Gu Si-Chun, Ye Qing, Yuan Can-Xing
Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai 200032, China.
Rev Neurosci. 2019 May 3;30(7):743-756. doi: 10.1515/revneuro-2018-0061. Print 2019 Oct 25.
A large number of articles have assessed the diagnostic accuracy of the metabolic pattern analysis of [F]fluorodeoxyglucose (F-FDG) positron emission tomography (PET) in Parkinson's disease (PD); however, different studies involved small samples with various controls and methods, leading to discrepant conclusions. This study aims to consolidate the available observational studies and provide a comprehensive evaluation of the clinical utility of F-FDG PET for PD. The methods included a systematic literature search and a hierarchical summary receiver operating characteristic approach. Sensitivity analyses according to different pattern analysis methods (statistical parametric mapping versus scaled subprofile modeling/principal component analysis) and control population [healthy controls (HCs) versus atypical parkinsonian disorder (APD) patients] were performed to verify the consistency of the main results. Additional analyses for multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) were conducted. Fifteen studies comprising 1446 subjects (660 PD patients, 499 APD patients, and 287 HCs) were included. The overall diagnostic accuracy of F-FDG in differentiating PD from APDs and HCs was quite high, with a pooled sensitivity of 0.88 [95% confidence interval (95% CI), 0.85-0.91] and a pooled specificity of 0.92 (95% CI, 0.89-0.94), with sensitivity analyses indicating statistically consistent results. Additional analyses showed an overall sensitivity and specificity of 0.87 (95% CI, 0.76-0.94) and 0.93 (95% CI, 0.89-0.96) for MSA and 0.91 (95% CI, 0.78-0.95) and 0.96 (95% CI, 0.92-0.98) for PSP. Our study suggests that the metabolic pattern analysis of F-FDG PET has high diagnostic accuracy in the differential diagnosis of parkinsonian disorders.
大量文章评估了[F]氟脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）代谢模式分析在帕金森病（PD）中的诊断准确性；然而，不同研究样本量小，对照和方法各异，导致结论不一。本研究旨在整合现有观察性研究，全面评估F-FDG PET对PD的临床应用价值。方法包括系统的文献检索和分层汇总接收器操作特征方法。根据不同的模式分析方法（统计参数映射与缩放子轮廓建模/主成分分析）和对照人群[健康对照（HCs）与非典型帕金森综合征（APD）患者]进行敏感性分析，以验证主要结果的一致性。对多系统萎缩（MSA）和进行性核上性麻痹（PSP）进行了额外分析。纳入了15项研究，共1446名受试者（660名PD患者、499名APD患者和287名HCs）。F-FDG在区分PD与APD和HCs方面的总体诊断准确性相当高，合并敏感性为0.88[95%置信区间（95%CI），0.85 - 0.91]，合并特异性为0.92（95%CI，0.89 - 0.94），敏感性分析表明结果具有统计学一致性。额外分析显示，MSA的总体敏感性和特异性分别为0.87（95%CI，0.76 - 0.94）和0.93（95%CI，0.89 - 0.96），PSP的总体敏感性和特异性分别为0.91（95%CI，0.78 - 0.95）和0.96（95%CI，0.92 - 0.98）。我们的研究表明，F-FDG PET代谢模式分析在帕金森综合征的鉴别诊断中具有较高的诊断准确性。
