摘要： 目的 探讨行为异常型额颞叶痴呆（bvFTD）患者脑组织¹⁸F-S16 PET显像特点以及tau蛋白沉积与葡萄糖代谢模式的相关性。方法 纳入2020年1月至2021年10月天津医科大学总医院收治的12例bvFTD患者和10例认知功能正常的对照者，行¹⁸F-S16 PET和¹⁸F-FDG PET显像，采用基于体素的分析（VBA）对比bvFTD组与对照组¹⁸F-S16和¹⁸F-FDG摄取差异脑区，半定量分析比较两组¹⁸F-S16和¹⁸F-FDG标准摄取值率（SUVR），图像视觉判读观察两组¹⁸F-S16摄取，Pearson相关分析探究¹⁸F-S16与¹⁸F-FDG两种示踪剂的全脑空间相关性以及各兴趣区摄取水平相关性。结果 VBA法显示，bvFTD患者右侧额上回、双侧额中回和额下回，双侧中央前回，双侧颞中回、右侧颞下回，右侧中央后回，左侧顶下小叶¹⁸F-S16摄取增加（均P < 0.01，FWE校正，像素阈值=50）；双侧额上回、双侧额中回、右侧额下回，双侧前扣带回，右侧岛叶¹⁸F-FDG摄取减少（均P=0.000，FWE校正，像素阈值=50）；二者重叠脑区主要位于右侧额上回、双侧额中回及右侧额下回。半定量分析显示，bvFTD组患者双侧额叶（P=0.000）、顶叶（P=0.015）和楔前叶（P=0.000） tau蛋白SUVR值均高于对照组，双侧额叶葡萄糖SUVR值低于对照组（P=0.002）。Pearson相关分析显示，bvFTD患者¹⁸F-S16与¹⁸F-FDG的全脑空间相关性较弱（r=0.050，P=0.000）； bvFTD患者仅双侧额叶tau蛋白SUVR值与葡萄糖SUVR值呈负相关关系（r=- 0.702，P=0.011）。¹⁸F-S16 PET图像视觉判读，bvFTD患者双侧额叶、顶叶、楔前叶和海马摄取增加。结论 ¹⁸F-S16 PET显像可以反映出bvFTD患者tau蛋白沉积特点及其与葡萄糖代谢模式的相关性。

关键词: 额颞叶痴呆, tau蛋白质类, 脱氧葡萄糖, 正电子发射断层显像术

Abstract: Objective To investigate the characteristics of ¹⁸F-S16 PET imaging in brain tissue of patients with behavioral variant frontotemporal dementia (bvFTD) and the correlation between tau protein deposition and glucose metabolism pattern. Methods A total of 12 bvFTD patients and 10 controls with normal cognitive function treated in Tianjin Medical University General Hospital from January 2020 to October 2021 were included, and all of them underwent ¹⁸F-S16 PET and ¹⁸F-FDG PET. The difference of ¹⁸F-S16 and ¹⁸F-FDG uptake between bvFTD group and control group was compared by voxel-based analysis (VBA). The ¹⁸F-S16 and ¹⁸F-FDG standard uptake value rate (SUVR) of 2 groups were compared by semi-quantitative analysis. The ¹⁸F-S16 uptake rate of 2 groups was observed by visual analysis. Pearson correlation analysis was used to explore the whole-brain spatial correlation of ¹⁸F-S16 and ¹⁸F-FDG tracers and the correlation of uptake levels in each region of interest (ROI). Results VBA method showed the uptake of ¹⁸F-S16 increased in the right superior frontal gyrus, bilateral middle frontal gyrus and inferior frontal gyrus, bilateral anterior central gyrus, bilateral middle temporal gyrus, right inferior temporal gyrus, right posterior central gyrus and left inferior parietal lobule in bvFTD patients (P < 0.01, for all, FWE correction, pixel threshold=50). The uptake of ¹⁸F-FDG in bilateral superior frontal gyrus, bilateral middle frontal gyrus, right inferior frontal gyrus, bilateral anterior cingulate gyrus and right insula decreased in bvFTD patients (P=0.000, for all, FWE correction, pixel threshold=50). The overlaps were mainly located in the right superior frontal gyrus, bilateral middle frontal gyrus and right inferior frontal gyrus. Semi-quantitative analysis showed the SUVR value of tau protein in bilateral frontal lobe (P=0.000), parietal lobe (P=0.015) and precuneus (P=0.000) in bvFTD group was higher than that in control group, and the SUVR value of glucose in bilateral frontal lobe was lower than that in control group (P=0.002). Pearson correlation analysis showed the whole-brain spatial correlation between ¹⁸F-S16 and ¹⁸F-FDG was weak in bvFTD patients (r=0.050, P=0.000). In bvFTD patients, only bilateral frontal tau SUVR was negatively correlated with glucose SUVR (r=-0.702, P=0.011). Visual analysis of ¹⁸F-S16 PET showed increased uptake in bilateral frontal, parietal, precuneus, and hippocampus in bvFTD patients. Conclusions ¹⁸F-S16 PET can reflect the characteristic of tau protein deposition and its correlation with glucose metabolic pattern in bvFTD patients.

Key words: Frontotemporal dementia, Tau proteins, Deoxyglucose, Positron-emission tomography