C-11 Pittsburgh Compound B PET in the Diagnosis of Cerebral Amyloid Angiopathy

以C－11 PiB正子造影運用於類澱粉血管病變之診斷

蔡欣熹(Hsin-Hsi Tsai) ； 蔡力凱(Li-Kai Tsai) ； 陳雅芳(Ya-Fang Chen) ； Marco Pasi ； 湯頌君(Sung-Chun Tang) ； 溫湘萍(Hsiang-Ping Wen) ； 顏若芳(Ruoh-Fang Yen) ； 鄭建興(Jiann-Shing Jeng)

《核子醫學暨分子影像雜誌》 32卷1期 (2019/03) Pp. 12-23

https://doi.org/10.6332/ANMMI.201903_32(1).0002

摘要

Background: We aimed to assess the diagnostic utility and performance of C-11 Pittsburgh compound B (PiB) positron emission tomography (PET), which detects brain amyloid deposition, for the diagnosis of underlying cerebral amyloid angiopathy (CAA) in patients with spontaneous intracerebral hemorrhage (ICH). Methods: Seventy-seven spontaneous ICH patients were recruited in our study. CAA was diagnosed by the Boston criteria. All patients (11 CAA, 66 non-CAA) underwent PiB PET to evaluate brain amyloid retention. The amyloid burden was visually assessed and dichotomized as PiB (+) and PiB (-). The global standardized uptake value ratio (SUVR) was also calculated using the cerebellum as reference. Results: Based on visual classification, 10/11 CAA patients were PiB (+) as compared with 10/66 non-CAA patients (sensitivity = 90.9%, 95% confidence interval [CI] = 58.7- 99.8; specificity = 84.9%, 95% CI = 73.9-92.5). Quantitative assessment using global SUVR ＞ 1.23 as the cutoff value yielded similar findings (sensitivity = 90.9%, 95% CI = 58.7-99.8; specificity = 89.4%, 95% CI = 79.4-95.6). There was no difference in the diagnostic performance between visual ratings and quantitative assessment (p = 0.51). Combining binary visual ratings and SUVR increased the specificity to 94.0% (95% CI = 85.2-98.3), without affecting sensitivity. Conclusions: C-11 PiB PET can be used as a diagnostic tool with high sensitivity and specificity for CAA in patients with spontaneous ICH. Visual ratings had a similar diagnostic efficacy as the quantitative method, and could be readily applied in clinical and research settings.

關鍵字

amyloid PET ； C-11 PiB ； cerebral amyloid angiopathy ； quantitative analysis ； visual interpretation

並列摘要

背景：本研究目的為評估C－11 Pittsburgh compound B（PiB）腦部正子造影於類澱粉血管病變（cerebral amyloid angiopathy, CAA）之診斷效力。方法：本研究納入77位自發性腦出血患者（11位CAA，66位非CAA）。所有病人皆接受了PiB腦部正子造影。經由視覺判讀，將其腦部類澱粉之沉積狀況分為PiB（+）或PiB（-）；除此之外，經過小腦校正之後，計算每位病人之標準PiB攝取值（standardized uptake value ratio, SUVR）作為定量分析使用。結果：根據視覺判讀之結果，11位CAA病人中有10位為PiB（+），而66位非CAA病人中，有10位為PiB（+）（敏感度=90.9%，95%信賴區間=58.7～99.8；特異度=84.9%，95%信賴區間=73.9～92.5）。定量分析中，若將SUVR值＞1.23當作臨界值以區分正子造影之結果，會得到類似的結果（敏感度=90.9%，95%信賴區間=58.7～99.8；特異度=89.4%，95%信賴區間=79.4～95.6）。視覺判讀與定量分析的診斷效力並無顯著差異（p=0.51）。結合視覺判讀及定量分析能增加特異度至94.0%（95%信賴區間=85.2～98.3）且不影響敏感度。結論：對於類澱粉血管病變腦出血，PiB正子造影為一高敏感度與高特異度之診斷工具。視覺判讀與定量分析具有類似的診斷與區分能力，應可以作為未來臨床及研究使用時，分析方式之選擇。

並列關鍵字

類澱粉正子造影 ； C-11 PiB ； 類澱粉腦血管病變 ； 定量分析 ； 視覺判讀