摘要
目的 探讨18F-PI-2620 PET/CT脑显像中SUV比值(SUVR)对不同认知障碍患者大脑内tau蛋白沉积模式的评估价值及其与认知的相关性.方法 本研究为横断面研究.回顾性纳入仁济医院2019年12月至2022年11月间67例受试者,包括54例阿尔茨海默病(AD)患者[男21例、女33例,年龄(68.6±7.8)岁]、7例轻度认知障碍(MCI)患者[男1例、女6例,年龄(63.1±11.2)岁]和6名健康对照(HC)[男4名、女2名,年龄(69.0±5.8)岁].对所有纳入者行18F-PI-2620 PET/CT检查,以小脑下部为参考脑区,获得额叶、颞叶、枕叶、顶叶、岛叶、全脑以及10个独立感兴趣脑区(杏仁核、眶额叶皮质、扣带回、枕上回、顶上回、顶下缘角回、楔前叶、颞下回、内嗅皮质和海马旁回)SUVR.检查前所有受试者行神经心理学认知量表评估[简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)].采用单因素方差分析和最小显著差异t检验分析3组受试者SUVR的差异;通过ROC曲线分析获得各脑区SUVR鉴别AD-MCI和AD-NC的最佳界值;采用Pearson相关分析探讨SUVR与认知量表评分的相关性.结果 AD组、MCI组和HC组的全脑SUVR分别为1.40±0.31、1.08±0.19和1.01±0.12.全脑和不同脑区分割方式获得SUVR的定量分析均可以鉴别AD与HC组、AD与MCI组,组间SUVR差异有统计学意义(F值:1.76～10.09,t值:2.98～7.47,均P＜0.05),但HC与MCI组间SUVR差异无统计学意义(t值:0.17～1.53,均P＞0.05).ROC曲线分析示以下SUVR界值鉴别诊断较好:AD与HC组,全脑1.18(AUC=0.89)、杏仁核1.13(AUC=0.94)、海马旁回1.26(AUC=0.94);AD 与 MCI 组,全脑 1.06(AUC=0.82)、杏仁核 1.18(AUC=0.88)、颞下回 1.28(AUC=0.88).全脑及额叶、枕叶、顶叶、颞叶、岛叶的SUVR与MMSE和MoCA评分呈负相关(r值:-0.64～-0.40,均P＜0.05).结论 在18F-PI-2620 PET脑显像中,SUVR定量分析可以辅助鉴别AD与HC、AD与MCI;全脑和五大脑叶的SUVR与MMSE和MoCA评分存在负相关.
Abstract
Objective To evaluate the values of 18F-PI-2620 PET/CT brain imaging with SUV ratio(SUVR)in the assessment of tau protein deposition in the brain of patients with different cognitive disorders and its correlation with cognition.Methods This was a cross-sectional study.From December 2019 to November 2022,a total of 67 subjects including 54 patients with Alzheimer's disease(AD;21 males,33 females,age(68.6±7.8)years),7 patients with mild cognitive impairment(MCI;1 male,6 females,age(63.1± 11.2)years)and 6 healthy controls(HC;4 males,2 females,age(69.0±5.8)years)were enrolled ret-rospectively in Renji Hospital.All participants were examined by 18F-PI-2620 PET/CT.SUVRs of brain re-gions were obtained,including frontal lobe,temporal lobe,occipital lobe,parietal lobe,insular lobe,whole brain,as well as 10 independent brain ROIs(amygdala,orbitofrontal cortex,cingulate gyrus,superi-or occipital gyrus,superior parietal gyrus,inferior angular gyrus,precuneus,inferior temporal gyrus,ento-rhinal cortex and parahippocampal gyrus),with inferior cerebellum cortex as the reference region.All par-ticipants were estimated by cognitive scales(mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)).One-way analysis of variance and the least significant difference t test were used to compare the differences of SUVR in each brain region among HC,MCI and AD groups.ROC curve analysis was used to determine the optimal cut-off values of SUVR in each brain region for the differential diagnosis of AD-MCI and AD-HC.Pearson correlation analysis was employed to examine the correlations of SUVR with cognitive scale scores.Results The SUVR of whole brain was 1.40±0.31 in AD group,1.08±0.19 in MCI group,and 1.01±0.12 in HC group.SUVR analysis in the whole brain and each brain region could distin-guish AD from HC,AD from MCI(F values:1.76-10.09,t values:2.98-7.47,all P＜0.05),but could not distinguish HC from MCI(t values:0.17-1.53,all P＞0.05).ROC curve analysis showed that the best cut-off value of SUVR was 1.18 for whole brain(AUC=0.89),1.13 for amygdala(AUC=0.94)and 1.26 for parahippocampal gyrus(AUC=0.94)for differential diagnosis of AD and HC,which was 1.06 for whole brain(AUC=0.82),1.18 for amygdala(AUC=0.88)and 1.28(AUC=0.88)for infratemporal gyrus to dif-ferential diagnosis of AD and MCI.SUVRs of the whole brain,frontal,occipital,parietal,temporal and insu-la were significantly negatively correlated with MMSE and MoCA cognitive scale scores(r values:from-0.64 to-0.40,all P＜0.05).Conclusions SUVR quantitative analysis in 18F-PI-2620 PET imaging can assist the differential diagnosis of AD and HC,AD and MCI.The SUVRs of whole brain and five lobes show negative correlations with MMSE and MoCA scores.
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