I-FP-CIT与I-MIBG心肌闪烁显像联合应用在鉴别帕金森病与其他帕金森综合征中的效用
The Utility of the Combined Use of I-FP-CIT and I-MIBG Myocardial Scintigraphy in Differentiating Parkinson's Disease from Other Parkinsonian Syndromes.
作者信息
Matsusue Eiji, Fujihara Yoshio, Tanaka Kenichiro, Aozasa Yuki, Shimoda Manabu, Nakayasu Hiroyuki, Nakamura Kazuhiko, Ogawa Toshihide
机构信息
Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan.
†Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan.
出版信息
Yonago Acta Med. 2018 Jun 18;61(2):117-127. doi: 10.33160/yam.2018.06.004. eCollection 2018 Jun.
BACKGROUND
I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) provide specific information that distinguish Parkinson's disease (PD) from parkinsonian syndromes other than PD (non-PD), including atypical parkinsonian disorder (APD) and non-PD other than APD (nPD-nAPD). The purpose of this study was to determine whether combining DAT-SPECT and MIBG myocardial scintigraphy using multiparametric scoring system (MSS) could improve diagnostic test accuracy in discriminating PD from APD or discriminating PD from nPD-nAPD.
METHODS
A total of 52 patients, including 36 PD, eight APD and eight nPD-nAPD, underwent both MIBG myocardial scintigraphy and DAT-SPECT, were evaluated. The heart-to-mediastinum (H/M) ratios (early and delayed), washout-rate (WR), the average (Ave) and asymmetry index (AI) of specific binding ratio (SBR) were calculated. Cutoff values were determined, using ROC analysis, for discriminating PD from APD and for discriminating PD from nPD-nAPD, on five parameters. All cases were scored as either 1 (PD) or 0 (nPD-nAPD or APD) for each parameter according to its threshold in each discrimination. These individual scores were summed for each case, yielding a combined score to obtain a cutoff value for the MSS in each discrimination.
RESULTS
For discriminating PD from nPD-nAPD, the highest accuracy was 80% at a cutoff value of 19% for the WR and a cut off value of 2 improved diagnostic accuracy to 84% for MSS. For discriminating PD from APD, the highest accuracy was 86% at a cutoff value of 2.8 for the H/M ratio (late) and a cut off value of 2 showed diagnostic accuracy of 86% for MSS.
CONCLUSION
A MSS has comparable or better accuracy compared to each parameter of MIBG myocardial scintigraphy and DAT-SPECT in distinguishing PD from nPD-nAPD or distinguishing PD from APD.
背景
碘代间位苄胍（MIBG）心肌闪烁显像和碘氟苯胍多巴胺转运体单光子发射计算机断层扫描（DAT-SPECT）可提供特定信息，用于区分帕金森病（PD）与非帕金森病的帕金森综合征（非PD），包括非典型帕金森病（APD）和非APD的非PD（nPD-nAPD）。本研究的目的是确定使用多参数评分系统（MSS）将DAT-SPECT和MIBG心肌闪烁显像相结合，是否能提高鉴别PD与APD或鉴别PD与nPD-nAPD的诊断测试准确性。
方法
对52例患者进行了评估，其中包括36例PD、8例APD和8例nPD-nAPD，均接受了MIBG心肌闪烁显像和DAT-SPECT检查。计算心脏与纵隔（H/M）比值（早期和延迟）、洗脱率（WR）、特异性结合率（SBR）的平均值（Ave）和不对称指数（AI）。使用ROC分析确定区分PD与APD以及区分PD与nPD-nAPD的五个参数的临界值。根据每个鉴别中的阈值，将所有病例的每个参数评分为1（PD）或0（nPD-nAPD或APD）。将每个病例的这些个体评分相加，得出综合评分，以获得每个鉴别中MSS的临界值。
结果
对于区分PD与nPD-nAPD，洗脱率临界值为19%时最高准确率为80%，MSS临界值为2时诊断准确率提高到84%。对于区分PD与APD，延迟期H/M比值临界值为2.8时最高准确率为86%，MSS临界值为2时诊断准确率为86%。
结论
在区分PD与nPD-nAPD或区分PD与APD方面，MSS与MIBG心肌闪烁显像和DAT-SPECT的各参数相比，具有相当或更高的准确性。
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