SPECT灌注成像在阿尔茨海默病诊断中的作用：临床-病理学研究

---

OBJECTIVE: Numerous studies have suggested that temporoparietal hypoperfusion
seen on brain imaging with SPECT may be useful in diagnosing AD during life.
However, these studies have often been limited by lack of pathologic validation
and unrepresentative samples. The authors performed this study to determine
whether SPECT imaging provides diagnostically useful information in addition to
that obtained from a clinical examination. METHODS: Clinical data and SPECT
images were collected prospectively, and patients were followed to autopsy.
Clinical history, pathologic findings, and SPECT images were each evaluated by
raters blind to other features, and clinical and SPECT diagnoses were compared
with pathologic diagnoses. The study population consisted of 70 patients with
dementia, followed to autopsy; 14 controls followed to autopsy; and 71 controls
(no autopsy performed). The primary outcome was the likelihood of a pathologic
diagnosis of AD given a positive clinical diagnosis, a positive SPECT diagnosis,
and both. RESULTS: When all participants (patients and controls) were included
in the analysis, the clinical diagnosis of "probable" AD was associated with an
84% likelihood of pathologic AD. A positive SPECT scan raised the likelihood of
AD to 92%, whereas a negative SPECT scan lowered the likelihood to 70%. SPECT
was more useful when the clinical diagnosis was "possible" AD, with the
likelihood of 67% without SPECT, 84% with a positive SPECT, and 52% with a
negative SPECT. Similar results were found when only patients with dementia were
included in the analysis. CONCLUSIONS: In the evaluation of dementia, SPECT
imaging can provide clinically useful information indicating the presence of AD
in addition to the information that is obtained from clinical evaluation.
[引自Neurology 2001 Apr 10;56(7):950-6]