Clinic for Trauma, Hand, Plastic and Reconstructive Surgery, Universitätsklinikum Ulm, Afrastr.11, 86316, Friedberg, Germany.
Neurozentrum Prien, Bernauer Str. 12, 83209, Prien, Germany.
Clin Auton Res. 2019 Dec;29(6):567-574. doi: 10.1007/s10286-018-0534-y. Epub 2018 Jun 5.
Metaiodobenylguanidine (MIBG) scintigraphy has been shown to enhance the probability of correct diagnosis in patients with parkinsonian syndromes (PS). Thus far, studies of the clinical usefulness of MIBG have been confined to cross-sectional assessments, which are inevitably associated with diagnostic uncertainty during the early stages of these syndromes. In this study, the initial clinical diagnosis was reevaluated longitudinally to assess the sensitivity and specificity of clinical and MIBG parameters in the early diagnosis of PS.
167 patients with PS (age 67.03 ± 8.92 years (mean ± standard deviation), duration of symptoms 2.48 ± 5.27 years, median Hoehn and Yahr score 2) underwent an initial clinical assessment and MIBG scintigraphy. Eighty seven of those patients (56 with Parkinson's disease (PD), 1 with multiple system atrophy (MSA), 23 with atypical PS, 7 with tremor syndrome) were clinically reevaluated a mean of 3 years later in order to verify their initial diagnosis.
The use of a lower limit of normal value of 1.74 for the heart-to-mediastinum ratio (HMR) achieved the best discrimination between PD and other PS. The sensitivity of MIBG scintigraphy to PD was 94%; it also had a specificity of 65%, a positive predictive value of 88%, and a negative predictive value of 79%. MIBG scintigraphy was better than initial clinical diagnosis alone (sensitivity 83%, specificity 39%) or levodopa responsiveness (sensitivity 92%, specificity 10%). However, a combination of clinical diagnosis and MIBG scintigraphy was found to be especially clinically useful (specificity 95%, sensitivity 83%, positive predictive value 95%, negative predictive value 83%).
MIBG scintigraphy was demonstrated to be a reliable tool for the diagnosis of early PD. The best diagnostic accuracy was achieved by combining a clinical examination with MIBG scintigraphy.
碘代苄胍（MIBG）闪烁扫描术已被证明可提高帕金森综合征（PS）患者正确诊断的可能性。到目前为止，MIBG 的临床应用研究仅限于横断面评估，而这些评估不可避免地与这些综合征早期的诊断不确定性有关。在这项研究中，我们对初始临床诊断进行了纵向重新评估，以评估临床和 MIBG 参数在 PS 早期诊断中的敏感性和特异性。
167 名 PS 患者（年龄 67.03 ± 8.92 岁（均值 ± 标准差），症状持续时间 2.48 ± 5.27 年，中位 Hoehn 和 Yahr 评分为 2）接受了初始临床评估和 MIBG 闪烁扫描。其中 87 名患者（56 名帕金森病（PD），1 名多系统萎缩（MSA），23 名非典型 PS，7 名震颤综合征）在平均 3 年后进行了临床重新评估，以验证其初始诊断。
使用 1.74 作为正常上限的心脏与纵隔比值（HMR）可最佳地区分 PD 和其他 PS。MIBG 闪烁扫描对 PD 的敏感性为 94%；特异性为 65%，阳性预测值为 88%，阴性预测值为 79%。MIBG 闪烁扫描优于单独的初始临床诊断（敏感性 83%，特异性 39%）或左旋多巴反应性（敏感性 92%，特异性 10%）。然而，发现将临床诊断与 MIBG 闪烁扫描相结合具有特别的临床实用性（特异性 95%，敏感性 83%，阳性预测值 95%，阴性预测值 83%）。
MIBG 闪烁扫描被证明是诊断早期 PD 的可靠工具。通过将临床检查与 MIBG 闪烁扫描相结合，可以获得最佳的诊断准确性。
