Schmitz-Steinkrüger Helen, Lange Catharina, Apostolova Ivayla, Mathies Franziska L, Frings Lars, Klutmann Susanne, Hellwig Sabine, Meyer Philipp T, Buchert Ralph
Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Nuclear Medicine, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Eur J Nucl Med Mol Imaging. 2021 May;48(5):1445-1459. doi: 10.1007/s00259-020-05085-2. Epub 2020 Oct 31.
The specific binding ratio (SBR) of I-FP-CIT (FP-CIT) in the putamen decreases with age by about 5% per decade and most likely is about 10% higher in females. However, the clinical utility of age and sex correction of the SBR is still a matter of debate. This study tested the impact of age and sex correction on the diagnostic performance of the putamen SBR in three independent patient samples.
Research sample: 207 healthy controls (HC) and 438 Parkinson's disease (PD) patients. Clinical sample A: 183 patients with neurodegenerative parkinsonian syndrome (PS) and 183 patients with non-neurodegenerative PS from one site. Clinical sample B: 84 patients with neurodegenerative PS and 38 patients with non-neurodegenerative PS from another site. Correction for age and sex of the putamen SBR was based on linear regression in the HC or non-neurodegenerative PS, separately in each sample. The area under the ROC curve (AUC) was used as performance measure.
The putamen SBR was higher in females compared to males (PPMI: 14%, p < 0.0005; clinical sample A: 7%, p < 0.0005; clinical sample B: 6%, p = 0.361). Age-related decline of the putamen SBR ranged between 3.3 and 10.4% (p ≤ 0.019). In subjects ≥ 50 years, age and sex explained < 10% of SBR between-subjects variance. Correction of the putamen SBR for age and sex resulted in slightly decreased AUC in the PPMI sample (0.9955 versus 0.9969, p = 0.025) and in clinical sample A (0.9448 versus 0.9519, p = 0.057). There was a small, non-significant AUC increase in clinical sample B (0.9828 versus 0.9743, p = 0.232).
These findings do not support age and sex correction of the putaminal FP-CIT SBR in the diagnostic workup of parkinsonian syndromes. This most likely is explained by the fact that the proportion of between-subjects variance caused by age and sex is considerably below the symptom threshold of about 50% reduction in neurodegenerative PS.
壳核中碘氟苯托品（FP-CIT）的特异性结合率（SBR）随年龄增长每十年下降约5%，且女性的该比率可能比男性高约10%。然而，对SBR进行年龄和性别校正的临床实用性仍存在争议。本研究在三个独立的患者样本中测试了年龄和性别校正对壳核SBR诊断性能的影响。
研究样本：207名健康对照者（HC）和438名帕金森病（PD）患者。临床样本A：来自一个地点的183名神经退行性帕金森综合征（PS）患者和183名非神经退行性PS患者。临床样本B：来自另一个地点的84名神经退行性PS患者和38名非神经退行性PS患者。壳核SBR的年龄和性别校正分别基于每个样本中HC或非神经退行性PS的线性回归。ROC曲线下面积（AUC）用作性能指标。
女性的壳核SBR高于男性（PPMI：14%，p < 0.0005；临床样本A：7%，p < 0.0005；临床样本B：6%，p = 0.361）。壳核SBR与年龄相关的下降幅度在3.3%至10.4%之间（p≤0.019）。在年龄≥50岁的受试者中，年龄和性别对受试者间SBR差异的解释率<10%。对壳核SBR进行年龄和性别校正后，PPMI样本（0.9955对0.9969，p = 0.025）和临床样本A（0.9448对0.9519，p = 0.057）的AUC略有下降。临床样本B的AUC有小幅、无统计学意义的增加（0.9828对0.9743，p = 0.232）。
这些发现不支持在帕金森综合征的诊断检查中对壳核FP-CIT SBR进行年龄和性别校正。这很可能是因为年龄和性别导致的受试者间差异比例远低于神经退行性PS中约50%降低的症状阈值。
