淀粉样蛋白和 tau 正电子发射断层扫描对诊断和患者管理变化的影响。

Impact of Amyloid and Tau PET on Changes in Diagnosis and Patient Management.

机构信息

From the Departments of Neurology (S.S., T.T., M.S., M.K., Y.N., J.N.), Neuropsychiatry (T.K., S.B., H.T., Yuki Momota, N.S., A.M., Y.Y., Y.S., R.S., K.F., Yu Mimura, M.M.), Radiology (Y.I., M.J.), Physiology (D.I.), and Memory Center (D.I.), Keio University School of Medicine, Tokyo; Department of Functional Brain Imaging (T.K.), Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba; and Office of Radiation Technology (R.U.), Keio University Hospital, Tokyo, Japan.

出版信息

Neurology. 2023 Jan 17;100(3):e264-e274. doi: 10.1212/WNL.0000000000201389. Epub 2022 Sep 29.

DOI:10.1212/WNL.0000000000201389

PMID:36175151

Abstract

BACKGROUND AND OBJECTIVES

Previous studies have evaluated the diagnostic effect of amyloid PET in selected research cohorts. However, these studies did not assess the clinical impact of the combination of amyloid and tau PETs. Our objective was to evaluate the association of the combination of 2 PETs with changes in diagnosis, treatment, and management in a memory clinic cohort.

METHODS

All participants underwent amyloid [F]florbetaben PET and tau PET using [F]PI-2620 or [F]Florzolotau, which are potentially useful for the diagnosis of non-Alzheimer disease (AD) tauopathies. Dementia specialists determined a pre- and post-PET diagnosis that existed in both a clinical syndrome (cognitive normal [CN], mild cognitive impairment [MCI], and dementia) and suspected etiology, with a confidence level. In addition, the dementia specialists determined patient treatment in terms of ancillary investigations and management.

RESULTS

Among 126 registered participants, 84.9% completed the study procedures and were included in the analysis (CN [n = 40], MCI [n = 25], AD [n = 20], and non-AD dementia [n = 22]). The etiologic diagnosis changed in 25.0% in the CN, 68.0% in the MCI, and 23.8% with dementia. Overall changes in management between pre- and post-PET occurred in 5.0% of CN, 52.0% of MCI, and 38.1% of dementia. Logistic regression analysis revealed that tau PET has stronger associations with change management than amyloid PET in all participants and dementia groups.

DISCUSSION

The combination of amyloid and tau PETs was associated with changes in management and diagnosis of MCI and dementia, and the second-generation tau PET has a strong impact on the changes in diagnosis and management in memory clinics.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that the combination of amyloid and tau PETs was associated with changes in management and diagnosis of MCI and dementia.

摘要

背景与目的

既往研究已评估了淀粉样蛋白 PET 在特定研究队列中的诊断效果。然而，这些研究并未评估淀粉样蛋白和 tau PET 联合应用的临床影响。我们的目的是评估在一个记忆门诊队列中，2 种 PET 联合应用与诊断、治疗和管理变化的相关性。

方法

所有参与者均接受了淀粉样蛋白[F]florbetaben PET 和 tau PET 检查，所用示踪剂分别为[F]PI-2620 或[F]Florzolotau，这些示踪剂可能有助于非阿尔茨海默病（AD）tau 病的诊断。痴呆专家根据认知正常[CN]、轻度认知障碍[MCI]和痴呆等临床综合征以及可疑病因，确定了 PET 前后的诊断，并给出了置信水平。此外，痴呆专家根据辅助检查和管理确定了患者的治疗方案。

结果

在注册的 126 名参与者中，84.9%完成了研究程序并纳入分析（CN[40 名]、MCI[25 名]、AD[20 名]和非 AD 痴呆[22 名]）。CN 中病因诊断变化率为 25.0%，MCI 中为 68.0%，痴呆中为 23.8%。PET 前后管理的总体变化在 CN 中为 5.0%，MCI 中为 52.0%，痴呆中为 38.1%。Logistic 回归分析显示，tau PET 与管理变化的相关性强于淀粉样蛋白 PET，无论在所有参与者还是在痴呆患者中均如此。