^18F-AV45PET/CT显像视觉分析及SUVR对不同认知障碍患者的辅助诊断价值  

Value of visual analysis and SUVR during ^18F-AV45 PET/CT imaging in the diagnosis of mild cognitive impairment and Alzheimer′s disease

作　　者：张晨鹏[1] 王成[1] 辛玫[1] 閤谦[1] 万良荣[1] 邱菊 徐群[2] 岳玲[3] 肖世富[3] 刘建军[1] Zhang Chenpeng;Wang Cheng;Xin Mei;Xia Qian;Wan Liangrong;Qiu Ju;Xu Qun;Yue Ling;Xiao Shifu;Liu Jianjun(Department of Nuclear Medicine,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Department of Neurology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Department of Geriatric Psychiatry,Shanghai Mental Health Center,School of Medicine,Shanghai Jiao Tong University/Alzheimer′s Disease and Related Disorders Center,Shanghai Jiao Tong University,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属仁济医院核医学科,200127 [2]上海交通大学医学院附属仁济医院神经内科,200127 [3]上海交通大学医学院附属精神卫生中心老年精神科、上海交通大学阿尔茨海默病诊治中心,200030

出　　处：《中华核医学与分子影像杂志》2020年第4期201-206,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：转化医学协同创新中心合作研究项目(TM201806).

摘　　要：目的 探讨^18F-AV45 PET/CT脑显像中视觉分析、标准摄取值比值(SUVR)对不同认知障碍患者大脑内β-淀粉样蛋白(Aβ)沉积情况的评估以及临床辅助诊断价值.方法 自2018年12月至2019年7月共纳入47例(名)受试者,包括5名[男3名、女2名,年龄(58±13)岁]健康人对照(NC)、8例[男2例、女6例,年龄(66±10)岁]阿尔茨海默病(AD)患者和34例[男16例、女18例,年龄(70±7)岁]轻度认知障碍(MCI)患者.对所有纳入者行^18F-AV45 PET/CT检查,进行视觉分析,并计算SUVR.对视觉分析和SUVR的诊断效率采用McNemar检验比较,一致性采用Kappa检验分析;组间比较采用单因素方差分析及Welch检验.另外,通过受试者工作特征(ROC)曲线分析获得SUVR的最佳界值.结果 SUVR和视觉分析评估的全部受试Aβ沉积阳性率分别是46.81%(22/47)和38.30% (18/47),差异无统计学意义(x^2=33.15,P>0.05),一致性较好(Kappa=0.83).以临床诊断为“金标准”,视觉分析与SUVR均可鉴别AD和NC:灵敏度分别为7/8和8/8,特异性均为5/5 (x^2=9.48,P>0.05),一致性较好(Kappa=0.84).SUVR定量分析可以鉴别AD与NC组、AD与MCI组,组间SUVR差异有统计学意义(F值:3.99~8.79,均P<0.01),无法鉴别NC与MCI组(均P>0.05).ROC曲线分析示,楔前叶SUVR> 1.08对AD与NC的鉴别诊断效能最高;侧颞叶SUVR> 1.06是鉴别AD与MCI的最佳界值.结论 在^18F-AV45 PET/CT显像中,视觉分析与SUVR定性判断大脑Aβ沉积能力一致,而SUVR定量分析可以辅助鉴别AD与NC、AD与MCI.Objective To evaluate the value of visual analysis and standardized uptake value ratio(SUVR)during ^18F-florbetapir(AV45)PET/CT brain imaging in diagnosis ofβ-amyloid(Aβ)deposition in patients with mild cognitive impairment(MCI)and Alzheimer′s disease(AD),and to explore the clinical ancillary value of the two indexes.Methods From December 2018 to July 2019,a total of 47 subjects,including 5(3 males,2 females,age(58±13)years)normal controls(NC),8(2 males,6 females,age(66±10)years)patients with AD and 34(16 males,18 females,age(70±7)years)patients with MCI were enrolled.All subjects underwent ^18F-AV45 PET/CT scan.All images were evaluated by visual analysis and SUVR were calculated.The diagnostic efficiencies of visual analysis and SUVR were compared by McNemar test and Kappa test.One-way analysis of variance and Welch test were used to compare data differences.The best threshold value of SUVR was obtained by receiver operating characteristic(ROC)curve analysis.Results The positive rate of Aβdeposition for all subjects was 46.81%(22/47)by SUVR analysis,and 38.30%(18/47)by visual analysis.There was no significant difference between the two methods(χ^2=33.15,P>0.05),and the consistency was good(Kappa=0.83).Considering the clinical diagnosis as the"gold standard",the Aβdeposition obtained by visual analysis and SUVR analysis can effectively distinguish AD from NC,and the sensitivities were 7/8 vs 8/8,respectively,both specificities were 5/5(χ^2=9.48,P>0.05),with good consistency(Kappa=0.84).SUVR quantitative analysis could distinguish AD from NC,AD from MCI(F values:3.99-8.79,all P<0.01),but could not distinguish NC from MCI(all P>0.05).ROC curve analysis showed that the best threshold value of precuneus′SUVR was 1.08 for the differential diagnosis of AD and NC;for the differential diagnosis of AD and MCI,the best threshold value of lateral temporal′s SUVR was 1.06.Conclusion Visual analysis was consistent with SUVR′s qualitative determination during ^18F-AV45 PET/CT imaging for brain Aβdeposition,w

关 键 词：阿尔茨海默病 认知障碍 淀粉样蛋白 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R74[医药卫生—神经病学与精神病学]