Okada Yukinori, Shiraishi Makoto, Nakamura Hisao, Maki Futaba, Sasaki Naoshi, Hasegawa Yasuhiro, Sasaki Oga, Nakashima Yasuo
Departments of Radiology.
Internal Medicine, Division of Neurology.
Nucl Med Commun. 2018 Nov;39(11):983-988. doi: 10.1097/MNM.0000000000000898.
The aim of this study was to study the significance of combining iodine-123-cardiac metaiodobenzylguanidine scintigraphy (I-MIBG scintigraphy) and iodine-123-ioflupane (I-ioflupane) dopamine transporter scintigraphy (I-ioflupane scintigraphy) in patients suspected of having Parkinson's disease (PD).
We carried out a retrospective study from April 2014 to December 2015 in 48 patients suspected of having new-onset PD who underwent both I-MIBG and I-ioflupane scintigraphies within 3 months. Cases included 37 patients diagnosed as having PD. Controls included 11 patients who had never been diagnosed as having PD or other diseases showing parkinsonism. The cutoff for diagnosing PD was a heart to mediastinum ratio (H/M ratio) of less than or equal to 2.2 for I-MIBG scintigraphy in the delayed phase and a specific binding ratio (SBR) of less than or equal to 3.8 for I-ioflupane scintigraphy. The combined use of both scintigraphies was studied using the formula SBR×H/M ratio as a marker for the logistic regression model.
Sixteen (33.3%) patients had SBR of greater than 3.8: eight with PD; eight were controls. Five of eight patients had an H/M ratio of less than or equal to 2.2 (62.5%) and had PD. In the receiver-operating characteristic analysis, the SBR×H/M ratio cutoff was 12.5, with an area under the curve of 0.844 (95% confidence interval: 0.619-1). In an age-adjusted regression analysis in patients with SBR of greater than 3.8, the SBR×H/M ratio was associated significantly with an odds ratio of 0.69 (95% confidence interval: 0.48-0.98, P=0.041).
If SBR is greater than 3.8, the SBR×H/M ratio can help diagnose PD. The combined use of the two scintigraphies can improve the diagnosis of PD.
本研究旨在探讨将碘-123-间碘苄胍心肌显像（I-MIBG显像）与碘-123-碘氟潘（I-碘氟潘）多巴胺转运体显像（I-碘氟潘显像）联合应用于疑似帕金森病（PD）患者的意义。
我们对2014年4月至2015年12月期间48例疑似新发PD且在3个月内接受了I-MIBG和I-碘氟潘显像的患者进行了一项回顾性研究。病例组包括37例确诊为PD的患者。对照组包括11例从未被诊断为PD或其他表现为帕金森综合征疾病的患者。诊断PD的标准为：I-MIBG显像延迟期心脏与纵隔比值（H/M比值）小于或等于2.2，I-碘氟潘显像特异性结合率（SBR）小于或等于3.8。使用公式SBR×H/M比值作为逻辑回归模型的标志物来研究两种显像的联合应用。
16例（33.3%）患者的SBR大于3.8：其中8例为PD患者；8例为对照组。8例患者中有5例（62.5%）的H/M比值小于或等于2.2且患有PD。在受试者工作特征分析中，SBR×H/M比值的截断值为12.5，曲线下面积为0.844（95%置信区间：0.619 - 1）。在SBR大于3.8的患者进行年龄校正回归分析时，SBR×H/M比值与比值比0.69显著相关（95%置信区间：0.48 - 0.98，P = 0.041）。
如果SBR大于3.8，SBR×H/M比值有助于诊断PD。两种显像的联合应用可提高PD的诊断水平。
