目的：探讨多模态分子显像在路易体痴呆的诊断及鉴别诊断中的应用价值。

方法：对2017年8月至2024年12月就诊于中国医学科学院北京协和医院神经科符合很可能的DLB诊断标准并接受¹⁸F-FDG PET/CT显像检查患者的临床资料及多模态分子显像进行回顾性分析。40例患者接受¹⁸F-FDG PET/CT，15例接受¹³¹I-MIBG SPECT，11例接受¹⁸F-FP-CIT PET/CT，12例接受¹⁸F-AV45 PET/CT，2例接受¹⁸F-PM-PBB3。对¹⁸F-FDG PET/CT进行分析时，随机纳入同期在我院健康体检行¹⁸F-FDG PET/CT显像检查且认知功能正常的性别、年龄与很可能DLB组相匹配的人群（n=40）作为对照，对DLB患者组及对照组的¹⁸F-FDG PET/CT图像进行视觉分析和半定量分析，半定量分析采用基于感兴趣区（region of internets ,ROI）和使用统计参数图对¹⁸F-FDG PET脑功能成像数据进行了逐体素的统计分析，对¹³¹I-MIBG SPECT、¹⁸F-FP-CIT PET/CT、¹⁸F-PM-PBB3 PET/CT采用视觉分析，对¹⁸F-AV45 PET/CT采用视觉分析和半定量分析。

结果：患者组纳入40例符合很可能DLB诊断标准的患者，男29例，女11例，平均年龄72岁。首发症状为认知功能下降8例（20%），帕金森样症状23例（57.5%），两症状同时出现9例（22.5%）。40例患者中，100%存在帕金森样症状和认知障碍，38例（38/40，95%）存在视幻觉，26例（26/40, 65%）存在快速眼动睡眠行为障碍。影像学视觉分析显示，相较对照组，患者组40例中有30例（30/40, 75%）¹⁸F-FDG PET/CT表现为典型的枕叶代谢减低、后扣带回岛征，其余10例（10/40, 25%）¹⁸F-FDG PET/CT图像不典型，表现为全脑普遍性代谢减低或颞叶代谢明显减低。¹⁸F-FDG PET/CT的半定量分析结果发现DLB组相比对照组在大脑顶、枕叶和颞叶外侧代谢减低，并且左侧较右侧更为严重；DLB组相比对照组显示出海马区代谢保留、杏仁核代谢增高的代谢模式。15例（15/15，100%）¹³¹I-MIBG显像提示心脏交感神经失支配，10例（10/11, 90.9%）¹⁸F-FP-CIT PET/CT提示基底节多巴胺能神经元受损,其中5例为双侧多巴胺转运体对称性分布减少，另5例为双侧多巴胺转运体非对称性分布减少，右侧较左侧更为严重。此外，12例患者加做¹⁸F-AV45 PET/CT，其中9例（9/12，81.8%）视觉分析呈阳性，对这9例视觉分析呈阳性的患者进行半定量分析计算CL值，半定量分析计算方法提示3例患者为阳性，6例患者为阴性。1例患者¹⁸F-PM-PBB3 PET/CT呈阳性。

结论：多模态分子显像（¹⁸F-FDG, ¹⁸F-FP-CIT, ¹⁸F-AV45, ¹⁸F-APN-1607 PET/CT和¹³¹I-MIBG SPECT）可提供多方面可视化信息，综合患者的临床表现、神经心理评估、实验室检查等多方面信息助力DLB早期诊断及鉴别诊断，并发现与AD共病的情况，精准全面地对病情进行评估。

Objective: To explore the value of multimodal molecular imaging in diagosis and differential diagnosis of dementia with Lewy bodies (DLB).

Methods: A retrospective analysis was performed on the clinical data and multimodal molecular imaging including ¹⁸F-FDG PET/CT imaging of patients with probable dementia with Lewy bodies (DLB) who were treated at the Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from August 2017 to December 2024. Among them, 40 patients underwent ¹⁸F-FDG PET/CT, 15 patients underwent 131I-MIBG imaging, and 11 patients underwent ¹⁸F-FP-CIT PET/CT. For 12 patients with poor cognitive function or atypical ¹⁸F-FDG PET/CT images, ¹⁸F-AV45 PET/CT examination was further carried out to clarify the pathological status in the brain, 2 patients underwent ¹⁸F-PM-PBB3 imaging. To analyze the ¹⁸F-FDG PET/CT, a group of individuals with normal cognitive function who underwent ¹⁸F-FDG PET/CT examination for health checkup during the same period and with the matched sex and age with the patients group were randomly included as the health control. The ¹⁸F-FDG PET/CT images of DLB patients and the control group were subjected to visual analysis and semi-quantitative analysis. Semi-quantitative analysis was based on region-of-interest (ROI) measurements, and statistical analysis of ¹⁸F-FDG PET brain functional imaging data were using statistical parametric mapping (SPM). Visual assessment was used for ¹³¹I-MIBG imaging, ¹⁸F-FP-CIT PET/CT, and ¹⁸F-PM-PBB3 PET/CT. Visual and semi - quantitative analysis are used for ¹⁸F - AV45 PET/CT.

Results: Among the 40 patients meeting the diagnostic criteria with probable DLB, 29 males and 11 females with an average age of 72 years. Cognitive decline was the initial symptom in 8 patients (20%), parkinsonian symptoms in 23 patients (57.5%), and both symptoms occurred simultaneously in 9 patients (22.5%). All 40 patients (100%) had parkinsonian symptoms and cognitive impairment, visual hallucinations occurred in 38 patients (38/40, 95%), and rapid eye movement sleep behavior disorder was present in 26 patients (26/40, 65%). Visual analysis of imaging showed that compared with the control group, 30 patients (30/40, 75%) showed typical hypometabolism in the occipital lobe and the posterior cingulate island sign on 18F-FDG PET/CT, while the remaining 10 patients (10/40, 25%) had atypical 18F-FDG PET/CT images, manifested as generalized hypometabolism of the whole brain or significantly reduced metabolism in the temporal lobe. The quantitative analysis of ¹⁸F-FDG PET/CT showed: for the semiquantitative analysis of ¹⁸F-FDG PET/CT, the results show that using SUVR and voxel-wise statistical analysis based on statistical parametric mapping (SPM), after the FWE correction level, it is found that the patient group has reduced metabolism in the parietal, occipital lobes and the lateral temporal lobe compared with the control group, and the left side is more severe than the right side. 131I-MIBG imaging in all 15 patients (15/15, 100%) suggested cardiac sympathetic nerve denervation, and ¹⁸F-FP-CIT PET/CT showed damage to dopaminergic neurons in the basal ganglia in 10 patients (10/11, 90.9%). Among the 10 patients, 5 cases showed symmetric reduction of DAT bilaterally, and the other 5 cases showed asymmetric reduction of DAT, with more severe reduction on the right side than the left side. In addition, among the 12 patients who underwent additional ¹⁸F-AV45 PET/CT, 9 patients (9/12, 81.8%) were positive. Semi-quantitative analysis to calculate the CL value was performed on the 9 patients with positive visual analysis. The semi-quantitative analysis calculation method suggested that 3 patients were positive and 6 patients were negative. ¹⁸F-PM-PBB3 PET/CT was positive in a patient.

Conclusion: Multimodal molecular imaging techniques (¹⁸F-FDG PET/CT, ¹⁸F-FP-CIT PET/CT, ¹⁸F-AV45 PET/CT, ¹⁸F-APN-1607 PET/CT, and ¹³¹I-MIBG SPECT) can provide multi-faceted visualizable information. Comprehensive integration of patients' clinical manifestations, neuropsychological assessments, laboratory tests, and other multi-faceted information facilitates the early diagnosis and differential diagnosis of dementia with Lewy bodies (DLB), identifies comorbid conditions with Alzheimer's disease (AD), and enables precise and comprehensive evaluation of the disease progression.