基于PET的神经影像学ATN框架在阿尔茨海默病诊断中的应用  

Application of PET-based neuroimaging ATN framework in the diagnosis of Alzheimer′s disease

作　　者：熊敏 尤鸿吉 罗小明 刘艺培 姜圣男 Xiong Min;You Hongji;Luo Xiaoming;Liu Yipei;Jiang Shengnan(Department of Nuclear Medicine,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院核医学科,广州510260

出　　处：《中华核医学与分子影像杂志》2024年第12期705-711,共7页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(81960556)。

摘　　要：目的探讨基于PET的神经影像学淀粉样蛋白、tau、神经变性(ATN)框架在轻度认知障碍(MCI)和阿尔茨海默病(AD)临床辅助诊断中的价值,并分析其与患者认知状态的关系。方法回顾性纳入2022年5月至2024年3月于广州医科大学附属第二医院诊断为AD、MCI或非AD对照(CP)并行^(18)F-FDG、^(18)F-AV45和^(18)F-AV1451 PET/CT显像的患者98例[男23例、女75例,年龄(67.8±8.6)岁]。记录患者临床资料、简易精神状态检查量表(MMSE)和蒙特利尔认知评价量表(MoCA)评分,将患者分为MCI组、轻度AD组、中度AD组、中-重度AD组和CP组。对PET图像进行视觉评估和半定量分析,获得^(18)F-FDG(8个)、^(18)F-AV45(14个)和^(18)F-AV1451(14个)独立脑分区SUV_(mean)和SUV比值(SUVR),以临床诊断为参考行ROC曲线分析。视觉评估与临床诊断的一致性采用Cohen′s Kappa系数分析。组间半定量比较采用两独立样本t检验、单因素方差分析、Mann-Whitney U检验或Kruskal-Wallis秩和检验。以年龄作为协变量计算SUVR与认知评分的偏相关系数。结果综合视觉评估诊断AD+MCI的灵敏度达87.65%(71/81),特异性为14/17,与临床诊断一致性中等(Kappa=0.60,P<0.001)。半定量分析MCI所有独立脑分区^(18)F-FDG摄取高于AD,而^(18)F-AV45和^(18)F-AV1451摄取则相反(t值:2.66~3.95,z值:4.98~15.04,均P<0.05)。AD的3个亚组间^(18)F-AV45摄取差异较小(H值:0.46~4.06,F值:0.03~0.08,均P>0.05)。除内侧颞叶和枕叶以外,中-重度AD组^(18)F-AV1451摄取有高于中度和轻度AD组的趋势(H值:0.20~5.17,均P>0.05)。^(18)F-FDG PET半定量区分MCI与CP的灵敏度较高(13/14),^(18)F-AV45诊断AD+MCI的灵敏度较高(92.59%,75/81),而^(18)F-AV1451区分AD与MCI的特异性高(14/14)(AUC值:0.87、0.90和0.92)。AD和MCI患者大脑皮质^(18)F-FDG摄取与MMSE和MoCA认知评分呈正相关(r值:0.30~0.43和0.29~0.45,均P<0.05),而^(18)F-AV45和^(18)F-AV1451摄取与MMSE和MoCA认知评分呈负相关(^(18)F-AV45:r值:-0.39~-0ObjectiveTo explore the value of the amyloid-tau-neurodegeneration(ATN)framework in neuroimaging based on PET for diagnosing mild cognitive impairment(MCI)and Alzheimer′s disease(AD),and analyze its relationship with clinical cognition.MethodsFrom May 2022 to March 2024,a total of 98 cases(23 males and 75 females,age(67.8±8.6)years)with a diagnosis of AD,MCI,or non-AD(control patients,CP)who underwent ^(18)F-FDG,^(18)F-AV45,and ^(18)F-AV1451 PET/CT imaging in the Second Affiliated Hospital of Guangzhou Medical University were included retrospectively.The clinical data,Mini-Mental State Examination(MMSE),and Montreal Cognitive Assessment(MoCA)scores were recorded.Cases were divided into MCI group,mild AD group,moderate AD group,moderate-severe AD group,and CP group.PET images were visually and semi-quantitatively evaluated.SUV_(mean) and SUV ratio(SUVR)were obtained from independent brain regions of ^(18)F-FDG(n=8),^(18)F-AV45(n=14)and ^(18)F-AV1451(n=14).ROC curve analysis was performed with clinical diagnosis as a criterion.The consistency between visual assessment and the clinical diagnosis was analyzed by Cohen′s Kappa coefficient.Semi-quantitative comparisons between groups were performed using the independent-sample t test,one-way analysis of variance,Mann-Whitney U test,or Kruskal-Wallis rank sum test.Age was used as a covariate to calculate the partial correlation coefficient between SUVR and cognitive scores.ResultsThe sensitivity and specificity of comprehensive visual assessment in diagnosing AD+MCI were 87.65%(71/81)and 14/17 respectively,showing a moderate consistency with clinical diagnosis(Kappa=0.60,P<0.001).Semi-quantitative analysis showed that ^(18)F-FDG uptakes in all independent brain regions of MCI patients were higher than those of AD patients,whereas the uptakes of ^(18)F-AV45 and ^(18)F-AV1451 were lower(t values:2.66-3.95,z values:4.98-15.04,all P<0.05).The difference in ^(18)F-AV45 uptake among the three subgroups of AD was relatively small(H values:0.46-4.06,F values:0.03-0.08,all

关 键 词：阿尔茨海默病 认知功能障碍 乙二醇类 咔啉类 氟脱氧葡萄糖F18 正电子发射断层显像术 

分 类 号：R749.16[医药卫生—神经病学与精神病学]