Stokkel Marcel P M, Dibbets-Schneider Petra, Koestering Elke, Dragoiescu Constantin, Blokland Koos A K
Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.
J Nucl Med Technol. 2007 Mar;35(1):21-6.
The present prospective study evaluated the diagnostic value of a standardized analysis of (123)I-N-omega-(fluoropropyl)-2beta-carbomethoxy-3beta-(4-iodophenyl)tropane (FP-CIT) SPECT studies acquired on a triple-head gamma-camera for patients with clinically uncertain movement disorders having tremor as the most striking feature.
(123)I-FP-CIT studies were performed on 52 consecutive patients (27 male and 25 female; mean age, 49.2 y; range, 17-80 y) who had a clinical diagnosis of Parkinson's disease (PD) (n = 21), hypokinetic rigid syndrome (n = 19), dystonia (n = 8), or essential tremor (n = 4). In all patients, the final diagnosis was based on a thorough clinical examination, the family history, and a 2-y follow-up. Two independent technologists analyzed (123)I-FP-CIT studies using a standardized quantitative method applying both fixed regions of interest (ROIs) and manually drawn ROIs. The mean values from both methods were compared using the Student t test, and the intra- and intertechnologist variabilities were tested.
In patients with PD, all ratios were significantly lower (P < 0.001) than those in patients with other movement disorders. No significant differences were found between the other groups tested. The manual method resulted in significantly lower values than did the standardized method (P < 0.001) and, for the putamen, showed significant differences between technologists. The standardized method showed no significant differences between technologists. The intra- and intertechnologist variabilities for this method were 0.14 +/- 0.13 (confidence value, 2.4%) and 0.19 +/- 0.18 (confidence value, 3.1%), respectively, whereas the intraclass correlation coefficients were 0.99 for 1 technologist and 0.98 for the 2 independent technologists.
Our data confirm that (123)I-FP-CIT SPECT has value in the differentiation of PD from other movement disorders. Acquisition using a triple-head gamma-camera and subsequent standardized analysis using fixed ROIs result in good intra- and intertechnologist agreement and can easily be applied in clinical practice.
本前瞻性研究评估了在三头γ相机上进行的（123）I-N-ω-（氟丙基）-2β-甲氧基羰基-3β-（4-碘苯基）托烷（FP-CIT）单光子发射计算机断层扫描（SPECT）标准化分析对以震颤为最显著特征的临床运动障碍不明确患者的诊断价值。
对52例连续患者（27例男性和25例女性；平均年龄49.2岁；范围17 - 80岁）进行（123）I-FP-CIT研究，这些患者临床诊断为帕金森病（PD）（n = 21）、运动不能-强直综合征（n = 19）、肌张力障碍（n = 8）或特发性震颤（n = 4）。所有患者的最终诊断基于全面的临床检查、家族史和2年的随访。两名独立的技术人员使用标准化定量方法分析（123）I-FP-CIT研究，该方法同时应用固定感兴趣区（ROIs）和手动绘制的ROIs。使用学生t检验比较两种方法的平均值，并测试技术人员内部和技术人员之间的变异性。
PD患者的所有比值均显著低于（P < 0.001）其他运动障碍患者。在测试的其他组之间未发现显著差异。手动方法得出的值显著低于标准化方法（P < 0.001），并且对于壳核，技术人员之间显示出显著差异。标准化方法在技术人员之间未显示出显著差异。该方法的技术人员内部和技术人员之间的变异性分别为0.14±0.13（置信值，2.4%）和0.19±0.18（置信值，3.1%），而组内相关系数对于一名技术人员为0.99，对于两名独立技术人员为0.98。
我们的数据证实（123）I-FP-CIT SPECT在区分PD与其他运动障碍方面具有价值。使用三头γ相机采集并随后使用固定ROIs进行标准化分析可实现良好的技术人员内部和技术人员之间的一致性，并且可以轻松应用于临床实践。
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