Imaging improves diagnosis of dementia with lewy bodies.
Imaging improves diagnosis of dementia with lewy bodies.
复制标题
DOI：
10.4306/pi.2009.6.4.233
复制
发表时间：
2009-12
影响因子：
2.7
通讯作者：
Saito T
中科院分区：
文献类型：
--
作者：
Tateno M;Kobayashi S;Saito T
路易体痴呆（Dementia with Lewy bodies，DLB）是继阿尔茨海默病（Alzheimer's disease，AD）之后的第二大常见的退行性痴呆，其临床特征为认知和警觉性的波动、复发性幻视和帕金森综合征的进行性认知下降。一旦DLB的这些特征性症状出现，将其与AD区分开来相对容易。然而，在疾病的早期阶段，各种类型的痴呆的临床症状在很大程度上重叠，仅根据临床表现很难将DLB与其他神经退行性痴呆区分开来。为了提高DLB生前诊断的准确性，最新的诊断标准纳入了123 I-间碘苄胍（MIBG）心肌造影或神经影像学（如计算机断层扫描（CT），磁共振成像（MRI），单光子发射计算机断层扫描（SPECT）和正电子发射断层扫描（PET））的结果。在本指南中，SPECT或PET显示的多巴胺转运蛋白摄取减少在各种神经影像学检查结果中最重要，并被列为提示性特征之一。通常存在但未被证明具有诊断特异性的支持性特征包括相对保留的内侧颞叶结构、枕叶灌注不足和异常MIBG心肌造影。在本文中，我们回顾了各种神经影像学检查的主要结果，并讨论了它们对诊断DLB的临床实用性。尽管目前尚无足够的证据支持这一结论，但考虑到临床的可及性，我们建议采用脑灌注SPECT和MIBG心肌显像来提高DLB的诊断水平。
Dementia with Lewy bodies (DLB) is the second most common cause of degenerative dementia after Alzheimer's disease (AD), and is clinically characterized by the progressive cognitive decline with fluctuations in cognition and alertness, recurrent visual hallucinations and Parkinsonism. Once these characteristic symptoms of DLB emerge, discriminating it from AD is relatively easy. However, in the early disease stages, the clinical symptoms of various types of dementias largely overlap and it is difficult to distinguish DLB from other neurodegenerative dementias based on clinical manifestations alone. To increase the accuracy of antemortem diagnosis of DLB, the latest diagnostic criteria incorporate findings from 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, or from neuroimaging such as computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET). In the present guidelines, decreased dopamine transporter uptake revealed by SPECT or PET receives the greatest importance among various neuroimaging findings and is listed as one of the suggestive features. Supportive features that commonly present but are not proven to have diagnostic specificity include relatively-preserved medial-temporal-lobe structures, occipital hypoperfusion, and abnormal MIBG myocardial scintigraphy. In this paper, we review the major findings on various neuroimaging modalities and discuss the clinical usefulness of them for the diagnosis of DLB. Although there is not enough evidence to reach the conclusion, considering the accessibility in clinical practice, in our personal views, we recommend the use of brain-perfusion SPECT and MIBG myocardial scintigraphy to improve the diagnosis of DLB.
登录
查看更多内容
DOI：
10.1007/s00259-002-0778-5
发表时间：
2002-05-01
影响因子：
9.1
作者：
Colloby, SJ;Fenwick, JD;O'Brien, JT
通讯作者：
O'Brien, JT
影响因子：
9.9
作者：
Cousins, DA;Burton, EJ;O'Brien, JT
通讯作者：
O'Brien, JT
影响因子：
8.6
作者：
Burn, DJ;O'Brien, JT
通讯作者：
O'Brien, JT
影响因子：
2.5
作者：
Bozzali, Marco;Cherubini, Andrea
通讯作者：
Cherubini, Andrea
影响因子：
14.5
作者：
Bozzali, M;Falini, A;Nemni, R
通讯作者：
Nemni, R