FDG PET imaging in patients with pathologically verified dementia.
FDG PET imaging in patients with pathologically verified dementia.
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发表时间：
2000-11
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通讯作者：
J. Hoffman;K. Welsh-Bohmer;M. Hanson;B. Crain;C. Hulette;N. Earl;R. Coleman;Maryland Joseph;Kathleen Bryan Alzheimer
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作者：
J. Hoffman;K. Welsh-Bohmer;M. Hanson;B. Crain;C. Hulette;N. Earl;R. Coleman;Maryland Joseph;Kathleen Bryan Alzheimer
本研究的目的是通过病理验证证实与阿尔茨海默氏病 (AD) 相关的 2 个信念：(a) 长期以来的印象，即 FDG PET 成像中指出的双侧颞顶叶代谢低下是与阿尔茨海默氏病 (AD) 相关的代谢异常；(b) 双侧颞顶叶代谢低下代谢模式的敏感性、特异性和诊断准确性允许区分其他退行性原因痴呆症。方法 对 22 名患有难以表征的记忆丧失或痴呆（使用标准临床标准）且最终获得病理学确诊的个体（8 名女性，14 名男性）进行了评估。 FDG PET 脑部扫描由经验丰富的核医学医师进行视觉分级，以确定是否存在阿尔茨海默氏型痴呆症中所见的经典双侧颞顶叶代谢低下。以病理诊断为金标准，确定双侧颞顶代谢低下代谢模式的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性。结果 12 名患者的临床诊断为可能或很可能 AD 被确定为痴呆的主要原因。临床诊断可能 AD 的敏感性和特异性分别为 63% 和 100%。临床诊断可能和可能 AD 的敏感性和特异性分别为 75% 和 100%。与 AD 相关的双侧颞顶代谢低下的敏感性、特异性和诊断准确性分别为 93%、63% 和 82%。结论 这项研究证实双侧颞顶代谢低下确实是与 AD 相关的典型代谢异常。此外，对于 FDG PET 扫描显示除双侧颞顶叶代谢减退以外的代谢模式的痴呆个体，应怀疑除 AD 之外的痴呆原因。这些观察结果对于区分痴呆综合征可能具有临床重要性。 FDG PET 的敏感性、特异性和诊断准确性可以作为用于评估痴呆症的测试，特别是用于确认临床怀疑 AD 的测试。
UNLABELLED The purpose of this study was to confirm with pathologic verification 2 beliefs related to Alzheimer's disease (AD): (a) the long-standing impression that bilateral temporo-parietal hypometabolism, as noted on FDG PET imaging, is the metabolic abnormality associated with Alzheimer's disease (AD) and (b) that the sensitivity, specificity, and diagnostic accuracy of the metabolic pattern of bilateral temporo-parietal hypometabolism allows differentiation between other degenerative causes of dementia. METHODS Twenty two individuals (8 women, 14 men) with difficult-to-characterize memory loss or dementia (using standard clinical criteria), and who eventually received pathologic confirmation of diagnosis, were evaluated. FDG PET brain scans were obtained and visually graded by an experienced nuclear medicine physician as to the presence of classic bilateral temporo-parietal hypometabolism as seen in Alzheimer's type dementia. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the metabolic pattern of bilateral temporo-parietal hypometabolism were determined using pathologic diagnosis as the gold standard. RESULTS The clinical diagnosis of possible or probable AD was determined as the primary cause of dementia in 12 patients. The sensitivity and specificity of the clinical diagnosis for probable AD were 63% and 100%, respectively. The sensitivity and specificity of the clinical diagnosis for possible and probable AD were 75% and 100%, respectively. The sensitivity, specificity, and diagnostic accuracy of bilateral temporo-parietal hypometabolism being associated with AD were 93%, 63%, and 82%, respectively. CONCLUSION This study confirms that bilateral temporo-parietal hypometabolism is indeed the classic metabolic abnormality associated with AD. Furthermore, in individuals with dementia whose FDG PET scans indicated a metabolic pattern other than bilateral temporo-parietal hypometabolism, a cause of dementia other than AD should be suspected. These observations may be of clinical importance in differentiating dementia syndromes. The sensitivity, specificity, and diagnostic accuracy of FDG PET are acceptable as tests to be used in the evaluation of dementia and particularly to confirm the clinical suspicion of AD.