Cerebral perfusion SPET correlated with Braak pathological stage in Alzheimer's disease
Cerebral perfusion SPET correlated with Braak pathological stage in Alzheimer's disease
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DOI：
10.1093/brain/awf185
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发表时间：
2002-08-01
期刊：
影响因子：
14.5
通讯作者：
Shepstone, B. J.
中科院分区：
文献类型：
--
作者：
Bradley, K. M.;O'Sullivan, V. T.;Shepstone, B. J.
在阿尔茨海默病中，局部脑灌注减少，特别是在后颞顶叶，是公认的。我们开始使用Tc-99 m-HMPAO单光子发射断层扫描（SPET）将灌注变化与阿尔茨海默病的病理阶段相关联。死后大脑中神经病理学分布的“Braak阶段”用于将生活中从混合（痴呆和对照）老年人群中获取的SPET扫描分类为内嗅阶段（n = 23个受试者）、边缘阶段（n = 30个受试者）和新皮质阶段（n = 36个受试者）阿尔茨海默病病理学。然后将SPET扫描配准到共同的标准Talaraich空间，并为每个病理阶段生成单个模板扫描。这些模板的比较揭示了区域灌注减少模式的演变。使用死亡前5年获得的早期SPET扫描进行了额外的比较。对于模板之间的比较，选择10%灌注变化的阈值，以便具有临床相关性和统计学显著性。灌注减少出现在前内侧颞叶、胼胝体下区、后扣带回皮质、楔前叶和可能的小脑半球的前上方面的内嗅和边缘系统阶段之间。大的后颞顶叶灌注缺损然后出现在边缘系统和新皮质阶段之间，最后出现大的额叶灌注缺损。这些灌注缺陷的时间过程似乎相对较长，这表明灌注变化可能有可能成为生活中阿尔茨海默病分期的诊断辅助手段。前内侧颞叶灌注的减少可能与现代高分辨率SPET和PET系统以及灌注型MRI序列具有未来相关性。
Reductions in regional cerebral perfusion, particularly in the posterior temporo-parietal lobes, are well recognized in Alzheimer's disease. We set out to correlate perfusion changes, using Tc-99m-HMPAO single photon emission tomography (SPET), with the pathological stage of Alzheimer's disease. The 'Braak stage' of the distribution of neurofibrillary pathology in post-mortem brains was used to classify SPET scans taken in life from a mixed (dementia and control) elderly population into the entorhinal stage (n = 23 subjects), limbic stage (n = 30 subjects) and neocortical stage (n = 36 subjects) Alzheimer's disease pathology. The SPET scans were then registered to a common, standard Talaraich space, and single template scans produced for each pathological stage. Comparison of these templates revealed an evolution in the pattern of reduction in regional perfusion. Additional comparisons were performed using earlier SPET scans obtained 5 years before death. For comparisons between templates, a threshold of 10% perfusion change was chosen so as to be clinically relevant as well as statistically significant. Reduced perfusion appears between the entorhinal and limbic stages in the anterior medial temporal lobe, subcallosal area, posterior cingulate cortex, precuneus and possibly the supero-anterior aspects of the cerebellar hemispheres. Large posterior temporo-parietal perfusion defects then appear between the limbic and neocortical stages, before finally large frontal lobe perfusion defects. The time course of these perfusion defects appears relatively long, suggesting that perfusion changes may have scope to be a diagnostic aid in staging Alzheimer's disease in life. The reduction in anterior medial temporal lobe perfusion may have future relevance on modern high resolution SPET and PET systems and also perfusion-type MRI sequences.