11C-DTBZ and 18F-FDG PET measures in differentiating dementias.
11C-DTBZ and 18F-FDG PET measures in differentiating dementias.
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2005-06
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通讯作者：
R. Koeppe;S. Gilman;A. Joshi;Suyu Liu;Roderick J. A. Little;L. Junck;M. Heumann;K. Frey;R. Albin
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作者：
R. Koeppe;S. Gilman;A. Joshi;Suyu Liu;Roderick J. A. Little;L. Junck;M. Heumann;K. Frey;R. Albin
随着新疗法的引入，无标签准确、早期区分痴呆症将变得越来越重要。根据标准的临床标准进行鉴别诊断的准确性有限。PET提供了提高诊断准确率的潜力。(18)F-FDG研究发现痴呆患者存在代谢异常，但特异性有限。PET还提供了量化其他生化标记物的能力，这些标记物可以产生更多有用的诊断信息。我们证明，(+)-(11)C-二氢四苯肼((11)C-DTBZ)研究提供了黑质纹状体终末密度(分布体积；DV)的指数，也提供了运输(K(1))的测量，其产生的信息可与(18)F-FDG的代谢测量相媲美。方法52例患者和19例对照组同时进行了(11)C-DTBZ和(18)F-FDG PET扫描。7例临床诊断为额颞叶痴呆(FTD)，25例为阿尔茨海默病(AD)，20例为路易体痴呆(DLB)。DTBZ扫描提供了K(1)和DV图，而(18)F-FDG扫描提供了葡萄糖代谢图。在受试者内部和跨受试者之间进行不同的PET测量之间的相关性分析。用Logistic回归进行判别分析，比较了(11)C-DTBZ K(1)和(18)F-FDG在区分受试者组中的表现。三名经验丰富的PET研究人员参与了一项使用(11)C-DTBZ K(1)和(18)F-FDG图像的评价者间可靠性研究。结果(11)C-DTBZ K(1)和(18)F-FDG测量的受试者内一致性较高，相关系数平均为0.92。(11)C-DTBZ DV与K(1)或(18)F-FDG的相关性较低，平均分别为0.37和0.31，表明K(1)和(18)F-FDG提供的信息与(11)C-DTBZ DV提供的非常不同的信息相比有更高的相似性。判别分析表明，(11)C-DTBZ K(1)和(18)F-FDG在区分本研究对象方面具有相似的敏感性和特异性。除了K(1)或(18)F-FDG之外，还包括(11)C-DTBZ DV，改善了组间的歧视。评分员使用K(1)和(18)F-FDG对PET扫描进行了几乎相同的分类。结论多项PET检查，无论是单一PET检查的两个参数如(11)C-DTBZ K(1)和DV，还是来自不同研究的两个参数，如(18)F-FDG和(11)C-DTBZ DV，都为诊断痴呆提供了有用的补充信息。单次(11)C-DTBZ扫描产生的K(1)和DV图像提供的诊断信息与使用(11)C-DTBZ和(18)F-FDG的两次扫描研究提供的诊断信息一样多。
UNLABELLED Accurate, early differentiation of dementias will become increasingly important as new therapies are introduced. Differential diagnosis by standard clinical criteria has limited accuracy. PET offers the potential to increase diagnostic accuracy. (18)F-FDG studies detect metabolic abnormalities in demented patients, but with limited specificity. PET also offers the ability to quantify other biochemical markers that can yield additional useful diagnostic information. We demonstrate that (+)-(11)C-dihydrotetrabenazine ((11)C-DTBZ) studies, which provide an index of nigrostriatal terminal density (distribution volume; DV), also provide a measure of transport (K(1)) that produces information comparable to the metabolic measure of (18)F-FDG. METHODS Fifty-two patients and 19 control subjects underwent both (11)C-DTBZ and (18)F-FDG PET scans. Seven had the clinical diagnosis of frontotemporal dementia (FTD), 25 had Alzheimer's disease (AD), and 20 had dementia with Lewy bodies (DLB). DTBZ scans provided maps of K(1) and DV, whereas (18)F-FDG scans provided maps of glucose metabolism. Correlation analyses were performed between the different PET measures both within and across subjects. Discriminant analysis using logistic regression compared the performance of (11)C-DTBZ K(1) and (18)F-FDG in differentiating subject groups. Three experienced PET researchers participated in an interrater reliability study using both (11)C-DTBZ K(1) and (18)F-FDG images. RESULTS Within-subject correspondence between (11)C-DTBZ K(1) and (18)F-FDG measures was high, with correlations averaging 0.92. Correlations between the (11)C-DTBZ DV and either K(1) or (18)F-FDG were far lower, averaging 0.37 and 0.31, respectively, indicating the much higher degree of similarity in information provided by K(1) and (18)F-FDG compared with the very different information provided by (11)C-DTBZ DV. Discriminant analysis demonstrated that (11)C-DTBZ K(1) and (18)F-FDG yielded similar levels of sensitivity and specificity for differentiating the subjects in this study. Including (11)C-DTBZ DV in addition to either K(1) or (18)F-FDG improved discrimination between groups. The raters classified PET scans nearly equivalently using K(1) and (18)F-FDG. CONCLUSION Multiple PET measures, whether 2 parameters from a single PET study such as (11)C-DTBZ K(1) and DV, or 2 parameters from different studies such as (18)F-FDG and (11)C-DTBZ DV, offer complementary information useful for diagnosing dementias. K(1) and DV images generated from a single (11)C-DTBZ scan provide as much diagnostic information as 2-scan studies using both (11)C-DTBZ and (18)F-FDG.