Neurology:MRI或可替代腰穿进行神经退行性疾病的鉴别

2013-01-09 Neurology dxy

MRI预测tt/Aβ的精确度很高 尽管潜在的神经病理不同,阿尔茨海默病(AD)和额颞叶变性(FTLD)可能存在重叠的临床表现,鉴别诊断很困难,往往需要进行活检做病理学诊断或者进行腰穿脑脊液检查。为此,美国宾州大学神经科的Corey T. McMillan等人的一项研究,尝试用MRI替代脑脊液检查对神经退行性疾病进行鉴别,结果发现,MRI可以替代脑脊液生物标志物作为一种筛查AD和FTLD病理机


MRI预测tt/Aβ的精确度很高

尽管潜在的神经病理不同,阿尔茨海默病(AD)和额颞叶变性(FTLD)可能存在重叠的临床表现,鉴别诊断很困难,往往需要进行活检做病理学诊断或者进行腰穿脑脊液检查。为此,美国宾州大学神经科的Corey T. McMillan等人的一项研究,尝试用MRI替代脑脊液检查对神经退行性疾病进行鉴别,结果发现,MRI可以替代脑脊液生物标志物作为一种筛查AD和FTLD病理机制的非侵入性操作。论文在线发表在2012年12月27的《神经病学》(Neurology)杂志上。

研究人员纳入185位患者符合AD或FTLD表现,临床诊断为神经系统退行性疾病的患者,他们进行了腰穿或容量性MRI。亚组中有32位患者经遗传学或活检证实为AD或FTLD。我们使用单价分解技术分解MRI容积,并用线性回顾和交叉验证以预测AD和FTLD患者的CSF总tau(tt)和β淀粉样蛋白 (Aβ1-42) 的比值(tt/Aβ)。随后使用4种趋同的资源(包括神经解剖可视化和对遗传或活检证实的AD或FTLD进行亚组分类)评估MRI为基础预测tt/Aβ的准确性。

研究结果显示:回归分析显示MRI预测tt/Aβ与真实脑脊液的tt/Aβ高度相关。在每个组中,预测的脑脊液tt/Aβ和真实的脑脊液tt/Aβ在神经解剖的相关存在广泛重叠:符合FTLD的低tt/Aβ与前额腹正中区相关;符合AD的高tt/Aβ与后皮质区相关。对于已知病理和已知脑脊液tt/Aβ水平获得临床诊断的患者,MRI预测tt/Aβ的精确度为75%。

该研究发现:MRI可以替代脑脊液生物标志物作为一种筛查AD和FTLD病理机制的非侵入性操作。   


Can MRI screen for CSF biomarkers in neurodegenerative disease?

Objective: Alzheimer disease (AD) and frontotemporal lobar degeneration (FTLD) may have overlapping clinical presentations despite distinct underlying neuropathologies, thus making in vivo diagnosis challenging. In this study, we evaluate the utility of MRI as a noninvasive screening procedure for the differential diagnosis of AD and FTLD.

Methods: We recruited 185 patients with a clinically diagnosed neurodegenerative disease consistent with AD or FTLD who had a lumbar puncture and a volumetric MRI. A subset of 32 patients had genetic or autopsy-confirmed AD or FTLD. We used singular value decomposition to decompose MRI volumes and linear regression and cross-validation to predict CSF total tau (tt) and β-amyloid (Aβ1-42) ratio (tt/Aβ) in patients with AD and patients with FTLD. We then evaluated accuracy of MRI-based predicted tt/Aβ using 4 converging sources including neuroanatomic visualization and categorization of a subset of patients with genetic or autopsy-confirmed AD or FTLD.

Results: Regression analyses showed that MRI-predicted tt/Aβ is highly related to actual CSF tt/Aβ. In each group, both predicted and actual CSF tt/Aβ have extensively overlapping neuroanatomic correlates: low tt/Aβ consistent with FTLD is related to ventromedial prefrontal regions while high tt/Aβ consistent with AD is related to posterior cortical regions. MRI-predicted tt/Aβ is 75% accurate at identifying underlying diagnosis in patients with known pathology and in clinically diagnosed patients with known CSF tt/Aβ levels.

Conclusion: MRI may serve as a noninvasive procedure that can screen for AD and FTLD pathology as a surrogate for CSF biomarkers.

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