[(123)]FP-CIT SPECT scans initially rated as normal became abnormal over time in patients with probable dementia with Lewy bodies.
[(123)]FP-CIT SPECT scans initially rated as normal became abnormal over time in patients with probable dementia with Lewy bodies.
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DOI：
10.1007/s00259-016-3312-x
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发表时间：
2016-06
影响因子：
9.1
通讯作者：
Lemstra AW
中科院分区：
文献类型：
--
作者：
van der Zande JJ;Booij J;Scheltens P;Raijmakers PG;Lemstra AW
SPECT成像上纹状体多巴胺转运蛋白（DAT）结合减少是诊断路易体痴呆（DLB）的强生物标志物。对于DAT SPECT扫描正常（DLB/S−）的患者是否符合可能DLB的临床标准仍存在很多不确定性。本研究的目的是描述这些患者的临床和影像学随访，并将其与基线扫描异常的DLB患者（DLB/S+）进行比较。从阿姆斯特丹痴呆队列中选择接受DAT成像（[123 I]FP-CIT SPECT）的DLB患者。所有[123 I]FP-CIT SPECT扫描由两名核医学医生独立评估，并在扫描正常的患者中获得随访成像。我们将DLB/S-患者的年龄和病程与DLB/S+患者相匹配，并比较了他们的临床特征。在67例[123 I]FP-CIT SPECT扫描中，7例（10.4%）被评定为正常。在5名DLB/S−患者中，进行了第二次[123 I]FP-CIT SPECT（平均1.5年后），这些扫描均异常。基线时未发现临床特征的显著差异。DLB/S−患者预计1年后MMSE评分会更好。该研究首次调查了初始[123 I]FP-CIT SPECT扫描被评定为正常且疾病进展期间的后续扫描被评定为异常的DLB患者。我们假设DLB/S−扫描可能代表一种相对罕见的DLB亚型，可能具有不同的严重程度或α-突触核蛋白病理学的扩散（“新皮质主导亚型”）。在临床实践中，如果DLB/S−患者的替代诊断不是迫在眉睫，则应考虑重复[123 I]FP-CIT SPECT。
Decreased striatal dopamine transporter (DAT) binding on SPECT imaging is a strong biomarker for the diagnosis of dementia with Lewy bodies (DLB). There is still a lot of uncertainty about patients meeting the clinical criteria for probable DLB who have a normal DAT SPECT scan (DLB/S−). The aim of this study was to describe the clinical and imaging follow-up in these patients, and compare them to DLB patients with abnormal baseline scans (DLB/S+). DLB patients who underwent DAT imaging ([123I]FP-CIT SPECT) were selected from the Amsterdam Dementia Cohort. All [123I]FP-CIT SPECT scans were evaluated independently by two nuclear medicine physicians and in patients with normal scans follow-up imaging was obtained. We matched DLB/S-− patients for age and disease duration to DLB/S+ patients and compared their clinical characteristics. Of 67 [123I]FP-CIT SPECT scans, 7 (10.4 %) were rated as normal. In five DLB/S− patients, a second [123I]FP-CIT SPECT was performed (after on average 1.5 years) and these scans were all abnormal. No significant differences in clinical characteristics were found at baseline. DLB/S− patients could be expected to have a better MMSE score after 1 year. This study was the first to investigate DLB patients with the initial [123I]FP-CIT SPECT scan rated as normal and subsequent scans during disease progression rated as abnormal. We hypothesize that DLB/S− scans could represent a relatively rare DLB subtype with possibly a different severity or spread of alpha-synuclein pathology (“neocortical predominant subtype”). In clinical practice, if an alternative diagnosis is not imminent in a DLB/S− patient, repeating [123I]FP-CIT SPECT should be considered.