Bonte F J, Weiner M F, Bigio E H, White C L
Nuclear Medicine Center, University of Texas Southwestern Medical Center at Dallas 75235-9061, USA.
Radiology. 1997 Mar;202(3):793-7. doi: 10.1148/radiology.202.3.9051035.
To evaluate single photon emission computed tomographic (SPECT) imaging of regional cerebral blood flow in the diagnosis of Alzheimer disease (AD) and the differential diagnosis of the dementias.
Regional cerebral blood flow SPECT was performed with inhaled xenon-133 in 261 patients and with injected technetium-99m hexamethyl-propyleneamine oxime (HMPAO) in 162 patients with possible dementia. In 16 patients, both agents were used in 1 day. SPECT images obtained in elderly healthy control subjects (with Xe-133 in 15, with Tc-99m HMPAO in 14) were available. In each patient without AD, further classification of disease was attempted. Histopathologic correlation was available in 54 patients (with autopsy in 51, with biopsy in three).
SPECT diagnoses were true-positive in 37, true-negative in eight, false-positive in three, and false-negative in six patients. Sensitivity was 86% (37 of 43; 95% confidence limits = .72, .95); specificity, 73% (eight of 11; confidence limits = .39, .94); positive predictive value, 92% (37 of 40; confidence limits = .80, .98); and negative predictive value, 57% (eight of 14; confidence limits = .29, .82).
Regional cerebral blood flow SPECT may assist in the early and late diagnoses of AD and in the differential-diagnosis of the dementias when there is a complicated or confusing clinical picture.
评估单光子发射计算机断层扫描（SPECT）脑血流灌注成像在阿尔茨海默病（AD）诊断及痴呆鉴别诊断中的价值。
对261例患者采用吸入式氙-133进行脑血流灌注SPECT检查，对162例疑似痴呆患者采用静脉注射锝-99m六甲基丙烯胺肟（HMPAO）进行检查。16例患者在同一天使用了两种显像剂。获取了老年健康对照者的SPECT图像（15例使用氙-133，14例使用锝-99m HMPAO）。对每例非AD患者，尝试进一步进行疾病分类。54例患者有组织病理学对照（51例尸检，3例活检）。
SPECT诊断结果为真阳性37例，真阴性8例，假阳性3例，假阴性6例。敏感性为86%（43例中的37例；95%置信区间=.72，.95）；特异性为73%（11例中的8例；置信区间=.39，.94）；阳性预测值为92%（40例中的37例；置信区间=.80，.98）；阴性预测值为57%（14例中的8例；置信区间=.29，.82）。
当临床表现复杂或不明确时，脑血流灌注SPECT有助于AD的早期和晚期诊断以及痴呆的鉴别诊断。
