18F氟脱氧葡萄糖正电子发射断层显像鉴别阿尔茨海默病和额颞叶痴呆的价值

Value of brain 18F-FDG PET/CT in differential diagnosis of AD and frontotemporal dementia

目的探讨18F-氟脱氧葡萄糖(18F-FDG)正电子发射断层显像(positron emission tomography,PET)/CT对阿尔茨海默病(AD)和额颞叶痴呆(FTD)的鉴别诊断价值。方法回顾性分析临床诊断为AD 20例和FTD 10例的18F-FDG PET/CT脑代谢显像资料,采用脑代谢影像进行视觉分析,测量相应部位的标准摄取值(standard up take value,SUV),以小脑为参考脑区,以放射性摄取减低脑区的SUV与小脑SUV的比值(SUVr)表示。采用NeuroQ脑分析软件进行定量分析其代谢模式特点。结果20例AD患者视觉分析显示,16例(80.0%)伴有双侧顶叶代谢减低,8例(40.0%)伴有双侧颞叶代谢减低,5例(25.0%)伴有单侧额叶代谢减低,2例(10.0%)伴有单侧颞叶代谢减低;定量分析显示,全部患者(100.0%)均伴有双侧顶叶代谢减低,18例(90.0%)伴有后扣带回代谢减低,17例(85.0%)伴有双侧颞叶代谢减低,7例(35.0%)伴有单侧额叶代谢减低。10例FTD患者视觉分析显示,8例(80.0%)患者伴有颞叶代谢减低,6例(60.0%)患者伴有额叶代谢减低,3例(30.0%)伴有双侧顶叶代谢减低;定量分析显示,10例患者(100.0%)均伴有额叶代谢减低,8例(80.0%)伴有颞叶代谢减低,4例(40.0%)伴有双侧顶叶代谢减低,4例(40.0%)伴有基底节代谢减低,3例(30.0%)伴有后扣带回代谢减低。AD患者和FTD患者额叶、顶叶和颞叶SUVr比较,差异有统计学意义(1.08±0.13 vs 0.75±0.09,0.78±0.14 vs 1.06±0.05,0.81±0.14 vs 0.95±0.12,P<0.01)。结论18F-FDG PET/CT脑显像显示的AD和FTD患者不同的代谢减低模式,有助于临床进行鉴别诊断。

Objective To study the value of brain 18F-fluorodeoxyglucose(18F-FDG)positron emission tomography(PET)/CT in differential diagnosis of Alzheimer disease(AD)and frontotemporal dementia(FTD).Methods The brain 18F-FDG PET/CT imaging data of 20 AD patients and 10 FTD patients were retrospectively analyzed by visual analysis and quantitative analysis respectively.The standard uptake value(SUV)in cerebelar area and SUVr in radioactivity uptaking cerebral area were measured.The characteristics of their metabolic mode were quantitatively analyzed by NeuroQ cerebral software.Results Visual analysis showed bilateral parietal lobe hypometabolism,bilateral temporal lobe hypometabolism,unilateral frontal lobe hypometabolism,unilateral temporal lobe hypometabolism in 16(80%),8(40%),5(25%),2(10%)AD patients respectively.Quantitative analysis revealed bilateral parietal lobe hypometabolism,posterior cingulate cortex hypometabolism,bilateral temporal lobe hypometabolism,unilateral temporal lobe hypometabolism in 20(100%),18(90%),17(85%),7(35%)AD patients respectively.Visual analysis showed frontal lobe hypometabolism,temporal lobe hypometabolism,bilateral parietal lobe hypomemetalism in 8(80%),6(60%),3(30%)FTD patients respectively.Quantitative analysis revealed frontal lobe hypometabolism,temporal lobe hypometabolism,parietal lobe hypometabolism,bilateral basal ganglia hypometabolism,posterior cingulate cortex hypometabolism in 10(100%),8(80%),4(40%),4(40%),3(30%)FTD patients respectively.The SUVr of frontal lobe was significantly higher than that of parietal lobe and temporal lobe(1.08±0.13 vs 0.75±0.09,0.78±0.14 vs 1.06±0.05,0.81±0.14 vs 0.95±0.12,P<0.01).Conclusion Different modes of hypometabolism detected by brain 18F-FDG PET/CT contribute to the differential diagnosis of AD and FTD.