Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia.
Department of Neurology, Austin Health, Melbourne, Victoria, Australia.
BMJ Open. 2018 Nov 15;8(11):e025533. doi: 10.1136/bmjopen-2018-025533.
To further validate the diagnostic utility of F-AV-133 vesicular monoamine transporter type 2 (VMAT2) positron emission tomography (PET) in patients with clinically uncertain parkinsonian syndromes (CUPS) by comparison to clinical diagnosis at 3 years follow-up.
DESIGN, SETTING AND PARTICIPANTS: In a previous study, we reported that F-AV-133 PET in community patients with CUPS changed diagnosis and management and increased diagnostic confidence. The current diagnosis of this cohort was obtained from the patient and treating specialist and compared with the diagnosis suggested 3 years earlier by the F-AV-133 PET. A second F-AV-133 PET was available in those with a discordant or inconclusive final diagnosis.
The primary end point was the proportion of patients who had a follow-up clinical diagnosis, which was concordant with their initial F-AV-133 PET scan. Secondary end points were the proportion of patients who had the same diagnosis at follow-up as that reached after the initial scan and the stability of diagnostic changes made after the first scan.
81 of the 85 patients previously recruited to the CUPS study had follow-up of which 79 had a clinical diagnosis and 2 remained CUPS. The diagnosis was in agreement with the initial F-AV-133 PET scan result in 74 cases. Five patients had a discordant diagnosis; one patient with rubral tremor had a severely abnormal scan that had worsened when rescanned; four cases with normal initial and repeat scans had a clinical diagnosis of Parkinson's disease. Two patients with suspected genetic disorders remained classified as CUPS and both had normal scans. In the 24 CUPS cohort patients where F-AV-133 PET initially changed diagnosis, this change was supported by follow-up diagnosis in all but the one rubral tremor case.
F-AV-133 PET is a useful tool in improving diagnostic accuracy in CUPS providing results and diagnostic changes that remain robust after 3 years follow-up.
通过与 3 年后的临床诊断相比，进一步验证 F-AV-133 囊泡单胺转运体 2（VMAT2）正电子发射断层扫描（PET）在临床不确定帕金森综合征（CUPS）患者中的诊断效用。
设计、设置和参与者：在之前的一项研究中，我们报告称，F-AV-133 PET 可改变社区 CUPS 患者的诊断和治疗，并增加诊断信心。本队列的当前诊断来自患者和治疗专家，并与 3 年前 F-AV-133 PET 建议的诊断进行比较。对于最终诊断不一致或不确定的患者，可获得第二次 F-AV-133 PET。
主要终点是有随访临床诊断的患者比例，该诊断与他们最初的 F-AV-133 PET 扫描结果一致。次要终点是在随访时与最初扫描后达到的相同诊断的患者比例，以及首次扫描后做出的诊断变化的稳定性。
85 例 CUPS 研究患者中有 81 例接受了随访，其中 79 例有临床诊断，2 例仍为 CUPS。74 例诊断与初始 F-AV-133 PET 扫描结果一致。5 例诊断不一致；1 例有红核震颤的患者，其扫描结果严重异常，再次扫描时恶化；4 例初始和重复扫描正常的患者，临床诊断为帕金森病。2 例疑似遗传疾病的患者仍归类为 CUPS，且均有正常扫描。在 24 例 CUPS 队列患者中，F-AV-133 PET 最初改变了诊断，除了一例红核震颤病例外，这些改变都得到了随访诊断的支持。
F-AV-133 PET 是一种有用的工具，可提高 CUPS 的诊断准确性，提供在 3 年随访后仍然可靠的结果和诊断变化。
