克-雅病<sup>18</sup>F-FDG PET影像学特点分析

doi:10.3969/j.issn.1672-6731.2021.05.007

中国现代神经疾病杂志 ›› 2021, Vol. 21 ›› Issue (5): 371-377. doi: 10.3969/j.issn.1672-6731.2021.05.007

• 中枢神经系统感染性疾病 • 上一篇下一篇

2 克-雅病¹⁸F-FDG PET影像学特点分析

林雪¹, 甄祯¹, 易芳², 杨吉刚³, 关鸿志⁴, 石琦⁵, 刘磊¹, 王佳伟^1,6, 郭燕军¹

1 100730 首都医科大学附属北京同仁医院神经内科;
2 100088 北京, 火箭军总医院神经内科;
3 100050 首都医科大学附属北京友谊医院核医学科;
4 100730 中国医学科学院北京协和医学院北京协和医院神经内科;
5 102206 北京, 中国疾病预防控制中心病毒病预防控制所;
6 100730 首都医科大学附属北京同仁医院中心实验室

收稿日期:2021-05-13 出版日期:2021-05-25 发布日期:2021-05-28
通讯作者: 郭燕军,Email:yguo12@ccmu.edu.cn
基金资助:
国家自然科学基金青年科学基金资助项目（项目编号：81301032）；传染病预防控制国家重点实验室开放课题（项目编号：2020SKLID311）

Characteristics of ¹⁸F-FDG PET in Creutzfeldt-Jakob disease

LIN Xue¹, ZHEN Zhen¹, YI Fang², YANG Ji-gang³, GUAN Hong-zhi⁴, SHI Qi⁵, LIU Lei¹, WANG Jia-wei^1,6, GUO Yan-jun¹

1 Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China;
2 Department of Neurology, PLA Rocket Force General Hospital, Beijing 100088, China;
3 Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;
4 Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
5 National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China;
6 Medical Research Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China

Received:2021-05-13 Online:2021-05-25 Published:2021-05-28
Supported by:
This study was supported by the National Natural Science Foundation for Young Scientists of China (No. 81301032) and Open Project of State Key Laboratory of Infectious Disease Prevention and Control (No. 2020SKLID311).

摘要/Abstract

摘要：

目的总结克-雅病患者¹⁸F-脱氧葡萄糖（¹⁸F-FDG） PET影像学特点。方法与结果 共纳入2018年8月至2020年1月8例克-雅病患者（包括散发性克-雅病7例、遗传性克-雅病1例），临床主要表现为快速进展性痴呆。DWI均存在皮质和（或）基底节区高信号（8/8例）；¹⁸F-FDG PET均呈单侧或双侧额顶颞叶葡萄糖低代谢（8/8例），其次依次为枕叶（7/8例）、丘脑（5/8例）、基底节区（3/8例）、脑干（3/8例）和小脑（3/8例）低代谢。对比分析葡萄糖低代谢区域与相应DWI高信号区域，发现皮质50个葡萄糖低代谢区域中40个呈DWI高信号，尤以额叶的一致性较好；皮质下25个葡萄糖低代谢区域中仅9个呈DWI高信号，尤以基底节区的一致性较好；脑干和小脑仅呈现葡萄糖低代谢。结论 ¹⁸F-FDG PET对于克-雅病的诊断与鉴别诊断具有较高的敏感性，特别是病情进展迅速的患者，¹⁸F-FDG PET低代谢多提示病变部位神经功能严重缺损。对于快速进展性痴呆且伴明显锥体外系症状或小脑症状的患者，¹⁸F-FDGPET显示皮质低代谢而DWI未见明显高信号，应考虑克-雅病的诊断。

关键词: 克-亚综合征, 磁共振成像, 正电子发射断层显像术, 氟脱氧葡萄糖F18

Abstract:

Objective To explore the characteristics of ¹⁸F-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) PET in Creutzfeldt-Jakob disease (CJD). Methods and Results The manifestations of ¹⁸F-FDG PET of 8 cases confirmed as CJD were analyzed retrospectively from August 2018 to January 2020. Five patients were male and 3 were female, with a mean age of (49.63 ±13.19) years. There were 7 sporadic CJD (sCJD) patients and one genetic CJD (gCJD) patient. All 8 patients were characterized by rapid progressive dementia. DWI hyperintensity in brain MRI were observed in all 8 patients. ¹⁸F-FDG PET analysis revealed frontal, parietal and temporal regions hypometabolism in all 8 cases. Occipital region hypometabolism was observed in 7 cases (7/8). For subcortical regions, hypometabolism were identified in thalamus (5/8), basal ganglia (3/8), brainstem (3/8) and cerebellum (3/8). Compared with the DWI hyperintensities, there were 40 hyperintense on DWI in the 50 cortical regions that were hypometabolic on ¹⁸F-FDG PET, especially in the frontal lobe. For subcortical regions, there were only 9 hyperintense on DWI in the 25 regions that were hypometabolic on ¹⁸F-FDG PET, especially the basal ganglia region. The brain stem and cerebellum hypometabolic regions showed no hyperintense on DWI. Conclusions The higher sensitivity of ¹⁸F-FDG PET is conducive to the differential diagnosis of CJD, especially in patients with rapid progression. ¹⁸F-FDG PET hypometabolism may indicate severe focal neurological impairment. The diagnosis of CJD should be considered for patients with rapidly progressive dementia accompanied with obvious symptoms of extra pyramidal system or cerebellum, cortical hypometabolism in ¹⁸F-FDG PET, and without obvious DWI hyperintensity.

Key words: Creutzfeldt-Jakob syndrome, Magnetic resonance imaging, Positron-emission tomography, Fluorodeoxyglucose F18

林雪, 甄祯, 易芳, 杨吉刚, 关鸿志, 石琦, 刘磊, 王佳伟, 郭燕军. 克-雅病¹⁸F-FDG PET影像学特点分析[J]. 中国现代神经疾病杂志, 2021, 21(5): 371-377.

LIN Xue, ZHEN Zhen, YI Fang, YANG Ji-gang, GUAN Hong-zhi, SHI Qi, LIU Lei, WANG Jia-wei, GUO Yan-jun. Characteristics of ¹⁸F-FDG PET in Creutzfeldt-Jakob disease[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(5): 371-377.

http://journal11.magtechjournal.com/cjcnn/CN/Y2021/V21/I5/371

参考文献

[1] Kim MO, Takada LT, Wong K, Forner SA, Geschwind MD. Genetic PrP prion diseases[J]. Cold Spring Harb Perspect Biol, 2018, 10:a033134.
[2] Puoti G, Bizzi A, Forloni G, Safar JG, Tagliavini F, Gambetti P. Sporadic human prion diseases:molecular insights and diagnosis[J]. Lancet Neurol, 2012, 11:618-628.
[3] Yang J, Kuang H, Wang Q, Liu J, Chen X, Shang H. Analysis of Chinese patients with sporadic Creutzfeldt-Jakob disease[J]. Prion, 2020, 14:137-142.
[4] Bernardi L, Bruni AC. Mutations in prion protein gene:pathogenic mechanisms in C-terminal vs. N-terminal domain, a review[J]. Int J Mol Sci, 2019, 20:3606.
[5] Mackenzie G, Will R. Creutzfeldt-Jakob disease:recent developments[J]. F1000Res, 2017, 6:2053.
[6] Thompson AG, Lowe J, Fox Z, Lukic A, Porter MC, Ford L, Gorham M, Gopalakrishnan GS, Rudge P, Walker AS, Collinge J, Mead S. The Medical Research Council prion disease rating scale:a new outcome measure for prion disease therapeutic trials developed and validated using systematic observational studies[J]. Brain, 2013, 136(Pt 4):1116-1127.
[7] Prodi E, Rossi S, Bertaina I, Pravatà E, Sacco L. Report of a case of Creutzfeldt-Jakob disease with an unusual clinical presentation[J]. Front Behav Neurosci, 2020, 14:55.
[8] Zizi G, Berger H, Lalire P, Dejust S, Morland D. ¹⁸F -FDG PET/CT in sporadic Creutzfeldt-Jakob disease[J]. Clin Nucl Med, 2020, 45:538-539.
[9] Kiliç AK, Kaymakamzade B, Saka E, Tan E. The sole initial imaging finding in Creutzfeldt-Jacob disease:focal FDG-PET hypometabolism[J]. Noro Psikiyatr Ars, 2018, 56:226-228.
[10] Mente KP, O'Donnell JK, Jones SE, Cohen ML, Thompson NR, Bizzi A, Gambetti P, Safar JG, Appleby BS. Fluorodeoxyglucose positron emission tomography (FDG-PET) correlation of histopathology and MRI in prion disease[J]. Alzheimer Dis Assoc Disord, 2017, 31:1-7.
[11] Renard D, Castelnovo G, Collombier L, Thouvenot E, Boudousq V. FDG-PET in Creutzfeldt-Jakob disease:analysis of clinical-PET correlation[J]. Prion, 2017, 11:440-453.
[12] Henkel K, Zerr I, Hertel A, Gratz KF, Schröter A, Tschampa HJ, Bihl H, Büll U, Grünwald F, Drzezga A, Spitz J, Poser S. Positron emission tomography with[¹⁸F]FDG in the diagnosis of Creutzfeldt-Jakob disease (CJD)[J]. J Neurol, 2002, 249:699-705.
[13] Renard D, Vandenberghe R, Collombier L, Kotzki PO, Pouget JP, Boudousq V. Glucose metabolism in nine patients with probable sporadic Creutzfeldt-Jakob disease:FDG-PET study using SPM and individual patient analysis[J]. J Neurol, 2013, 260:3055-3064.
[14] Kim EJ, Cho SS, Jeong BH, Kim YS, Seo SW, Na DL, Geschwind MD, Jeong Y. Glucose metabolism in sporadic Creutzfeldt-Jakob disease:a statistical parametric mapping analysis of 18 F-FDG PET J. Eur J Neurol, 2012, 19:488-493.
[15] Zhang L, Guo Y, Hu H, Wang J, Liu Z, Gao F. FDG-PET and NeuN-GFAP immunohistochemistry of hippocampus at different phases of the pilocarpine model of temporal lobe epilepsy[J]. Int J Med Sci, 2015, 12:288-294.
[16] Prieto E, Domínguez-Prado I, Riverol M, Ortega-Cubero S, Ribelles MJ, Luquin MR, de Castro P, Arbizu J. Metabolic patterns in prion diseases:an FDG PET voxel-based analysis[J]. Eur J Nucl Med Mol Imaging, 2015, 42:1522-1529.
[17] Ortega-Cubero S, Pagola I, Luquin MR, Viteri C, Pastor P, Gállego Pérez-Larraya J, de Castro P, Domínguez I, Irimia P, Martínez -Vila E, Arbizu J, Riverol M. Clinical and neuroimaging characteristics of 14 patients with prionopathy:a descriptive study[J]. Neurologia, 2015, 30:144-152.
[18] Euskirchen P, Buchert R, Koch A, Schulz-Schaeffer WJ, Schreiber SJ, Sobesky J. Sporadic Creutzfeldt-Jakob disease with mesiotemporal hypermetabolism[J]. J Neurol Sci, 2014, 345:278-280.
[19] Matías-Guiu JA, Guerrero-Márquez C, Cabrera-Martín MN, Gómez -Pinedo U, Romeral M, Mayo D, Porta-Etessam J, Moreno-Ramos T, Carreras JL, Matías-Guiu J. Amyloid-and FDG -PET in sporadic Creutzfeldt-Jakob disease:correlation with pathological prion protein in neuropathology[J]. Prion, 2017, 11:205-213.
[20] Bagyinszky E, Yang Y, Giau VV, Youn YC, An SSA, Kim S. Novel prion mutation (p. Tyr225Cys) in a Korean patient with atypical Creutzfeldt-Jakob disease[J]. Clin Interv Aging, 2019, 14:1387-1397.
[21] George P, Newey CR, Mente KP, Pioro EP. Positron emission tomography imaging in a case of E200K mutation-related spongiform encephalopathy with non-diagnostic magnetic resonance imaging and cerebrospinal fluid testing[J]. SAGE Open Med Case Rep, 2017, 5:2050313X17700347.
[22] Furukawa F, Ishibashi S, Sanjo N, Yamashita H, Mizusawa H. Serial magnetic resonance imaging changes in sporadic Creutzfeldt-Jakob disease with valine homozygosity at codon 129 of the prion protein gene[J]. JAMA Neurol, 2014, 71:1186-1187.
[23] Baumgartner A, Rauer S, Mader I, Meyer PT. Cerebral FDG-PET and MRI findings in autoimmune limbic encephalitis:correlation with autoantibody types[J]. J Neurol, 2013, 260:2744-2753.
[24] Shin YW, Lee ST, Shin JW, Moon J, Lim JA, Byun JI, Kim TJ, Lee KJ, Kim YS, Park KI, Jung KH, Lee SK, Chu K. VGKC-complex/LGI1-antibody encephalitis:clinical manifestations and response to immunotherapy[J]. J Neuroimmunol, 2013, 265:75-81.
[25] Leypoldt F, Buchert R, Kleiter I, Marienhagen J, Gelderblom M, Magnus T, Dalmau J, Gerloff C, Lewerenz J. Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis:distinct pattern of disease[J]. J Neurol Neurosurg Psychiatry, 2012, 83:681-686.

选择文件类型/文献管理软件名称

选择包含的内容

2 克-雅病¹⁸F-FDG PET影像学特点分析

Characteristics of ¹⁸F-FDG PET in Creutzfeldt-Jakob disease

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	潘希娟, 邢英琦, 刘玉梅. 脑小血管病影像学评分方法[J]. 中国现代神经疾病杂志, 2023, 23(7): 633-637.
[2]	邵暇荔, 张泳, 金莉蓉, 王剑. 震颤为主型帕金森病与特发性震颤患者脑灌注对比分析[J]. 中国现代神经疾病杂志, 2023, 23(6): 542-548.
[3]	刘智强, 陈金桃, 唐文龙, 翁超群, 张金锋, 林志雄. Dandy-Walker综合征患儿腹腔分流术前后临床与影像学特征分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 433-438.
[4]	贺电. 应重视实时震动诱导转化技术在克-雅病临床诊断中的应用[J]. 中国现代神经疾病杂志, 2023, 23(4): 271-274.
[5]	姚莉萍, 王睿晗, 包翌, 蔡瀚林, 陈芹. 后部皮质萎缩临床及影像学特征分析[J]. 中国现代神经疾病杂志, 2023, 23(4): 326-334.
[6]	仲秀艳, 聂尧婷, 唐仁芸, 李艳, 吴远华, 蔡静. 克-雅病合并神经系统副肿瘤综合征一例[J]. 中国现代神经疾病杂志, 2023, 23(4): 346-350.
[7]	葛懿, 陈聪, 王爽, 丁瑶. 7T超高场强MRI在耐药性癫痫诊断与治疗中的应用进展[J]. 中国现代神经疾病杂志, 2023, 23(3): 161-166.
[8]	耿雨梅, 李存, 李慧敏, 王梦莹, 康慧聪. 伴癫痫发作的自身免疫性脑炎临床特征分析[J]. 中国现代神经疾病杂志, 2023, 23(3): 205-213.
[9]	李建瑞, 刘宵雪, 许强, 骆仲强, 卢光明, 张志强. 扩散峰度成像直方图联合EphA2分级在胶质瘤分级诊断中的价值[J]. 中国现代神经疾病杂志, 2023, 23(3): 254-263.
[10]	孙梦凡, 姜季委, 王艳丽, 张源, 徐俊. 动脉自旋标记测定脑血流量在阿尔茨海默病研究中的进展[J]. 中国现代神经疾病杂志, 2023, 23(1): 29-34.
[11]	于宁波, 游煜根, 王鸿鹏, 秦岩丁, 梁思泉, 韩建达. 机器人辅助神经介入手术研究进展[J]. 中国现代神经疾病杂志, 2023, 23(1): 45-52.
[12]	李佩湖, 封浑, 李吕力, 姜炳坚. 以脑卒中样发病的可逆性胼胝体压部病变综合征Ⅱ型二例[J]. 中国现代神经疾病杂志, 2022, 22(9): 817-822.
[13]	姚庆宇, 马龙冰, 菅凤增. 脊髓空洞症大鼠模型长期稳定性评价[J]. 中国现代神经疾病杂志, 2022, 22(8): 662-668.
[14]	沈东超, 邹鹏, 侯波, 杨洵哲, 刘明生, 崔丽英. 肢体发病与延髓发病的肌萎缩侧索硬化症患者脑灰质结构成像对比研究[J]. 中国现代神经疾病杂志, 2022, 22(7): 601-607.
[15]	刘子悦, 朱以诚. 脑小静脉与脑结构变化相关研究进展[J]. 中国现代神经疾病杂志, 2022, 22(6): 450-454.

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

2 克-雅病18F-FDG PET影像学特点分析

Characteristics of 18F-FDG PET in Creutzfeldt-Jakob disease

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

2 克-雅病¹⁸F-FDG PET影像学特点分析

Characteristics of ¹⁸F-FDG PET in Creutzfeldt-Jakob disease