter, we review data discussing the utility of neuroimaging biomarkers in sporadic FTLD, with an emphasis on current and future clinical applications. Among those modalities readily utilized in clinical settings, T1-weighted structural magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are best supported in differential diagnosis and as targets for clinical trial endpoints. However, a number of nonclinical neuroimaging modalities, including diffusion tensor imaging and resting-state functional connectivity MRI, show promise as biomarkers to predict progression and as clinical trial endpoints. Other neuroimaging modalities, including amyloid PET, Tau PET, and arterial spin labeling MRI, are also discussed, though more work is required to establish their utility in FTLD in clinical settings.
额颞叶痴呆（FTLD）是一种临床表现和病理均十分复杂的疾病。神经影像学技术的进步为研究潜在的病理生理学和识别有助于诊断、预后、监测和确定临床试验终点的临床生物标志物提供了一套专门的工具。在本章中，我们综述了神经影像学生物标志物在散发型 FTLD 中的应用数据，重点讨论了当前和未来的临床应用。在临床环境中可广泛应用的各种模态中，T1 加权结构磁共振成像（MRI）和 18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）在鉴别诊断和作为临床试验终点方面的作用得到了最好的支持。然而，一些非临床神经影像学模态，包括弥散张量成像和静息态功能连通性 MRI，作为预测进展和临床试验终点的生物标志物具有很大的应用潜力。其他神经影像学模态，包括淀粉样蛋白 PET、Tau PET 和动脉自旋标记 MRI，也有相关讨论，尽管还需要更多的工作来确定它们在 FTLD 临床环境中的应用。
