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

doi:10.3969/j.issn.1672-6731.2021.05.007

Chinese Journal of Contemporary Neurology and Neurosurgery ›› 2021, Vol. 21 ›› Issue (5): 371-377. doi: 10.3969/j.issn.1672-6731.2021.05.007

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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).

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

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）

Abstract

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

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

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.

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.

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

克-雅病¹⁸F-FDG PET影像学特点分析

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