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首页> 外文期刊>Neuroimaging clinics of North America >Neuroimaging in Alzheimer disease: an evidence-based review.
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Neuroimaging in Alzheimer disease: an evidence-based review.

机译：阿尔茨海默氏病的神经影像学：循证审查。

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Current clinical criteria (DSM-IIIR and NINCDS-ADRDA) for the diagnosis of dementia and AD are reliable; however, these criteria remain to be validated by clinicians of different levels of expertise at different clinical settings. Structural neuroimaging has an important role in initial evaluation of dementia for ruling out potentially treatable causes. Although CT is the appropriate choice when brain tumors, subdural hematoma, or normal pressure hydrocephalus is suspected, MR imaging is more sensitive to the white-matter changes in vascular dementia. The diagnostic accuracy of PET, SPECT, 1H MRS, and MR volumetry of the hippocampus for distinguishing patients with AD from healthy elderly individuals is comparable to the accuracy of a pathologically confirmed clinical diagnosis. Sensitivity of PET for distinguishing patients with dementia with Lewy bodies from AD, however, is higher than that of clinical evaluation; similarly, SPECT and 1H MRS may be adjuncts to clinical evaluation for distinguishing patients with frontotemporal dementia from those with AD. Neuroimaging is valuable in predicting future development of AD in patients with MCI and in carriers of the ApoE epsilon 4 allele who are at a higher risk of developing AD than are cognitively normal elderly individuals. Quantitative MR techniques (e.g., MR volumetry, DWI, magnetization transfer MR imaging, and 1H MRS) and PET are sensitive to the structural and functional changes in the brains of patients with MCI, and hippocampal volumes on MR imaging are associated with future development of AD in these individuals. PET is also sensitive to the regional metabolic decline in the brains of carriers of the ApoE epsilon 4 allele. The longitudinal decrease of whole brain and hippocampal volumes on MR imaging, NAA levels on 1H MRS, cerebral glucose metabolism on PET, and cerebral blood flow on SPECT are associated with rate of cognitive decline in patients with AD. These neuroimaging markers may be useful for monitoring symptomatic progression in groups of patients with AD for drug trials. Furthermore, antemortem MR-based hippocampal volumes correlate with the pathologic stage of AD, and the rate of hippocampal volume loss on MR imaging correlates with clinical disease progression in the cognitive continuum from normal aging to MCI and to AD. Hence, as an in vivo correlate of pathologic involvement, structural imaging measures are potential surrogate markers for disease progression in patients with established AD and in patients with prodromal AD, who will benefit most from disease-modifying therapies underway.
机译：目前用于诊断痴呆和AD的临床标准（DSM-IIIR和NINCDS-ADRDA）是可靠的;但是，这些标准仍有待于不同临床背景下具有不同专业知识水平的临床医生进行验证。结构性神经影像学在痴呆症的初步评估中具有重要作用，以排除可能可治疗的原因。尽管在怀疑脑瘤，硬膜下血肿或正常压力脑积水时，CT是合适的选择，但MR成像对血管性痴呆的白质变化更敏感。海马的PET，SPECT，1H MRS和MR容积法对AD患者与健康老年患者的区分准确度可与病理证实的临床诊断相媲美。 PET区分路易体痴呆患者与AD的敏感性高于临床评估。同样，SPECT和1H MRS可能是临床评估的辅助手段，以区分额颞叶痴呆患者和AD患者。神经影像学对于预测MCI患者和ApoE epsilon 4等位基因携带者中AD的未来发展非常有价值，与认知正常的老年人相比，这些携带者罹患AD的风险更高。定量MR技术（例如MR容量测定，DWI，磁化转移MR成像和1H MRS）和PET对MCI患者大脑的结构和功能变化敏感，而MR成像的海马体积与MCI的未来发展相关这些个体中的AD。 PET还对ApoE epsilon 4等位基因携带者的大脑区域性代谢下降敏感。磁共振成像显示全脑和海马体积的纵向减少，1H MRS上的NAA水平，PET上的脑葡萄糖代谢以及SPECT上的脑血流量与AD患者的认知下降率有关。这些神经影像标记物可用于监测患有AD的患者群体的症状进展以进行药物试验。此外，基于死前MR的海马体积与AD的病理阶段相关，而在MR成像中海马体积损失的速率与从正常衰老到MCI和AD的认知连续性中的临床疾病进展相关。因此，作为病理学参与的体内相关因素，结构性影像学检查是建立AD和前驱AD患者疾病进展的潜在替代标志物，他们将从正在进行的疾病改良疗法中受益最多。

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