Scan without evidence of dopaminergic deficit: A 10-year retrospective study
Scan without evidence of dopaminergic deficit: A 10-year retrospective study
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DOI：
10.1016/j.parkreldis.2016.07.002
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发表时间：
2016-10-01
影响因子：
4.1
通讯作者：
Burkhard, Pierre R.
中科院分区：
文献类型：
--
作者：
Nicastro, Nicolas;Garibotto, Valentina;Burkhard, Pierre R.
I-123-iofiupane SPECT是一种评估黑质纹状体多巴胺系统完整性的有效方法。几项独立研究表明，1-15%的疑似退行性帕金森病（主要是帕金森病）患者的扫描未发现多巴胺能缺陷（SWEDD）的证据。已经提出，大多数SWEDD患者要么表现为类似PD的非退行性疾病，如非典型震颤或肌张力障碍，要么在以后重复扫描时表现出异常。我们在这里假设扫描解释方法也可能在这个问题上发挥关键但被低估的作用。方法：我们之前通过分析一组非退行性疾病患者的扫描结果，建立了纹状体摄取的年龄相关参考值。然后，我们研究了大量患有退行性帕金森病的人群（N = 410, 80%患有帕金森病），使用相同的成像方案，以评估基于常规视觉评估的正常扫描患者的患病率。每次扫描最终使用与对照组相同的自动化方法和详细的3D分析进行重新评估。结果：发现10例潜在的SWEDD病例（2.4%）。然而，两种重新评估方法独立显示，这些扫描结果均超出参考范围和/或重新仔细检查时视觉异常，除了一例（0.2%）患有皮质基底综合征。结论：SPECT误读是SWEDD人群的一个重要因素，这表明疑似SWEDD病例不仅应该引起严重的诊断挑战，同样重要的是，详细的扫描重新评估。在退行性帕金森病中，真正的SWEDD病例似乎极为罕见。我们认为SWEDD的概念本身更容易混淆，而不是有用的，应该绝对放弃。(C) 2016 Elsevier Ltd.版权所有。
Introduction: I-123-iofiupane SPECT is a powerful method to assess nigrostriatal dopamine system integrity. Several independent studies have shown that 1-15% of patients with suspected degenerative parkinsonism, mainly PD, have scans without evidence of dopaminergic deficit (SWEDD). It has been proposed that most SWEDD patients either present with a non-degenerative condition mimicking PD, such as atypical tremor or dystonia, or demonstrate an abnormal scan when repeated later. We here hypothesized that scan interpretation methods may also play a crucial yet underestimated role in this issue.Methods: We previously established age-dependent reference values of striatal uptake by analyzing scans from a cohort of patients with non-degenerative conditions. We then studied a large population with well-established degenerative parkinsonism (N = 410, 80% with PD), using identical imaging protocol, to evaluate the prevalence of patients with normal scans based on routine visual assessment. Each scan was eventually reassessed using the same automated method as for controls and a detailed 3D analysis.Results: Ten potential SWEDD cases (2.4%) were identified. However, both reassessment methods independently showed that these scans were all outside reference limits and/or visually abnormal when reexamined carefully, except for one case (0.2%) with corticobasal syndrome.Conclusion: SPECT misinterpretation emerges as an important contributor to the SWEDD population, suggesting that suspected SWEDD cases should prompt not only a serious diagnosis challenge but, equally important, a detailed scan reassessment. True SWEDD cases seem extremely rare in degenerative parkinsonism. We propose that the very concept of SWEDD is more confusing than helpful and should be definitely abandoned. (C) 2016 Elsevier Ltd. All rights reserved.