Read S L, Miller B L, Mena I, Kim R, Itabashi H, Darby A
Department of Psychiatry, VA Medical Center, West Los Angeles UCLA School of Medicine 90073, USA.
J Am Geriatr Soc. 1995 Nov;43(11):1243-7. doi: 10.1111/j.1532-5415.1995.tb07400.x.
The clinical diagnosis of dementia continues to be flawed. Although the diagnosis of Alzheimer's disease (AD) is better than 90% at research centers in highly selected patients, the diagnosis of patients with non-AD dementias and atypical AD patients is poor. Single photon emission computed tomography (SPECT) is a functional imaging technique touted as a diagnostic technique for the degenerative disorders. However there have been few clinicopathological studies using SPECT.
Twenty-seven consecutive dementia patients were evaluated clinically at a University-based specialty dementia clinic, and a diagnosis of a specific dementia was made. SPECT imaging was used in helping to select a clinical diagnosis. The correlations between clinical, SPECT and autopsy diagnoses were analyzed.
Single photon emission computed tomography predicted pathologic diagnosis in 25 of 27 patients with dementia (92.6%), compared with clinical diagnosis, which was confirmed in 20/27 (74.1%). Distinct patterns were associated with dementia caused by AD, Fronto-Temporal Dementia (FTD), and Jakob-Creutzfeldt Disease (JCD). Vascular insults not seen with computerized tomography (CT) or magnetic resonance imaging (MRI) were found with SPECT. Three different pathologies were found in patients with Parkinsonian-Dementias (PD): Lewy-Body Variant of AD, Diffuse Lewy-bodies without plaques, and substantia nigra neuronal loss without plaques or Lewy-bodies. All showed a temporal-parietal pattern with SPECT that was similar to AD.
SPECT provides useful positive information in dementia, particularly the differentiation of AD, FTD, and JCD. However, it does not distinguish PD from AD.
痴呆的临床诊断仍然存在缺陷。尽管在研究中心对经过高度筛选的患者而言，阿尔茨海默病（AD）的诊断准确率高于90%，但对非AD痴呆患者和非典型AD患者的诊断效果不佳。单光子发射计算机断层扫描（SPECT）是一种功能成像技术，被吹捧为用于退行性疾病的诊断技术。然而，使用SPECT的临床病理研究很少。
在一家大学附属的专业痴呆诊所对27例连续的痴呆患者进行临床评估，并做出特定痴呆的诊断。SPECT成像用于辅助选择临床诊断。分析了临床、SPECT和尸检诊断之间的相关性。
与临床诊断相比，单光子发射计算机断层扫描在27例痴呆患者中的25例（92.6%）预测了病理诊断，临床诊断在20/27例（74.1%）中得到证实。不同的模式与AD、额颞叶痴呆（FTD）和克雅氏病（JCD）引起的痴呆相关。SPECT发现了计算机断层扫描（CT）或磁共振成像（MRI）未显示的血管损伤。帕金森病痴呆（PD）患者发现了三种不同的病理情况：AD的路易体变异型、无斑块的弥漫性路易体以及无斑块或路易体的黑质神经元丢失。所有这些在SPECT上均显示出与AD相似的颞顶叶模式。
SPECT在痴呆诊断中提供了有用的阳性信息，特别是在区分AD、FTD和JCD方面。然而，它无法将PD与AD区分开来。
