轻度认知功能障碍与阿尔茨海默病^(18)F-flutemetamol PET/CT脑显像初步研究

^(18)F-flutemetamol PET/CT imaging in the diagnosis of mild cognitive impairment and Alzheimer's disease:a preliminary study

本文通过^(18)F-flutemetamol(^(18)F-FMM)在轻度认知功能障碍(Mild Cognitive Impairment,MCI)及阿尔茨海默病(Alzheimer's Disease,AD)患者各脑区的分布情况,探讨影响^(18)F-FMM结合的因素,初步评估^(18)F-FMM正电子发射断层扫描结合计算机断层成像术(Positron Emission Tomography/Computed Tomography,PET/CT)诊断MCI、AD患者的应用价值。自2020年7月至2021年4月在上海地区招募24名MCI患者[男12名,女12名,年龄(70.54±9.27)岁],25名AD患者[男11名,女14名,年龄(70.56±7.30)岁]及9名健康对照(Normal Control,NC)[男2名,女7名,年龄(57.67±9.00)岁]。所有受试者行^(18)F-FMM PET/CT脑显像,采用视觉评估法及标准化摄取值比值(Standardized Uptake Value Ratio,SUVR)测量法对脑显像结果进行定性及半定量分析。采用独立样本t检验、单因素方差分析、秩和检验分析定量资料组间差异;采用Pearson卡方检验及Fisher确切概率法进行定性资料组间差异比较。通过受试者工作特征(Receiver Operating Characteristic,ROC)曲线分析^(18)F-FMM PET/CT脑显像对MCI、AD的诊断效能,并采用多元线性回归分析可能影响^(18)F-FMM结合的因素。结果表明:NC、MCI及AD组视觉评估阳性率存在统计学差异(χ^(2)=26.85,p<0.001),三组间各脑区SUVR均存在统计学差异(H值:11.54~19.34,F值:7.43、11.48,p均<0.01),三组全脑SUVR平均值均存在统计学差异(Z值:−3.87、−2.79、−2.45,p均<0.0167);MCI与AD组在枕叶、颞叶、顶叶与后扣带回的视觉评估阳性率有统计学意义(χ^(2)=7.53~10.89,p均<0.01),NC组各脑区SUVR均低于AD组,颞叶、额叶及楔前叶SUVR低于MCI组;MCI组枕叶、颞叶、额叶、顶叶SUVR低于AD组。ROC曲线表明,颞叶SUVR值和全脑SUVR平均值可用于鉴别NC、MCI、AD。多元线性回归分析结果表明认知水平与各脑区^(18)F-FMM SUVR呈显著负相关性关系。^(18)F-FMM PET/CT脑显像可较直观反映中老年人认知水平,可用于对MCI和AD的诊断。

[Background]^(18)F-Flutemetamol(^(18)F-FMM)PET/CT imaging has been widely applied to the diagnosis of mild cognitive impairment and Alzheimer's disease.[Purpose]This study aims to explore the distributions of^(18)FFMM in different brain regions of mild cognitive impairment(MCI)and Alzheimer's disease(AD)patients and the factors that may affect the combination of^(18)F-FMM,evaluating the use of^(18)F-FMM PET/CT imaging in the diagnosis of MCI and AD patients.[Methods]From July 2020 to April 2021,24 subjects with MCI(12 males,12 females,aged of(70.54±9.27)years old),25 subjects with AD(11 males,14 females,aged(70.56±7.30)years old)and 9 subjects as normal controls(NC,2 males,7 females,aged(57.67±9.00)years old)were recruited from Shanghai.The^(18)F-FMM PET/CT brain imaging of all subjects were qualitatively and semi-quantitatively analyzed by visual evaluation and standardized uptake value ratio(SUVR),respectively.Student's t-test,one-way analysis of variance and rank sum test were used for the comparison of quantitative variables.Pearson's chi-squared test and Fisher's exact test were used for the comparison of qualitative variables.The diagnostic efficiency was obtained by ROC curve.Multiple linear regression analysis was used to analyze the factors that might affect the combination of^(18)FFMM.[Results]The positive rate of visual assessment was significantly different in NC,MCI and AD groups(χ^(2)=26.85,p<0.001),and significant differences existed statistically in SUVR of all brain regions among the three groups(H value:11.54~19.34,F value:7.43,11.48,all p<0.01).The mean values of SUVR in the whole brain of the three groups were statistically different(Z value:−3.87,−2.79,−2.45,all p<0.0167).Compared with MCI group,the positive rate in occipital lobe,temporal lobe,parietal lobe and posterior cingulate gyrus was statistically significant(χ^(2)=7.53~10.89,all p<0.01).With respect to NC,SUVR of all brain regions was lower than that in AD,while SUVR of temporal lobe,frontal lobe and precuneu were lower than that in MCI.Meanwhile,SUVR of occipital lobe,temporal lobe,frontal lobe and parietal lobe in MCI were lower than that in AD.Receiver operating characteristic(ROC)curves showed that the SUVR value of temporal lobe and the mean value of SUVR in the whole brain had the ability to distinguish NC,MCI and AD in sequence.Multiple linear regression analysis showed that cognitive level was significantly negatively correlated with^(18)F-FMM SUVR in different brain regions.[Conclusion]^(18)F-FMM PET/CT brain imaging could reflect the cognitive level of middle-aged and elderly people intuitively and has clear diagnostic value for MCI and AD.