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在意识障碍中PET成像和功能性MRI的诊断精度:一项临床验证研究
Johan Stender1, Olivia Gosseries2, Marie-Aurélie Bruno2
1Coma Science Group, Cyclotron Research Center and Neurology Department, University and University Hospital of Liège, Liège, Belgium; Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
Lancet (London, England)
|April 22, 2014
概括
大脑 (18) F-氧葡萄糖 (FDG) PET成像准确识别最小意识状态,并预测有意识障碍的患者的康复. 与功能性MRI (fMRI) 相比,这种神经成像技术提供了更好的诊断准确性.
科学领域:
- 神经科学是一个神经科学.
- 医疗成像医学成像
- 神经学 神经学
背景情况:
- 临床床检查在准确诊断不响应性清醒综合征 (UWS) 和最小意识状态 (MCS) 中存在局限性.
- 对于这些疾病,在临床环境中使用PET和fMRI等神经成像技术的诊断和预后价值还没有完全确定.
- 这项研究旨在验证两种神经成像方法,PET和fMRI,用于诊断意识障碍.
研究的目的:
- 为了验证大脑 (18)F-氧葡萄糖 (FDG) PET和功能性MRI (fMRI) 用于诊断意识障碍.
- 评估这些神经成像方法的诊断准确性和预后效用.
- 为了比较PET和fMRI在识别最小意识状态和预测患者结果方面的有效性.
主要方法:
- 一项验证研究,涉及在大学医院诊断出UWS,锁定综合症或MCS的患者.
- 使用昏迷恢复量表修订 (CRS-R) 进行了重复的标准化临床评估.
- 在精神激活任务中使用大脑 (18) F-FDG PET 和fMRI,CRS-R诊断作为参考标准.
主要成果:
- (18) F-FDG PET在识别MCS方面表现出高灵敏度 (93%) 和高一致性 (85%) 与CRS-R得分.
- 活跃的fMRI显示MCS诊断的敏感性较低 (45%),与PET相比,与行为评分的一致性较低 (63%).
- (18)F-FDG PET在74%的患者中正确预测了结果,而fMRI在56%的患者中预测了结果.
结论:
- 大脑 (18) F-FDG PET是补充病床检查的宝贵工具,用于诊断UWS并预测长期康复.
- 活性fMRI也可能有助于差异诊断,但似乎不如PET准确.
- 神经成像,特别是PET,可以识别行为不响应的患者的意识,其中很大一部分随后恢复了意识.
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