Positron emission tomography in evaluation of dementia - Regional brain metabolism and long-term outcome
Positron emission tomography in evaluation of dementia - Regional brain metabolism and long-term outcome
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DOI：
10.1001/jama.286.17.2120
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发表时间：
2001-11-07
影响因子：
120.7
通讯作者：
Phelps, ME
中科院分区：
文献类型：
--
作者：
Silverman, DHS;Small, GW;Phelps, ME
背景在脑葡萄糖利用的缺陷已被确定在患者的认知功能障碍归因于各种疾病的过程，但其预后和诊断价值仍有待defined.Objective评估的敏感性和特异性，脑代谢模式在一个单一的时间点预测随后的文件进行性痴呆。1991年至2000年，在加州大学洛杉矶进行的146例接受痴呆评估并对疾病进展进行至少2年随访的患者中，[F-18]氟脱氧葡萄糖的正电子发射断层扫描（PET）研究，1984年至2000年，对138名在国际机构联盟接受痴呆评估的患者进行了PET研究，平均2.9年后进行组织病理学诊断。主要结果测量每位患者中[F-18]氟脱氧葡萄糖的区域分布，通过先验建立的标准分类为对于一般进行性神经变性疾病和具体阿尔茨海默病（AD）的存在为阳性或阴性，结果PET诊断进展性痴呆的敏感性为93%（191/206），特异性为76%（59/206），诊断进展性痴呆的敏感性为93%（191/206），特异性为76%（59/206）。78）。在基于神经病理学诊断的患者中，PET识别AD患者和任何神经退行性疾病患者的灵敏度分别为94%，特异性分别为73%和78%。在一次阴性脑PET扫描后数年内经历进展与非进展过程的阴性似然比为0.10（95%置信区间，0.06-0.16），并且脑代谢的初始模式与总体上随后的进展过程显著相关（P
Context Deficits in cerebral glucose utilization have been identified in patients with cognitive dysfunction attributed to various disease processes, but their prognostic and diagnostic value remains to be defined.Objective To assess the sensitivity and specificity with which cerebral metabolic patterns at a single point in time forecast subsequent documentation of progressive dementia.Design, Setting, and Patients Positron emission tomography (PET) studies of [F-18]fluorodeoxyglucose in 146 patients undergoing evaluation for dementia with at least 2 years' follow-up for disease progression at the University of California, Los Angeles, from 1991 to 2000, and PET studies in 138 patients undergoing evaluation for dementia at an international consortium of facilities, with histopathological diagnoses an average of 2.9 years later, conducted from 1984 to 2000.Main Outcome Measures Regional distribution of [F-18]fluorodeoxyglucose in each patient, classified by criteria established a priori as positive or negative for presence of a progressive neurodegenerative disease in general and of Alzheimer disease (AD) specifically, compared with results of longitudinal or neuropathologic analyses.Results Progressive dementia was detected by PET with a sensitivity of 93% (191/206) and a specificity of 76% (59/78). Among patients with neu ro pathologically based diagnoses, PET identified patients with AD and patients with any neurodegenerative disease with a sensitivity of 94% and specificities of 73% and 78%, respectively. The negative likelihood ratio of experiencing a progressive vs nonprogressive course over the several years following a single negative brain PET scan was 0.10 (95% confidence interval, 0.06-0.16), and the initial pattern of cerebral metabolism was significantly associated with the subsequent course of progression overall (P