阿尔茨海默病18F-FDG PET显像诊断的研究☆

目的探讨阿尔茨海默病(AD)脑葡萄糖代谢及其18F-脱氧葡萄糖正电子发射计算机断层扫描(18F-FDGPET)显像的影像学特征和PET诊断标准.方法静脉注射18F-FDG后行脑断层显像,检查13例AD、13例非AD痴呆及13例正常人.获得纹状体、丘脑、黑质、顶叶、颞叶、额叶、枕叶、海马单位面积放射性计数与小脑计数的比值(Rcl/cb),进行半定量分析,并与MR进行对照.结果AD患者PET异常率为100%,MR异常者占10/13.PET显像特征①对称性双侧颞顶叶及海马伴额叶或枕叶代谢减低占9例(9/13);②双侧颞叶对称性代谢减低伴海马或额叶代谢下降占3例(3/13);③双顶叶对称性代谢降低1例(1/13).12例(12/13)非AD痴呆表现为不对称、多发性代谢降低,降低区位于黑质、纹状体、丘脑及脑皮质区,MR异常率为11/13.结论在除外脑内结构特异性损害基础上,PET发现对称性双颞顶叶、海马或颞叶、顶叶,伴或不伴枕叶、额叶代谢下降,可诊断AD.PET对AD早期诊断及鉴别诊断具有临床意义.     

~(18)F-FDG PET显像鉴别阿尔茨海默病与额颞叶痴呆临床价值

目的探讨18F-FDG PET显像在阿尔茨海默病与额颞叶痴呆鉴别诊断中的应用价值。方法对临床明确诊断的阿尔茨海默病(20例)和行为异常型额颞叶痴呆(20例)患者的18F-FDG PET显像资料进行回顾,分析两组患者皮质代谢降低脑区间的差异。结果视觉分析显示,两组患者均表现为皮质代谢降低,阿尔茨海默病患者以双侧颞顶叶和后扣带回代谢降低明显,以及部分额叶皮质代谢降低,而基底节和丘脑不受累,18/20患者双侧大脑半球皮质代谢降低范围和程度基本对称;额颞叶痴呆患者额叶和前颞叶皮质代谢均降低,其中11例同时伴部分顶叶皮质和基底节、丘脑等皮质下核团不同程度降低,16/20患者双侧大脑半球代谢降低程度和范围明显不对称,4例以右侧为主、12例以左侧为主。结论由于18F-FDG PET显像所显示的阿尔茨海默病和额颞叶痴呆患者之皮质代谢降低图型不同,故具有较好的鉴别诊断价值。     

帕金森病/帕金森综合征18F-FDG PET脑显像技术操作及报告解读要素

18氟-脱氧葡萄糖正电子发射断层扫描(18F-FDG PET)脑显像通过呈现脑部葡萄糖代谢的分布特征,可反映大脑局部的突触活性以及与疾病发生、进展特异相关的生理病理学改变,已被证实在帕金森病/帕金森综合征的鉴别诊断中具有较好的临床应用价值.文中在强调重视18F-FDG PET脑显像技术操作规范的基础上,总结综述了原发性...     

阿尔茨海默病与PET

本文介绍了 ＰＥＴ在 Ａｌｚｈｅｉｍｅｒ病及相关痴呆的早期诊断中的意义。     

阿尔茨海默病与PET

本介绍了PET在Alzheimer病及相关痴呆的早期诊断中的意义。     

轻度认知障碍^18F-FDG PET显像的研究进展

轻度认知障碍(MCI)的病理改变与早期或临床前期阿尔茨海默病(AD)相似,MCI患者已经成为预测AD是否发生、有效延缓或早期干预治疗AD的最适群体,FDG PET脑功能显像可反映局部脑内葡萄糖代谢率,为MCI的病理学研究及临床诊断提供一种新的可靠工具.正确认识MCI与正常脑老化、AD脑葡萄糖代谢的不同、FDG PET图像特征及影响因素、对于预测病程及早期干预治疗、检测治疗效果、预防AD的发生及提高老年人生活质量有着重要的意义.     

阿尔茨海默病的18F-FDG PET脑显像特征及意义

目的探讨轻、中、重度阿尔茨海默病(AD)患者的脑~(18)F-FDG正电子发射断层显像(PET/CT)特点。方法对10例AD患者和10例健康对照的脑~(18)F标记的脱氧葡萄糖正电子发射断层显像(~(18)F-FDG PET)进行视觉分析,测量感兴趣区的FDG标准化摄取值(SUV),并通过计算获得其与同侧小脑FDG的SUV的比值,比较组间是否有显著性差异。结果轻度AD患者的FDG摄取代谢降低区为后扣带回及楔前叶,且呈双侧不对称性,中度AD患者的颞叶、顶叶FDG代谢降低双侧对称且降低明显,重度AD患者全脑皮质代谢明显降低。结论 AD患者的~(18)F-FDG PET脑显像特征反映认知功能的损害程度,是临床诊断和评估AD的有力工具。     

~(18)F-FDG PET检测阿尔茨海默病的脑葡萄糖代谢

目的　观察阿尔茨海默病 (AD)患者脑的葡萄糖代谢情况及在正电子发射计算机断层扫描 (PET)的影像表现。方法　用1 8F FDGPET对 15例AD患者的脑葡萄糖代谢变化进行了放射性计数测量 ,并与病人的神经心理测验得分进行相关分析。结果　AD组双侧的顶 /小脑、额 /小脑比及颞 /小脑比的比值均较正常对照组明显减低 ;并与神经心理测验得分有相关关系。结论　AD患者大脑的葡萄糖代谢与正常老年人不同 ,顶 /小脑、额 /小脑比及颞 /小脑比是一个较敏感的指标 ;其减低的程度与认知功能损害的程度成正比     

AD患者18F-FDG PET/CT脑显像糖代谢改变模式亚型研究

目的 分析阿尔茨海默病(Alzheimer disease, AD)患者¹⁸F-脱氧葡萄糖(fluorodeoxy glucose, FDG)正电子发射断层显像/计算机体层成像(positron emission tomography/computed tomography, PET/CT)脑显像的代谢改变亚型特点,并比较各亚型间临床表现的差异。方法 收集于北京协和医院神经科诊断为很可能AD且β淀粉样蛋白显像为阳性的患者51例(AD组),10名健康体检者作为对照,收集两组受试者¹⁸F-FDG PET/CT脑显像资料,结合视觉分析对AD组与健康对照组¹⁸F-FDG PET/CT图像进行基于体素的定量分析,按主要¹⁸F-FDG代谢减低脑区分布对AD组进行分型,分析各亚型间临床表现的差异。结果 根据代谢减低最明显的部位,将AD组分为边缘系受累为主(A型)、顶颞叶外侧皮层及额叶皮层为主(B型)、后皮质为主(C型)及不对称单侧颞叶受累为主(D型)4种亚型。本组患者以A型组为多见[共31例(61.0%)],均存...     

发作间期颞叶癫痫的18F-FDG PET 显像研究

目的：采用诊断试验评价方法评估发作间期^18F-FDG PET显像对颞叶癫痫定性和病业定位的诊断价值，探讨其外科治疗的意义。方法：26例CT或MRI检查正常，经临床及脑电图诊断的颞叶癫痫患者在同期进行发作间期^18F-FDG PET脑显像，图像通过目测和半定量的方法进行分析，PET显示的低代谢区行皮层脑电图（EcoG）或深部脑电图（DEEG）描记以评估^18F-FDG PET检测癫痫灶的特异性，17例定位明确的单侧颞叶癫痫行前颞叶切除术，术手进行随访。2例PET未检出癫痫灶，7例DEEG定位双侧病灶未行手术治疗。结果：26例颞叶癫痫中，发现^18F-FDG PET对癫痫灶检出的灵敏度为92%（24/26），特异度为87%(21/24)。结论：从颞叶癫痫的定性定位诊断来看，发作间期^18F-FDG PET脑显像对癫痫灶的检出率较高，但^18F-FDG PET显示的低代谢区与癫痫灶的位置并非完全重叠，尚需要其他的诊断措施加以肯定，^18F-FDG PET和皮层脑电图或深部脑电图对癫痫病灶定位的一致性是手术成功的关键。     

阿尔茨海默病脑磁共振研究

目的 了解Ａｌｚｈｅｉｍｅｒ病（ＡＤ）脑结构性变化的特点及与健康老人增龄性改变的差异。方法 对２２例ＡＤ和２９例健康老人分别按年龄为６０～６５岁、６６～７０岁和７０岁以上三组,ＡＤ为ａｄ１、ａｄ２和ａｄ３组,健康老人为ｎｏｒ１、ｎｏｒ２和ｎｏｒ３组。全部对象作ＭＲＩ检查。结果 ｎｏｒ３的灰质体积、总脑脊液体积及右侧海马体积与ｎｏｒ１和ｎｏｒ２相比有显著差异;与健康老人相比,ＡＤ的灰质体积,双侧海马体积显著降低,而总脑脊液、脑室外脑脊液、侧脑室、三脑室和四脑室体积显著升高。结论 与健康老人增龄性变化相比,ＡＤ脑结构性改变的涉及范围广,变化幅度大。     

阿尔茨海默病正电子发射计算机断层扫描和神经心理测定的初步研究

目的 探讨阿尔茨海默病(Alzheimer’s disease,AD)的脑葡萄糖代谢、神经心理学特点及AD的正电子发射计算机断层扫描(positron emission photography,PET)诊断。方法 对13例AD患者和11例年龄、性别和文化程度相匹配的健康对照者(HC)进行PET检查、简易智能状态检查(mini-mental state examination,MMSE)、韦克斯勒记忆量表测定(wechsler memory scale,WMS)和日常生活能力量表(activity of daily living,ADL)测定。结果 ①AD组MMSE、WMS分值明显低于HC组(P<0.01)。②肉眼读片,AD组存在脑萎缩,尤其是颞叶萎缩;大脑皮层放射性分布不均匀;健康老人可出现顶叶局部脑葡萄糖代谢率(regional cerebral metabolism rate of glucose,rCMRglc)的减低,但程度较轻;AD组全脑rGMRglc减低,以顶叶为最明显,其次为颞叶,再次为额叶。③AD组在双侧额叶上、中、下回、眶回、直回、颞叶中下回、顶上小叶、缘上回、前扣带回、尾状核、岛叶、丘脑,左侧角回、左侧杏仁核等脑区rCMRglc半定量指标降低较明显,与健康对照组相比,差异具有显著性或高度显著性((P<0.05-P<0.001);AD组病人额叶上中下回葡萄糖代谢半定量指标降低最为明显,其次为丘脑和尾状核。④相关分析表明,MMSE评分与性别呈负相关(P=0.025);右侧顶上小叶和右侧丘脑的rCMRg     

PET和TCD对阿耳茨海默病早期诊断的研究

目的 利用正电子发射计算机断层扫描（ｐｏｓｉｔｒｏｎ ｅｍｉｓｓｉｏｎ ｔｏｍｏｇｒａｐｈｙ,ＰＥＴ）和经颅多普勒超声（ｔｒａｎｓｃｒａｎｉａｌ ｄｏｐｐｌｅｒ,ＴＣＤ）相结合的方法探讨阿耳茨海默病（Ａｌｚｈｅｉｍｅｒ’ｓ ｄｉｓｅａｓｅ,ＡＤ）的早期诊断,以及ＡＤ与脑血液供应之间的关系。方法 ２０例可疑ＡＤ患者和２０例正常对照行ＰＥＴ、ＴＣＤ以及临床神经心理量表检查,对局部脑区葡萄糖代谢率（ｒｅ     

正电子断层显像技术在阿尔茨海默病中的研究进展

阿尔茨海默病(Alzheimer's disease,AD)是老年人最常见的痴呆类型,为一种进行性神经系统变性疾病[1].其主要神经病理学特征包括神经元纤维缠结(neurofibrillary tangles,NET)、老年斑(senile plaque,Sp)的出现及神经元的减少.迄今为止,AD病因不明,缺乏客观的诊断及有效治疗方法.当AD患者出现临床症状时,往往已处于临床中期阶段,即中度AD,此时治疗效果较差,且很难逆转病情的进展,因此研究者们都在努力寻找早期诊断标记物及疾病修复疗法,结果发现正电子断层显像(PET)技术有望成为实现这个目标的重要手段.研究表明,PET技术可以被用于研究脑代谢变化、各种神经递质系统、炎症过程及蛋白质聚合物(尤其是淀粉样蛋白沉积物)[2].PET利用11C标记的匹兹堡复合物B(11C- PIB)和18F脱氧葡萄糖(18F- FDG)在体显像,可以了解脑内Aβ蛋白分布及葡萄糖代谢情况[3].本文将近年来PET影像技术在AD基础及临床方面的研究情况作一综述.     

老年性痴呆与血管性痴呆的^18F—FDG PET显像分析

目的 比较老年性痴呆（AD）和血管性痴呆（VD）^18F-FDG PET显像特征,为诊断和治疗提供帮助。方法 将受者分为3组：其中AD组14例,VD组6例,正常对照组6例。静脉注射^18F-FDG 185－370MBq,40min后采用PET扫描仪行脑显像。结果 正常对照组双侧各脑叶和小脑的葡萄糖代谢分布对称。VD组6例,病灶呈非对称性分布于脑叶皮层,其中4例病灶波及多叶及丘脑和基底节,并出现交叉性小脑失联络。AD组的双侧顶叶、颞叶的代谢明显减少（P＜0．001,P＜0．05）。结论 AD和VD的PET显像各有其特点,PET能敏感地区分他们。     

Progress in neuroimaging of Alzheimer's disease

The main purposes of neuroimaging in Alzheimer’s disease (AD) have progressed from diagnosis of advanced AD to diagnosis of very early AD at a prodromal stage of mild cognitive impairment (MCI), prediction of conversion from MCI to AD and differential diagnosis from other diseases causing dementia. Structural MRI studies and functional studies using FDG‐PET and brain perfusion SPECT are widely used in diagnosis of AD. Outstanding progress in the diagnostic accuracy of these neuroimaging modalities has been obtained using statistical analysis on a voxel‐by‐voxel basis after spatial normalization of individual scans to a standardized brain‐volume template instead of visual inspection or a conventional region of interest technique. In a very early stage of AD, this statistical approach revealed gray matter loss in medial temporal areas prominently in the entorhinal cortex and hypometabolism or hypoperfusion in the posterior cingulate cortex and precunei. These two findings might be related in view of anatomical knowledge that the regions are linked through the circuit of Papez. This statistical approach also offers a predictive value of conversion from MCI to AD and accurate evaluation of therapeutic effects on brain metabolism or perfusion. This development in functional and structural imaging might be an important surrogate marker for trials of disease‐modifying agents.     

阿尔茨海默病PET/SPECT受体显像的临床研究进展

本综述以阿尔茨海默病(Alzheimer's disease ,AD)为代表的痴呆疾病的中枢神绎系统乙酰胆碱、苯二氮卓类、5-羟色胺、多巴胺及组胺等递质的受体及受体亚型水平的PET／SPECT显像的临床研究进展，揭示PET／SPECT受体显像在AD的病因、病理机制、早期诊断以及药物评价等研究方面的作用，并且对该领域的研究方向提供一些建议。     

In vivo proton magnetic resonance spectroscopy of the temporal lobe in Alzheimer's disease

PURPOSE: Prior proton magnetic resonance spectroscopy (MRS) studies have consistently reported decreased brain n-acetyl aspartate (NAA) levels and increased myo-inositol (mI) levels in subjects with Alzheimer's disease (AD) relative to healthy comparison subjects. These studies have usually been conducted in small and homogeneous populations of patients with established Alzheimer's disease. Few studies have tested the usefulness of this finding in a general population seeking evaluation for memory loss and other cognitive declines. We designed a study to evaluate the significance of single-voxel proton MRS findings in these patients with memory loss and other cognitive declines. GENERAL METHOD: Thirty-five subjects with a primary complaint of memory loss and other cognitive declines were consecutively referred over a period of 13 months to a specialty clinic. Patients with a diagnosis of mild to moderate probable Alzheimer's disease (N = 22), non-Alzheimer's dementia (depression, multiinfarct dementia, Parkinson's Disease, Korsakoff's Psychosis, and bipolar disorder; N = 13), and healthy comparison subjects (N = 18) were examined with respect to possible differences in metabolites using proton MRS in a 3.4-ml anterior temporal lobe voxel. FINDINGS: The Alzheimer's disease group had 10.7% lower NAA/creatine (Cr) ratios relative to the healthy comparison group and 9.4% lower NAA/creatine relative to the non-Alzheimer's dementia group (15.0% lower NAA/creatine relative to the depression subgroup of the non-Alzheimer's dementia group). There were no significant differences in choline (Cho) or myo-inositol ratios among the groups. There were significant correlations between NAA/creatine ratios and mini-mental status exam (MMSE) scores in subjects with Alzheimer's disease (t = 2.41, p = 0.032) but not in subjects with non-Alzheimer's dementia or in its depression subgroup. CONCLUSIONS: This study found a reduction in the neuronal marker NAA in the anterior temporal lobe of patients diagnosed with probable Alzheimer's disease, using a short add-on proton MRS exam. This change was not observed in patients whose memory loss and other cognitive declines were not attributed to Alzheimer's disease, suggesting that it may aid in the diagnosis or detection of Alzheimer's disease.     

Quantitative EEG mapping and PET in Alzheimer's disease

Quantitative analysis of topographical EEG was studied in comparison with measurement of regional glucose metabolism by PET in 42 patients with clinical diagnosis of probable dementia of Alzheimer type (AD) and in 15 age-matched normal controls. Measures analyzed included global and regional data from areas typically affected and not affected by AD pathology. While disturbance of metabolism followed a typical regional pattern, relative alpha, theta and delta power were more globally altered without selectivity for specific regions. Separation between AD and age matched controls by relative theta power was correct in 86% and was close to that by temporo-parietal glucose metabolism (correct classification 87%). Relative theta power as well as temporo-parietal glucose metabolism were significantly correlated (τ_B = 0.54 and −0.53, respectively) to severity of AD assessed by the global deterioration scale. These results indicate that EEG measures may be used with an accuracy close to metabolic values from PET for the assessment of severity of AD.