99mTc Hexamethyl-Propylene-Aminoxime Single-Photon Emission Computed Tomography Prediction of Conversion From Mild Cognitive Impairment to Alzheimer Disease
99mTc Hexamethyl-Propylene-Aminoxime Single-Photon Emission Computed Tomography Prediction of Conversion From Mild Cognitive Impairment to Alzheimer Disease
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DOI：
10.1097/jgp.0b013e3181ec8696
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发表时间：
2010-11-01
影响因子：
7.2
通讯作者：
Parsey, Ramin
中科院分区：
文献类型：
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作者：
Devanand, D. P.;Van Heertum, Ronald L.;Parsey, Ramin
目标：探讨单光子发射计算机断层扫描（SPECT）预测轻度认知功能障碍（MCI）向阿尔茨海默病（AD）转化的实用性。设计：纵向、前瞻性研究。设置：大学为基础的记忆障碍诊所。对象：127例MCI患者和59例健康对照者随访1-9年。测量值：进行诊断评估、神经心理学测试、社会/认知功能、嗅觉鉴定、载脂蛋白E基因型、磁共振成像和脑Tc-99 m六甲基丙烯胺肟SPECT扫描与视觉评级，以及感兴趣区域（ROI）分析。结果如下：SPECT颞叶和顶叶血流的视觉评级不能区分最终MCI转换为AD（N = 31）和非转换者（N = 96），但总体评级预测转换（41.9%的灵敏度和82.3%的特异性，Fisher精确检验p = 0.013）。每个ROI的血流不能预测，但是当在MCI患者的中值处进行二分时，低血流增加了顶叶转化为AD的风险。（风险比：2.96，95%置信区间：1.16-7.53，p = 0.023）和内侧颞区（风险比：3.12，95%置信区间：1.14-8.56，p = 0.027）。在3年的随访样本中，低顶叶（p < 0.05）和内侧颞叶（p < 0.01）血流预测转换为AD，有或没有控制年龄，简易精神状态检查和载脂蛋白E β 4基因型。当其他强预测因素包括在逻辑回归分析中时，这些措施失去了意义：言语记忆，社会/认知功能，嗅觉识别缺陷，海马和内嗅皮层体积。结论：SPECT视觉评分在预测MCI转化为AD方面的效用有限。当其他更强的预测因子可用时，使用SPECT定量的低顶叶和内侧颞叶血流的适度预测效用可能会降低。(Am J Geriatr Psychiatry 2010; 18：959-972）
Objective: To examine the utility of single-photon emission computed tomography (SPECT) to predict conversion from mild cognitive impairment (MCI) to Alzheimer disease (AD). Design: Longitudinal, prospective study. Setting: University-based memory disorders clinic. Participants: One hundred twenty seven patients with MCI and 59 healthy comparison subjects followed up for 1-9 years. Measurements: Diagnostic evaluation, neuropsychological tests, social/cognitive function, olfactory identification, apolipoprotein E genotype, magnetic resonance imaging, and brain Tc-99m hexamethyl-propylene-aminoxime SPECT scan with visual ratings, and region of interest (ROI) analyses were done. Results: Visual ratings of SPECT temporal and parietal blood flow did not distinguish eventual MCI converters to AD (N = 31) from nonconverters (N = 96), but the global rating predicted conversion (41.9% sensitivity and 82.3% specificity, Fisher's exact test p = 0.013). Blood flow in each ROI was not predictive, but when dichotomized at the median value of the patients with MCI, low flow increased the hazard of conversion to AD for parietal (hazard ratio: 2.96, 95% confidence interval: 1.16-7.53, p = 0.023) and medial temporal regions (hazard ratio: 3.12, 95% confidence interval: 1.14-8.56, p = 0.027). In the 3-year follow-up sample, low parietal (p < 0.05) and medial temporal (p < 0.01) flow predicted conversion to AD, with or without controlling for age, Mini-Mental State Examination, and apolipoprotein E epsilon 4 genotype. These measures lost significance when other strong predictors were included in logistic regression analyses: verbal memory, social/cognitive functioning, olfactory identification deficits, hippocampal, and entorhinal cortex volumes. Conclusions: SPECT visual ratings showed limited utility in predicting MCI conversion to AD. The modest predictive utility of quantified low parietal and medial temporal flow using SPECT may decrease when other stronger predictors are available. (Am J Geriatr Psychiatry 2010; 18: 959-972)