Journal of Alzheimer’s Disease ( IF 4 ) Pub Date : 2020-12-23 , DOI: 10.3233/jad-200890 Yi-Wen Bao 1 , Anson C M Chau 2 , Patrick Ka-Chun Chiu 3 , Yat Fung Shea 3 , Joseph S K Kwan 4 , Felix Hon Wai Chan 3 , Henry Ka-Fung Mak 1, 5
Abstract
Background:
With the more widespread use of 18F-radioligand-based amyloid-β (Aβ) PET-CT imaging, we evaluated Aβ binding and the utility of neocortical 18F-Flutemetamol standardized uptake value ratio (SUVR) as a biomarker.
Objective:
18F-Flutemetamol SUVR was used to differentiate 1) mild cognitive impairment (MCI) from Alzheimer’s disease (AD), and 2) MCI from other non-AD dementias (OD).
Methods:
109 patients consecutively recruited from a University memory clinic underwent clinical evaluation, neuropsychological test, MRI and 18F-Flutemetamol PET-CT. The diagnosis was made by consensus of a panel consisting of 1 neuroradiologist and 2 geriatricians. The final cohort included 13 subjective cognitive decline (SCD), 22 AD, 39 MCI, and 35 OD. Quantitative analysis of 16 region-of-interests made by Cortex ID software (GE Healthcare).
Results:
The global mean 18F-Flutemetamol SUVR in SCD, MCI, AD, and OD were 0.50 (SD-0.08), 0.53 (SD-0.16), 0.76 (SD-0.10), and 0.56 (SD-0.16), respectively, with SUVR in SCD and MCI and OD being significantly lower than AD. Aβ binding in SCD, MCI, and OD was heterogeneous, being 23%, 38.5%, and 42.9% respectively, as compared to 100% amyloid positivity in AD. Using global SUVR, ROC analysis showed AUC of 0.868 and 0.588 in differentiating MCI from AD and MCI from OD respectively.
Conclusion:
18F-Flutemetamol SUVR differentiated MCI from AD with high efficacy (high negative predictive value), but much lower efficacy from OD. The major benefit of the test was to differentiate cognitively impaired patients (either SCD, MCI, or OD) without AD-related-amyloid-pathology from AD in the clinical setting, which was under-emphasized in the current guidelines proposed by Amyloid Imaging Task Force.
中文翻译:
从记忆诊所连续招募的认知障碍患者中淀粉样蛋白结合的异质性:评估定量 18F-Flutemetamol PET-CT 在区分阿尔茨海默病和其他痴呆症轻度认知障碍中的效用
摘要
背景:
随着基于18F-放射性配体的淀粉样蛋白-β (Aβ) PET-CT 成像的更广泛使用,我们评估了 Aβ 结合和新皮质18 F-Flutemetamol 标准化摄取值比 (SUVR) 作为生物标志物的效用。
客观的:
18 F-Flutemetamol SUVR 用于区分 1) 轻度认知障碍 (MCI) 与阿尔茨海默病 (AD),以及 2) MCI 与其他非 AD 痴呆 (OD)。
方法:
从大学记忆诊所连续招募的 109 名患者接受了临床评估、神经心理学测试、MRI 和18 F-Flutemetamol PET-CT。诊断是由 1 名神经放射科医师和 2 名老年病学家组成的小组协商一致做出的。最后一组包括 13 名主观认知能力下降 (SCD)、22 名 AD、39 名 MCI 和 35 名 OD。通过 Cortex ID 软件(GE Healthcare)对 16 个感兴趣区域进行定量分析。
结果:
SCD、MCI、AD 和 OD的全球平均18 F-Flutemetamol SUVR 分别为 0.50 (SD-0.08)、0.53 (SD-0.16)、0.76 (SD-0.10) 和 0.56 (SD-0.16),其中SCD 和 MCI 中的 SUVR 和 OD 显着低于 AD。与 AD 中 100% 的淀粉样蛋白阳性相比,SCD、MCI 和 OD 中的 Aβ 结合是异质的,分别为 23%、38.5% 和 42.9%。使用全局 SUVR,ROC 分析显示 AUC 分别为 0.868 和 0.588,用于区分 MCI 与 AD 和 MCI 与 OD。
结论:
18 F-Flutemetamol SUVR 以高功效(高阴性预测值)区分 MCI 与 AD,但与 OD 的功效低得多。该测试的主要好处是将没有 AD 相关淀粉样蛋白病理学的认知障碍患者(SCD、MCI 或 OD)与临床环境中的 AD 区分开来,这一点在淀粉样蛋白成像任务提出的当前指南中没有得到重视力量。