Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50134, Florence, Italy.
Department of Nuclear Medicine, Hospital of Prato, Via Suor Niccolina Infermiera, 20/22, 59100, Prato, Italy.
Neurol Sci. 2022 Sep;43(9):5333-5341. doi: 10.1007/s10072-022-06166-w. Epub 2022 Jun 14.
The early differential diagnosis among neurodegenerative parkinsonian disorders becomes essential to set up the correct clinical-therapeutic approach. The increased utilization of [F] fluoro-deoxy-glucose positron emission tomography (FDG PET) and the pressure for cost-effectiveness request a systematic evaluation and a validation of its utility in clinical practice. This retrospective study aims to consider the contribution, in terms of increasing accuracy and increasing diagnostic confidence, of voxel-based FDG PET analyses in the differential diagnosis of these disorders, including Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, and cortico-basal syndrome.
Eighty-three subjects with a clinically confirmed diagnosis of degenerative parkinsonian disorders who underwent FDG brain PET/CT were selected. A voxel-based analysis was set up using statistical parametric mapping (SPM) on MATLAB to produce maps of brain hypometabolism and relative hypermetabolism. Four nuclear physicians (two expert and two not expert), blinded to the patients' symptoms, other physicians' evaluations, and final clinical diagnosis, independently evaluated all data by visual assessment and by adopting metabolic maps.
In not-expert evaluators, the support of both hypometabolism and hypermetabolism maps results in a significant increase in diagnostic accuracy as well as clinical confidence. In expert evaluators, the increase in accuracy and in diagnostic confidence is mainly supported by hypometabolism maps alone.
In this study, we demonstrated the additional value of combining voxel-based analyses with qualitative assessment of brain PET images. Moreover, maps of relative hypermetabolism can also make their contribution in clinical practice, particularly for less experienced evaluators.
在神经退行性帕金森病障碍的早期鉴别诊断变得至关重要，以便建立正确的临床治疗方法。[F]氟脱氧葡萄糖正电子发射断层扫描（FDG PET）的广泛应用以及对成本效益的压力要求对其在临床实践中的效用进行系统评估和验证。本回顾性研究旨在考虑基于体素的 FDG PET 分析在这些疾病（包括帕金森病、多系统萎缩、进行性核上性麻痹和皮质基底节综合征）的鉴别诊断中的作用，在提高准确性和诊断信心方面的作用。
选择 83 名经临床确诊为退行性帕金森病障碍的患者，这些患者接受了 FDG 脑 PET/CT 检查。使用 MATLAB 上的统计参数映射（SPM）建立基于体素的分析，以生成脑代谢低下和相对代谢亢进的图谱。四名核医学医师（两名专家和两名非专家）在不了解患者症状、其他医师评估和最终临床诊断的情况下，通过视觉评估和代谢图谱独立评估所有数据。
在非专家评估者中，代谢低下和代谢亢进图谱的支持显著提高了诊断准确性和临床信心。在专家评估者中，准确性和诊断信心的提高主要由代谢低下图谱单独支持。
在这项研究中，我们证明了将基于体素的分析与脑 PET 图像的定性评估相结合的附加价值。此外，相对代谢亢进的图谱也可以在临床实践中做出贡献，特别是对于经验较少的评估者。
