99mTc-ECD SPECT脑显像NeuroGamTM诊断早期认知障碍

目的 前瞻性评价基于NeuroGam^TM Brodmann分区定量技术研究^99mTc-ECD SPECT脑显像早期诊断早期认知障碍（mild cognitive impairment，MCI）的能力。方法 纳入同济大学附属第十人民医院及上海交通大学附属第六人民医院经过筛选的24例受试者，包括MCI组患者18例及健康志愿者（NC组）6例，在复旦大学附属华山医院核医学科进行^99mTc-ECD SPECT脑显像，并使用NeuroGam^TM技术对脑显像进行定量分析，研究Brodmann分区的4-11、17-25、28、31-32、36-40以及44-47等共29个大脑皮层区域的血流灌注情况。结果 受试者平均年龄为（65.3±8.4）岁，其中MCI组男性受试者7例，女性受试者11例，平均年龄为（67.1±7.0）岁；NC组男性受试者2例，女性受试者4例，平均年龄为（59.8±10.4）岁；MCI组与NC组受试者的年龄差异无统计学意义。受试者蒙特利尔认知评估量表（Montreal cognitive assessment scale，MoCA）评分平均值为22.6±5.1，简易精神状态评价量表（mini-mental state examination，MMSE）评分平均值为25.5±3.7，MCI组受试者MoCA评分平均值为20.8±4.5，NC组受试者MoCA评分平均值为28.2±0.8；MCI组受试者MMSE评分平均值为24.3±3.6，NC组受试者MMSE评分平均值为29.0±0.6，MCI组与NC组受试者的MoCA评分与MMSE评分差异有统计学意义（P=0.005，P=0.001）。MCI组与NC组受试者29个Brodmann分区的脑血流灌注值对比中17R、18R、19R、39L、39R 5个Brodmann区域的脑血流灌注值分别为68.0、59.3、54.2、50.0、54.0和72.7、64.8、60.6、59.7、58.51，差异有统计学意义（P<0.05），Brodmann 17R、18R、19R、39L、39R 5个区域的ROC曲线下面积（area under curve，AUC）分别为0.815、0.856、0.866、0.764、0.759，其中17R、18R、19R区域的P<0.05。结论 17R、18R、19R 3个Brodmann区域脑血流灌注减低对诊断早期认知障碍有较高的诊断效能。

Diagnosis of mild cognitive impairment using 99mTc-ECD SPECT brain imaging with NeuroGamTM technology

Objective To prospectively evaluate the ability of ^99mTc-ECD SPECT brain imaging for early diagnosis of mild cognitive impairment (MCI) based on the quantitative technique of Neurogam Brodmann areas.Methods A total of 24 subjects from Shanghai Tenth People's Hospital, Tongji University and Shanghai Jiao Tong University Affiliated Sixth People's Hospital were enrolled, including 18 patients in MCI group and 6 healthy volunteers (Normal Control, NC group). The ^99mTc-ECD SPECT brain imaging was performed in the Department of Nuclear Medicine, Huashan Hospital, Fudan University, and the quantitative analysis of the brain imaging was performed using NeuroGam technology. The blood perfusion of 29 cerebral cortical regions in Brodmann areas was studied, including 4-11, 17-25, 28, 31-32, 36-40, and 44-47.Results The mean age of the subjects was (65.3±8.4) years old. There were 7 males and 11 females in the MCI group, with an average age of (67.1±7.0) years old. There were 2 males and 4 females in the NC group, with an average age of (59.8±10.4) years old. The age difference between MCI group and NC group was not statistically significant. The mean score of Montreal cognitive assessment scale (MoCA) was 22.6±5.1, the mean score of mini-mental state examination (MMSE) was 25.5±3.7, the mean score of MCI group was 20.8±4.5, and the mean score of NC group was 28.2±0.8. The average MMSE score of the subjects in the MCI group was 24.3±3.6, and that in the NC group was 29.0±0.6. The difference between MoCA score and MMSE score of the subjects in the MCI group and the NC group was statistically significant. The cerebral blood flow perfusion values of 29 Brodmann areas in the MCI group and the NC group were compared (P=0.005, P=0.001). The cerebral blood flow perfusion values of 5 Brodmann areas (17R, 18R, 19R, 39L, 39R) in the MCI group were 68.0, 59.3, 54.2, 50.0, 54.0, respectively.The areas under the receiver operating characteristic curve of Brodmann areas of 17R, 18R, 19R, 39L and 39R were 0.815, 0.856, 0.866, 0.764 and 0.759, respectively, and P < 0.05 for 17R, 18R and 19R regions.Conclusion The decrease of cerebral blood flow perfusion in the 3 Brodmann areas (17R, 18R and 19R) has a high diagnostic efficiency in the diagnosis of mild cognitive impairment.