18F-FDG PET/CT和MRI对疑似阿尔茨海默病患者1年内临床进展的评估意义

Significance of 18F-flurodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging in assessing clinical progression within 1 year in patients with suspected Alzheimer disease

摘要:

目的 分析¹⁸F-氟代脱氧葡萄糖正电子发射断层成像／计算机体层扫描（¹⁸F-FDG PET/CT）和磁共振成像（MRI）对疑似阿尔茨海默病（AD）的遗忘型轻度认知障碍（aMCI）患者1年内疾病进展的评估价值。方法 前瞻性纳入2021年8月至2022年8月在保定市第一中心医院治疗的表征AD的临床aMCI患者（146例，60～90岁）作为研究对象。记录随访1年内患者疾病进展结局，进展为AD的患者为进展组（49例），其余为未进展组（97例）。采用¹⁸F-FDG PET/CT和MRI对患者的疾病进展情况进行评估。结果 进展组患者的年龄、基线脑脊液总tau蛋白（T-tau）含量以及MRI总脑室容积高于未进展组（P<0.05），而基线简易精神状态检查量表评分、¹⁸F-FDG PET/CT脑灰质和白质标准化摄取值比（SUVR）低于未进展组（P<0.05）。单因素及多因素Logistics回归分析显示，SUVR及MRI总脑室容积均为随访1年内进展为AD的风险因素。SUVR+MRI总脑室容积预测aMCI患者随访1年内疾病进展为AD的受试者操作特征曲线下面积为0.753（95%CI：0.674～0.832），优于两者单独预测。在多变量模型中，每增加1个异常标志物（SUVR<1.063、MRI总脑室容积>44 472 mm³或脑脊液T-tau>400 ng/L），进展为AD的风险就会逐渐增加。结论 ¹⁸F-FDG PET/CT联合MRI对表征AD的aMCI患者1年内发生疾病进展具有预测价值。

Abstract:

Objective To investigate the significance of ¹⁸F-flurodeoxyglucose positron emission tomography/computed tomography （¹⁸F-FDG PET/CT） and magnetic resonance imaging （MRI） in assessing disease progression within 1 year in amnestic mild cognitive impairment （aMCI） patients suspected of Alzheimer disease （AD）.Methods A prospective study was conducted among 146 patients with aMCI， aged 60-90 years， who were treated in Baoding First Central Hospital from August 2021 to August 2022. The outcome of disease progression was recorded within 1 year of follow-up， and the 49 patients with progression to AD were enrolled as progression group， and the 97 patients without progression to AD were enrolled as non-progression group. The methods of ¹⁸F-FDG PET/CT and MRI were used to assess disease progression in patients.Results Compared with the non-progression group， the progression group had significantly higher age， content of total tau （T-tau） in cerebrospinal fluid at baseline， and total ventricular volume on MRI （P<0.05）， as well as significantly lower Mini-Mental State Examination score and standardized uptake value ratio （SUVR） of the gray matter and white matter on ¹⁸F-FDG PET/CT （P<0.05）. The univariate and multivariate Logistic regression analyses showed that SUVR and total ventricular volume on MRI were risk factors for disease progression to AD within 1 year of follow-up. SUVR combined with total ventricular volume on MRI had an area under the ROC curve of 0.753 （95% confidence interval： 0.674-0.832） in predicting disease progression to AD in aMCI patients within 1 year of follow-up， which was better than each predictor used alone. In multivariable models， for every abnormal marker （SUVR<1.063， total ventricular volume on MRI>44 472 mm³ or T-tau>400 ng/L in cerebrospinal fluid） added， the risk of progression to AD graually increased.Conclusions The combination of ¹⁸F-FDG PET/CT and MRI has a certain value in predicting disease progression within 1 year in aMCI patients suspected of AD.