联合使用 CIScore 和 VSRAD 参数分析对路易体痴呆和阿尔茨海默病进行鉴别诊断的价值。
The usefulness of combined analysis using CIScore and VSRAD parameters for differentiating between dementia with Lewy body and Alzheimer's disease.
机构信息
Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
出版信息
Jpn J Radiol. 2024 Oct;42(10):1206-1212. doi: 10.1007/s11604-024-01604-5. Epub 2024 Jun 10.
PURPOSE
The Cingulate Island score (CIScore) is useful index for differentiating between dementia with Lewy body (DLB) and Alzheimer's disease (AD) using regional cerebral blood flow (rCBF) SPECT. The Z score standing for medial temporal lobe (MTL) atrophy and the ratio of Z score between dorsal brain stem (DBS) to MTL are useful indices for differentiating between DLB and AD using MRI with VSRAD. The current study investigated the diagnostic ability by the combined use of rCBF SPECT and MRI in the differentiation between AD and DLB.
MATERIALS AND METHODS
In cases with 42 AD and 28 DLB undertaken Tc-99m-ECD SPECT and MRI, we analyzed differential diagnostic ability between AD and DLB among following conditions by single or combined settings. Namely, they were (1) the CIScore as a parameter of rCBF SPECT (DLB ≦ 0.25), (2) Z score value of MTL atrophy (DLB ≦ 2.05), (3) the ratio of Z score of DBS to medial temporal gray matter as a parameter of brain atrophy using VSRAD (DLB ≧ 0.38). Also, we analyzed them both including and omitting the elderly (over 75 years old).
RESULTS
The accuracy of differential diagnosis in this condition was 74% for (1), 69% for (2), and 67% for (3). The accuracy by combination condition was 84% for (1) and (2), 81% for (1) and (3), and 67% for (2) and (3), respectively. The combination method by CIScore and the Z score of MTL showed the best accuracy. When we confined condition to ages younger than 75 years, the accuracy improved to 94% in the combination method.
CONCLUSION
The combined use of CIScore and Z score of MTL was suggested to be useful in the differential diagnosis between DLB and AD particularly in younger than 75 years old.
目的
使用区域性脑血流 SPECT，Cingulate 岛评分（CIScore）是区分路易体痴呆（DLB）和阿尔茨海默病（AD）的有用指标。使用 VSRAD 磁共振成像（MRI），中颞叶（MTL）萎缩的 Z 评分和背侧脑干（DBS）与 MTL 之间 Z 评分的比值是区分 DLB 和 AD 的有用指标。本研究探讨了 SPECT 和 MRI 联合使用在区分 AD 和 DLB 中的诊断能力。
材料与方法
对 42 例 AD 和 28 例 DLB 患者进行 Tc-99m-ECD SPECT 和 MRI 检查，我们分析了以下情况的 AD 和 DLB 之间的鉴别诊断能力，包括单因素或联合设置：（1）CIScore 作为 rCBF SPECT 的参数（DLB≤0.25）；（2）MTL 萎缩的 Z 评分值（DLB≤2.05）；（3）使用 VSRAD 的 DBS 与内侧颞叶灰质 Z 评分比值作为脑萎缩的参数（DLB≥0.38）。此外，我们还分析了包括和不包括老年人（75 岁以上）的情况。
结果
该条件下，（1）的鉴别诊断准确率为 74%，（2）为 69%，（3）为 67%。（1）和（2）联合条件的准确率为 84%，（1）和（3）为 81%，（2）和（3）为 67%。CIScore 和 MTL 的 Z 评分的联合方法具有最佳的准确性。当我们将条件限制在 75 岁以下时，联合方法的准确率提高到 94%。
结论
CIScore 和 MTL 的 Z 评分的联合使用可能有助于区分 DLB 和 AD，特别是在 75 岁以下的患者。
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