Objective: To analyze single-photon emission tomography (SPECT) images of cerebral blood flow perfusion using an easy Z-score imaging system (eZIS) and explore the value of SPECT and eZIS in early diagnosis of Alzheimer's disease (AD).
Methods: We retrospectively analyzed the clinical data of 71 subjects undergoing brain perfusion SPECT examination in our department from September, 2018 to September, 2020 and identified 31 eligible subjects for this study. Among these subjects, according to the NIA-AA criteria (2011 edition), 12 were diagnosed with mild cognitive impairment due to AD (MCI) and 11 with AD dementia stage (AD); 8 elderly subjects were healthy without cognitive impairment (NC). All these subjects underwent brain perfusion SPECT, and eZIS-assisted analysis was used to obtain the index values (severity, range and ratio). The differences in the severity, extent and ratio among the 3 groups were compared, and the diagnostic efficacy of single and joint analysis of the 3 indexes for early AD was analyzed.
Results: There was no significant difference in gender, age and education level among the 3 groups (P>0.05). Compared with those in NC group, the Mini Mental State Examination Scale (MMSE) scores were significantly lowered in AD group and MCI group; the MMSE score was significantly lower in AD group than in MCI group (P < 0.05). The patients with AD had significantly greater disease severity and extent than those with MCI group; the severity, range and ratio in both AD group and MCI group were significantly higher than those of NC group, but the ratio did not differ significantly between AD group and MCI group (P>0.05). In single index analysis, severity had the highest diagnostic performance (AUC=0.911) and sensitivity (87.0%); the diagnostic performance and sensitivity of joint analysis were better than those of single analysis, and joint analysis of range and ratio showed high diagnostic performance (AUC=0.948) and sensitivity (87.0%).
Conclusion: The analysis of brain perfusion SPECT using an eZIS program can be useful for early diagnosis of AD.
目的: 利用简易Z-Score成像系统（eZIS）对脑血流灌注SPECT图像进行分析，探讨其在早期阿尔茨海默病（AD）诊断中的价值。
方法: 回顾性分析2018年9月~2020年9月至南方医院核医学科行脑血流灌注SPECT检查的71例受检者的临床资料，根据2011版NIA-AA标准诊断为阿尔茨海默病源性轻度认知障碍（MCI）12例，阿尔茨海默病痴呆阶段（AD）11例，无认知障碍的的健康中老年人（NC）8例。所有受检者均已行脑血流灌注SPECT显像，并应用eZIS辅助分析，获得指标值——严重程度、范围和比率。应用SPSS23.0软件比较3组间严重程度、范围、比率的差异，并分析3个指标值单项及联合分析在早期AD中诊断效能。
结果: （1）3组受检者间性别（P=0.58）、年龄（P=0.21）、受教育程度（P=0.88）的差异无统计学意义；AD组（P=0.00）、MCI组（P=0.04）简易精神状态检查量表（MMSE）分数低于NC组，AD组（P=0.02）MMSE分数明显低于MCI组，差异均有统计学意义；（2）AD组的严重程度（P=0.00）、范围（P=0.00）高于MCI组，AD组、MCI组的严重程度（P=0.00、0.00）、范围（P=0.00、0.00）、比率（P=0.00、0.00）均高于NC组，且差异均有统计学意义，AD组、MCI组的比率（P=0.09）差异无统计学意义；（3）单项分析时严重程度的诊断性能（AUC=0.911）和灵敏度（87.0%）最高，联合分析时诊断性能及灵敏度均高于单项分析，其中范围、比率联合分析的诊断性能（AUC=0.948）和灵敏度（87.0%）较高。
结论: eZIS辅助脑血流灌注SPECT分析在早期阿尔茨海默病诊断中有较高的应用价值。
Keywords: Alzheimer's disease; Brain perfusion SPECT; Easy Z-score imaging system; Mild cognitive impairment.