比较疑似阿尔茨海默病患者的 2-[18F]FDG-PET 和脑脊液生物标志物的临床影响。
Comparison of the clinical impact of 2-[18F]FDG-PET and cerebrospinal fluid biomarkers in patients suspected of Alzheimer's disease.
机构信息
Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
出版信息
PLoS One. 2021 Mar 12;16(3):e0248413. doi: 10.1371/journal.pone.0248413. eCollection 2021.
BACKGROUND
The two biomarkers 2-[18F]FDG-PET and cerebrospinal fluid biomarkers are both recommended to support the diagnosis of Alzheimer's disease. However, there is a lack of knowledge for the comparison of the two biomarkers in a routine clinical setting.
OBJECTIVE
The aim was to compare the clinical impact of 2-[18F]FDG-PET and cerebrospinal fluid biomarkers on diagnosis, prognosis, and patient management in patients suspected of Alzheimer's disease.
METHODS
Eighty-one patients clinically suspected of Alzheimer's disease were retrospectively included from the Copenhagen Memory Clinic. As part of the clinical work-up all patients had a standard diagnostic program examination including MRI and ancillary investigations with 2-[18F]FDG-PET and cerebrospinal fluid biomarkers. An incremental study design was used to evaluate the clinical impact of the biomarkers. First, the diagnostic evaluation was based on the standard diagnostic program, then the diagnostic evaluation was revised after addition of either cerebrospinal fluid biomarkers or 2-[18F]FDG-PET. At each diagnostic evaluation, two blinded dementia specialists made a consensus decision on diagnosis, prediction of disease course, and change in patient management. Confidence in the decision was measured on a visual analogue scale (0-100). After 6 months, the diagnostic evaluation was performed with addition of the other biomarker. A clinical follow-up after 12 months was used as reference for diagnosis and disease course.
RESULTS
The two biomarkers had a similar clinical value across all diagnosis when added individually to the standard diagnostic program. However, for the correctly diagnosed patient with Alzheimer's disease cerebrospinal fluid biomarkers had a significantly higher impact on diagnostic confidence (mean scores±SD: 88±11 vs. 82±11, p = 0.046) and a significant reduction in the need for ancillary investigations (23 vs. 18 patients, p = 0.049) compared to 2-[18F]FDG-PET.
CONCLUSION
The two biomarkers had similar clinical impact on diagnosis, but cerebrospinal fluid biomarkers had a more significant value in corroborating the diagnosis of Alzheimer's disease compared to 2-[18F]FDG-PET.
背景
两种生物标志物——2-[18F]FDG-PET 和脑脊液生物标志物均被推荐用于支持阿尔茨海默病的诊断。然而，在常规临床环境中，对于这两种生物标志物的比较，我们知之甚少。
目的
本研究旨在比较 2-[18F]FDG-PET 和脑脊液生物标志物在疑似阿尔茨海默病患者的诊断、预后和患者管理方面的临床影响。
方法
本研究回顾性纳入了 81 例来自哥本哈根记忆诊所的疑似阿尔茨海默病患者。作为临床评估的一部分，所有患者均接受了标准诊断程序检查，包括 MRI 和 2-[18F]FDG-PET 和脑脊液生物标志物等辅助检查。本研究采用增量研究设计来评估生物标志物的临床影响。首先，基于标准诊断程序进行诊断评估，然后分别添加脑脊液生物标志物或 2-[18F]FDG-PET 后，对诊断评估进行修订。在每次诊断评估时，两名盲法痴呆专家就诊断、疾病进程预测和患者管理变更做出共识决策。通过视觉模拟量表（0-100）衡量对决策的信心。6 个月后，添加另一种生物标志物进行诊断评估。12 个月的临床随访用于诊断和疾病进程的参考。
结果
当单独将两种生物标志物添加到标准诊断程序中时，它们在所有诊断中的临床价值相似。然而，对于正确诊断为阿尔茨海默病的患者，脑脊液生物标志物在诊断信心方面的影响显著更高（平均得分±标准差：88±11 对 82±11，p=0.046），并且显著减少了辅助检查的需求（23 例患者对 18 例患者，p=0.049），而 2-[18F]FDG-PET 则不然。
结论
两种生物标志物对诊断的临床影响相似，但与 2-[18F]FDG-PET 相比，脑脊液生物标志物在证实阿尔茨海默病诊断方面具有更显著的价值。
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