Temporoparietal Hypometabolism in Frontotemporal Lobar Degeneration and Associated Imaging Diagnostic Errors

被引:57
作者
Womack, Kyle B. [1 ,2 ]
Diaz-Arrastia, Ramon [1 ]
Aizenstein, Howard J. [3 ]
Arnold, Steven E. [4 ,5 ]
Barbas, Nancy R. [6 ,7 ]
Boeve, Bradley F. [9 ]
Clark, Christopher M. [5 ]
DeCarli, Charles S. [10 ]
Jagust, William J. [11 ,12 ]
Leverenz, James B. [15 ,16 ]
Peskind, Elaine R. [16 ]
Turner, R. Scott [6 ,7 ]
Zamrini, Edward Y. [19 ,20 ]
Heidebrink, Judith L. [6 ,7 ]
Burke, James R. [21 ]
DeKosky, Steven T. [3 ]
Farlow, Martin R. [22 ]
Gabel, Matthew J. [23 ]
Higdon, Roger [17 ,18 ]
Kawas, Claudia H. [13 ,14 ]
Koeppe, Robert A. [8 ]
Lipton, Anne M. [1 ,2 ]
Foster, Norman L. [19 ,20 ]
机构
[1] Univ Texas SW Med Ctr Dallas, Dept Neurol, Dallas, TX 75390 USA
[2] Univ Texas SW Med Ctr Dallas, Dept Psychiat, Dallas, TX 75390 USA
[3] Univ Pittsburgh, Dept Psychiat, Pittsburgh, PA USA
[4] Univ Penn, Dept Psychiat, Philadelphia, PA 19104 USA
[5] Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA
[6] Univ Michigan, Ctr Med, Dept Vet Affairs, Neurol Serv, Ann Arbor, MI 48109 USA
[7] Univ Michigan, Dept Neurol, Ann Arbor, MI USA
[8] Univ Michigan, Dept Radiol, Ann Arbor, MI 48109 USA
[9] Mayo Clin, Dept Neurol, Rochester, MN USA
[10] Univ Calif Davis, Dept Neurol, Sacramento, CA 95817 USA
[11] Univ Calif Berkeley, Dept Neurosci, Berkeley, CA 94720 USA
[12] Univ Calif Berkeley, Dept Publ Hlth, Berkeley, CA 94720 USA
[13] Univ Calif Irvine, Dept Neurol, Irvine, CA 92717 USA
[14] Univ Calif Irvine, Dept Neurobiol & Behav, Irvine, CA 92717 USA
[15] Univ Washington, Dept Neurol, Seattle, WA 98195 USA
[16] Univ Washington, Dept Psychiat & Behav Sci, Seattle, WA 98195 USA
[17] Seattle Childrens Hosp, Seattle, WA USA
[18] Reg Med Ctr, Seattle, WA USA
[19] Univ Utah, Ctr Alzheimers Care Imaging & Res, Salt Lake City, UT USA
[20] Univ Utah, Dept Neurol, Salt Lake City, UT USA
[21] Duke Univ, Dept Neurol, Durham, NC USA
[22] Indiana Univ, Dept Neurol, Indianapolis, IN 46204 USA
[23] Washington Univ, Dept Polit Sci, St Louis, MO USA
基金
美国国家卫生研究院;
关键词
PROGRESSIVE SUPRANUCLEAR PALSY; AMYOTROPHIC-LATERAL-SCLEROSIS; CEREBRAL GLUCOSE-METABOLISM; VOXEL-BASED MORPHOMETRY; ALZHEIMERS-DISEASE; CHROMOSOME; 9P; OPEN-LABEL; DEMENTIA; MUTATIONS; ATROPHY;
D O I
10.1001/archneurol.2010.295
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To evaluate the cause of diagnostic errors in the visual interpretation of positron emission tomographic scans with fludeoxyglucose F 18 (FDG-PET) in patients with frontotemporal lobar degeneration (FTLD) and patients with Alzheimer disease (AD). Design: Twelve trained raters unaware of clinical and autopsy information independently reviewed FDG-PET scans and provided their diagnostic impression and confidence of either FTLD or AD. Six of these raters also recorded whether metabolism appeared normal or abnormal in 5 predefined brain regions in each hemisphere frontal cortex, anterior cingulate cortex, anterior temporal cortex, temporoparietal cortex, and posterior cingulate cortex. Results were compared with neuropathological diagnoses. Setting: Academic medical centers. Patients: Forty-five patients with pathologically confirmed FTLD (n=14) or AD (n=31). Results: Raters had a high degree of diagnostic accuracy in the interpretation of FDG-PET scans; however, raters consistently found some scans more difficult to interpret than others. Unanimity of diagnosis among the raters was more frequent in patients with AD (27 of 31 patients [87%]) than in patients with FTLD (7 of 14 patients [50%]) (P=.02). Disagreements in interpretation of scans in patients with FTLD largely occurred when there was temporoparietal hypometabolism, which was present in 7 of the 14 FTLD scans and 6 of the 7 scans lacking unanimity. Hypometabolism of anterior cingulate and anterior temporal regions had higher specificities and positive likelihood ratios for FTLD than temporoparietal hypometabolism had for AD. Conclusions: Temporoparietal hypometabolism in FTLD is common and may cause inaccurate interpretation of FDG-PET scans. An interpretation paradigm that focuses on the absence of hypometabolism in regions typically affected in AD before considering FTLD is likely to misclassify a significant portion of FTLD scans. Anterior cingulate and/or anterior temporal hypometabolism indicates a high likelihood of FTLD, even when temporoparietal hypometabolism is present. Ultimately, the accurate interpretation of FDG-PET scans in patients with dementia cannot rest on the presence or absence of a single region of hypometabolism but rather must take into account the relative hypometabolism of all brain regions.
引用
收藏
页码:329 / 337
页数:9
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