Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, Nancy, F-54000, France.
Department of Methodology, Promotion and Investigation, Université de Lorraine, CHRU-Nancy, Nancy, F-54000, France.
Alzheimers Res Ther. 2024 Aug 13;16(1):182. doi: 10.1186/s13195-024-01535-3.
Precisely defining the delay in onset of dementia is a particular challenge for early diagnosis. Brain [F] fluoro-2-deoxy-2-D-glucose (F-FDG) Positron Emission Tomography (PET) is a particularly interesting tool for the early diagnosis of neurodegenerative diseases, through the measurement of the cerebral glucose metabolic rate. There is currently a lack of longitudinal studies under real-life conditions, with sufficient patients, to accurately evaluate the predictive values of brain F-FDG PET scans. Here, we aimed to estimate the value of brain F-FDG PET for predicting the risk of dementia conversion and the risk of occurrence of a neurodegenerative pathology.
Longitudinal data for a cohort of patients with no diagnosis of dementia at the time of recruitment referred by a tertiary memory clinic for brain F-FDG PET were matched with (Prince M, Wimo A, Guerchet Maëlenn, Ali G-C, Wu Y-T et al. World Alzheimer Report 2015. The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends. [Research Report] Alzheimer's Disease International. 2015. 2015.) data from the French National Health Data System (NHDS), (Jack CR, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, et al. NIA-AA Research Framework: Toward a biological definition of Alzheimer's disease. Alzheimers Dement. 2018;14(4):535-62.) data from the National Alzheimer Bank (NAB), and (Davis M, O`Connell T, Johnson S, Cline S, Merikle E, Martenyi F, et al. Estimating Alzheimer's Disease Progression Rates from Normal Cognition Through Mild Cognitive Impairment and Stages of Dementia. CAR. 2018;15(8):777-88.) lumbar puncture (LP) biomarker data. The criteria for dementia conversion were the designation, within the three years after the brain F-FDG PET scan, of a long-term condition for dementia in the NHDS and a dementia stage of cognitive impairment in the NAB. The criterion for the identification of a neurodegenerative disease in the medical records was the determination of LP biomarker levels.
Among the 403 patients (69.9 ± 11.4 years old, 177 women) from the initial cohort with data matched with the NHDS data, 137 were matched with the NAB data, and 61 were matched with LP biomarker data. Within three years of the scan, a F-FDG PET had negative predictive values of 85% for dementia conversion (according to the NHDS and NAB datasets) and 95% for the presence of LP neurodegeneration biomarkers.
A normal brain F-FDG PET scan can help rule out the risk of dementia conversion and the presence of cerebrospinal fluid (CSF) biomarker of neurodegeneration early with high certainty, allowing modifications to patient management regimens in the short term.
Clinical Trials database (NCT04804722). March 18, 2021. Retrospectively registered.
精确定义痴呆的发病时间对于早期诊断来说是一项特别具有挑战性的任务。脑 [F] 氟代-2-脱氧-2-D-葡萄糖（F-FDG）正电子发射断层扫描（PET）是一种特别有趣的工具，可通过测量脑葡萄糖代谢率来对神经退行性疾病进行早期诊断。目前，由于缺乏真实生活条件下的足够患者的纵向研究，因此无法准确评估脑 F-FDG PET 扫描的预测值。在这里，我们旨在评估脑 F-FDG PET 对预测痴呆转化风险和神经退行性病变发生风险的价值。
对来自三级记忆诊所的招募时无痴呆诊断的患者队列的纵向数据进行了匹配，与法国国家健康数据系统（NHDS）（Prince M、Wimo A、Guerchet Maëlenn、Ali G-C、Wu Y-T 等人。2015 年世界阿尔茨海默病报告。痴呆症的全球影响：患病率、发病率、成本和趋势分析。[研究报告]阿尔茨海默病国际。2015. 2015.）、国家阿尔茨海默病银行（NAB）（Jack CR、Bennett DA、Blennow K、Carrillo MC、Dunn B、Haeberlein SB 等人。NIA-AA 研究框架：迈向阿尔茨海默病的生物学定义。阿尔茨海默病杂志。2018；14（4）：535-62.）和腰椎穿刺（LP）生物标志物数据进行了匹配。痴呆转化的标准是在脑 F-FDG PET 扫描后三年内，NHDS 中指定了长期痴呆状况，NAB 中指定了痴呆认知障碍阶段。在病历中确定神经退行性疾病的标准是确定 LP 生物标志物水平。
在与 NHDS 数据相匹配的初始队列的 403 名患者（69.9±11.4 岁，177 名女性）中，137 名与 NAB 数据相匹配，61 名与 LP 生物标志物数据相匹配。扫描后三年内，FDG PET 对痴呆转化（根据 NHDS 和 NAB 数据集）的阴性预测值为 85%，对存在 LP 神经退行性生物标志物的阴性预测值为 95%。
正常的脑 F-FDG PET 扫描可以帮助早期高确定性地排除痴呆转化的风险和存在脑脊液（CSF）神经退行性生物标志物，从而可以在短期内修改患者的治疗方案。
临床试验数据库（NCT04804722）。2021 年 3 月 18 日。回顾性注册。
