Division of Neurorehabilitation, Geneva University Hospitals, Switzerland.
Division of Neurology, Geneva University Hospitals, Switzerland; Faculty of Medicine, University of Geneva, Switzerland.
J Neurol Sci. 2018 Feb 15;385:17-21. doi: 10.1016/j.jns.2017.11.039. Epub 2017 Dec 1.
I-FP-CIT SPECT imaging is a reliable method to assess presynaptic dopaminergic pathways in degenerative parkinsonisms and dementia with Lewy bodies (DLB).
We aimed at examining sensitivity of combined visual and semi-quantitative I-FP-CIT SPECT analyses in a prospective cohort of subjects with DLB and degenerative parkinsonisms - Parkinson's disease (PD), multiple system atrophy (MSA), corticobasal syndrome (CBS) and progressive supranuclear palsy (PSP) to determine prevalence and clinical significance of scans without evidence of dopaminergic deficit (SWEDD). 372 scans performed from 2013 to 2016 with the same SPECT acquisition and processing protocol were analyzed. We identified 155 patients with degenerative parkinsonism and 53 with DLB. Diagnoses relied on validated clinical criteria for each condition. Semi-quantitative assessment was based on previously established local reference limits (including striatal volumes of interest uptake, caudate-to-putamen ratio and striatal asymmetry index).
3/155 (2.1%) subjects with degenerative parkinsonism (1 CBS, 1 MSA-C and 1 PD) and 1/53 (1.9%) with DLB had a normal visual SPECT. Subsequent semi-quantitative analysis showed mild striatal uptake impairment for the DLB and the PD subject. Therefore, only two patients (1 CBS and 1 MSA) had a strictly normal combined assessment.
The present study shows that SWEDD cases represent a negligible proportion of patients with degenerative conditions (1.3%), when stringent diagnostic criteria are applied, a thorough follow-up is performed and visual SPECT analysis is combined with precise semi-quantitative assessment.
I-FP-CIT SPECT 成像技术是评估退行性帕金森病和路易体痴呆（DLB）患者的前突触多巴胺能通路的可靠方法。
我们旨在通过前瞻性队列研究，检查 DLB 及退行性帕金森病患者（帕金森病 [PD]、多系统萎缩 [MSA]、皮质基底节综合征 [CBS] 和进行性核上性麻痹 [PSP]）中联合视觉和半定量 I-FP-CIT SPECT 分析的敏感性，以确定无多巴胺能缺陷扫描（SWEDD）的患病率和临床意义。我们分析了 2013 年至 2016 年间使用相同 SPECT 采集和处理方案进行的 372 次扫描。我们确定了 155 名退行性帕金森病患者和 53 名 DLB 患者。每种疾病的诊断均依赖于各自条件的验证临床标准。半定量评估基于先前建立的局部参考限值（包括感兴趣的纹状体摄取、尾状核与壳核比值和纹状体不对称指数）。
155 名退行性帕金森病患者中有 3 例（2.1%）（1 例 CBS、1 例 MSA-C 和 1 例 PD）和 53 例 DLB 患者中的 1 例（1.9%）SPECT 视觉检查正常。随后的半定量分析显示 DLB 和 PD 患者的纹状体摄取轻度受损。因此，只有两名患者（1 例 CBS 和 1 例 MSA）的综合评估完全正常。
当应用严格的诊断标准、进行彻底的随访并将视觉 SPECT 分析与精确的半定量评估相结合时，本研究表明 SWEDD 病例在退行性疾病患者中仅占很小比例（1.3%）。
