Prediction of outcomes in MCI with (123)I-IMP-CBF SPECT: a multicenter prospective cohort study.
Prediction of outcomes in MCI with (123)I-IMP-CBF SPECT: a multicenter prospective cohort study.
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DOI：
10.1007/s12149-013-0768-7
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发表时间：
2013-12
影响因子：
2.6
通讯作者：
Yonekura, Yoshiharu
中科院分区：
文献类型：
--
作者：
Ito, Kengo;Mori, Etsuro;Fukuyama, Hidenao;Ishii, Kazunari;Washimi, Yukihiko;Asada, Takashi;Mori, Satoru;Meguro, Kenichi;Kitamura, Shin;Hanyu, Haruo;Nakano, Seigo;Matsuda, Hiroshi;Kuwabara, Yasuo;Hashikawa, Kazuo;Momose, Toshimitsu;Uchida, Yoshitaka;Hatazawa, Jun;Minoshima, Satoshi;Kosaka, Kenji;Yamada, Tatsuo;Yonekura, Yoshiharu
多中心前瞻性队列研究（评估轻度认知功能损害的日本合作SPECT研究：J-COSMIC）旨在检查123 I-N-异丙基-4-碘苯丙胺脑血流（IMP-CBF）SPECT在轻度认知功能损害（MCI）患者中早期诊断阿尔茨海默病（AD）的价值。在41个参与机构的319名遗忘型MCI患者中，每名患者均接受了临床和神经心理学检查以及基线时的123 I-IMP-CBF SPECT。受试者定期随访3年，并评估痴呆的进展。SPECT图像分别通过中央图像判读和自动感兴趣区（ROI）分析分为AD/DLB（路易体痴呆）模式和非AD/DLB模式。Logistic回归分析用于评估基线123 I-IMP-CBF SPECT是否可预测纵向临床结局。216例遗忘型MCI患者中有99例（排除3例癫痫（n = 2）或脑积水（n = 1）和100例随访不完整的患者）在观察期内转为AD。中央图像解释和自动ROI分析预测转换为AD，总体诊断准确率分别为56%和58%（灵敏度，76%和81%;特异性，39%和37%）。多变量逻辑回归分析确定SPECT作为一个预测因素，区分AD转换者和非转换者。SPECT阳性预测自动ROI分析转换为AD的比值比为2.5，将SPECT数据与性别和简易精神状态检查（MMSE）相结合进一步改善了分类（联合比值比20.08）。123 I-IMP-CBF SPECT结合自动ROI分析和中央图像解释对预测个体遗忘型MCI患者3年随访期间的临床结局敏感，但相对非特异性。具有统计学意义的预测因子的组合，包括SPECT与自动ROI分析和神经心理学评估，可以增加预测效用。本文的在线版本（doi：10.1007/s12149-013-0768-7）包含补充材料，可供授权用户使用。
The multicenter prospective cohort study (Japan Cooperative SPECT Study on Assessment of Mild Impairment of Cognitive Function: J-COSMIC) aimed to examine the value of 123I-N-isopropyl-4-iodoamphetamine cerebral blood flow (IMP-CBF) SPECT in regards to early diagnosis of Alzheimer’s disease (AD) in patients with mild cognitive impairment (MCI). Three hundred and nineteen patients with amnestic MCI at 41 participating institutions each underwent clinical and neuropsychological examinations and 123I-IMP-CBF SPECT at baseline. Subjects were followed up periodically for 3 years, and progression to dementia was evaluated. SPECT images were classified as AD/DLB (dementia with Lewy bodies) pattern and non-AD/DLB pattern by central image interpretation and automated region of interest (ROI) analysis, respectively. Logistic regression analyses were used to assess whether baseline 123I-IMP-CBF SPECT was predictive of longitudinal clinical outcome. Ninety-nine of 216 amnestic MCI patients (excluding 3 cases with epilepsy (n = 2) or hydrocephalus (n = 1) and 100 cases with incomplete follow-up) converted to AD within the observation period. Central image interpretation and automated ROI analysis predicted conversion to AD with 56 and 58 % overall diagnostic accuracy (sensitivity, 76 and 81 %; specificity, 39 and 37 %), respectively. Multivariate logistic regression analysis identified SPECT as a predictor, which distinguished AD converters from non-converters. The odds ratio for a positive SPECT to predict conversion to AD with automated ROI analysis was 2.5 and combining SPECT data with gender and mini-mental state examination (MMSE) further improved classification (joint odds ratio 20.08). 123I-IMP-CBF SPECT with both automated ROI analysis and central image interpretation was sensitive but relatively nonspecific for prediction of clinical outcome during the 3-year follow-up in individual amnestic MCI patients. A combination of statistically significant predictors, both SPECT with automated ROI analysis and neuropsychological evaluation, may increase predictive utility. The online version of this article (doi:10.1007/s12149-013-0768-7) contains supplementary material, which is available to authorized users.
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