AD型与非AD型变性痴呆大脑葡萄糖代谢的SPM分析

Voxel-based analysis of cerebral glucose metabolism in AD and non-AD degenerative dementia using statistical parametric mapping

目的探讨阿尔茨海默病（AD）型与非AD型变性痴呆患者的大脑葡萄糖代谢特征。方法对23例AD患者、24例非AD型变性痴呆[包括9例帕金森病痴呆（PDD）、7例额颞痴呆（FTD）及8例路易体痴呆（DLB）]患者及40名健康对照者进行静息状态下的^18F-脱氧葡萄糖（FDG）PET脑显像。结果采用统计参数图（SPM）法进行基于体素水平分析。结果（1）AD组：AD患者大脑葡萄糖代谢较对照组减低的脑区包括双侧颞．顶联合皮质区、额叶、楔前叶及后扣带回等部位。（2）非AD型变性痴呆组：FTD组大脑葡萄糖代谢较对照组减低的脑区包括双侧额叶、顶叶、岛叶、扣带回及左侧楔前叶、右侧皮质下结构等部位，以双侧额叶及皮质下结构为著；PDD组大脑葡萄糖代谢较对照组减低的脑区包括双侧额叶、颞．顶联合皮质区及皮质下结构，如基底节、丘脑等部位；DLB组大脑葡萄糖代谢较对照组减低的脑区包括双侧枕叶、楔前叶、额叶、顶叶及左侧前扣带回、右侧颞叶及皮质下结构如基底节、丘脑等部位，以双侧颞．顶．枕叶联合皮质区为著。结论AD型与非AD型变性痴呆的大脑葡萄糖代谢特征不同，^18F-FDGPET脑显像可为临床诊断及鉴别诊断神经变性痴呆提供依据。

Objective It is know that Alzheimer＇s disease （AD） and non-AD degenerative dementia have some clinical features in common. The aim of this study was to investigate the specific patterns of regional, cerebral glucose metabolism of AD and non-AD degenerative dementia patients, using a voxel-based ^18F-fluorodeoxyglucose （FDG） PET study. Methods Twenty-three AD patients and 24 non-AD degenerative dementia patients including 9 Parkinson＇s disease with dementia （PDD）, 7 frontal-temporal dementia （FTD）, 8 dementia of Lewy bodies （DLB） patients, and 40 normal controls（NC） were included in the study. To evaluate the relative cerebral metabolic rate of glucose （rCMRglc）, ^18F-FDG PET imaging was performed in all subjects. Subsequently, statistical comparison of PET data with NC was performed using statistical parametric mapping （SPM）. Results The AD-asseciated FDG imaging pattern typically presented as fecal cortical hypometabolism in bilateral parietotemporal association cortes and（or） frontal lobe and the posterior cingulate gyrus. As compared with the comparative NC, FTD group demonstrated significant regional reductions in rCMRglc in bilateral frontal, parietal lobes, the cingulate gyri, insulae, left precuneus, and the subeortical structures （including right putamen, right medial dorsal nucleus and ventral anterior nucleus）. The PDD group showed regional reductions in rCMRglc in bilateral frontal cortexes, parietotemporal association cortexes, and the subcortical structures （including left caudate, right putamen, the dorsomedial thalamus, lateral posterior nucleus, and pulvinar）. By the voxel-by-voxel comparison between the DLB group and NC group, regional reductions in rCMRglc included bilateral occipital cortexes, precuneuses, frontal and parietal lobes, left anterior cingulate gyrus, right superior temporal cortex, and the subeortical structures including putamen, caudate, lateral posterior nucleus, and pulvinar. Conclusions The rCMRglc was found to be different between AD and non-AD degenerative dementia patients. Voxel-based analysis for evaluating ,^18F-FDG PET results of degenerative dementia would be likely to be valuable in further diagnosis and evaluation of dementia-related disorders.