Clinical utility of MRI and SPECT in the diagnosis of cognitive impairment referred to memory clinic
Clinical utility of MRI and SPECT in the diagnosis of cognitive impairment referred to memory clinic
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DOI：
10.1017/s1041610217001624
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发表时间：
2018-05-01
影响因子：
7
通讯作者：
Ng, Boon Lung
中科院分区：
文献类型：
--
作者：
Guinane, John;Ng, Boon Lung
背景资料：尽管其有限的可用性和潜在的显着变化之间和每种方式内，这是第一项研究，前瞻性地测量MRI和/或SPECT脑扫描的临床效用，除了常规诊断检查的患者提出的记忆clinic.Methods：一个单中心的研究进行了12个月的采样期的便利。对于每一位接受MRI和/或SPECT扫描的患者，要求初级老年病学家或老年精神病学家指定一个初步诊断。最初的诊断，然后进行比较后，任何扫描或神经心理学测试已经完成了最终的共识diagnosis.Results：在12个月的研究期间，66例（26%）被称为扫描出的253例患者纳入研究。16/44（36%）例MRI结果为阳性，13/35（37%）例SPECT结果为阳性。11/44例（25%）的诊断与MRI扫描结果一致，9/35例（26%）的诊断与SPECT扫描结果一致。通过MRI扫描，在1例患者（1/50（2%））中发现了潜在可逆的病理学，提示正常压力脑积水。测试一个阳性结果所需的数量为3.8（95% CI 2.0-23.3），6.0（95% CI NA）和1.7（95% CI 1.3-2.5）分别用于仅MRI、仅SPECT以及MRI和SPECT联合。本研究中MRI和/或SPECT扫描的临床效用可能广泛上级现有的国际证据，需要进一步的研究来确定积极扫描结果的预测因素。
Background: Despite of their limited availability and potential for significant variation between and within each modality, this is the first study to prospectively measure the clinical utility of MRI and/or SPECT brain scanning in addition to the routine diagnostic workup of patients presenting to memory clinic.Methods: A single center study was conducted over a convenience of 12-month sampling period. For each patient referred for MRI and/or SPECT scanning, the primary geriatrician or psychogeriatrician was asked to assign an initial diagnosis. The initial diagnosis was then compared with the final consensus diagnosis after any scans or neuropsychology testing had been completed.Results: During the 12-month study period, 66 patients (26%) were referred for scans out of a total of 253 patients included in the study. There were 16/44 (36%) positive MRI outcomes and 13/35 (37%) positive SPECT outcomes. The diagnosis changed consistent with the MRI scan findings in 11/44 (25%) and changed consistent with the SPECT scan findings in 9/35 (26%). Potentially reversible pathology was identified in a single patient, 1/50 (2%), via an MRI scan that suggested normal pressure hydrocephalus. The number needed to test for one positive outcome was 3.8 (95% CI 2.0-23.3), 6.0 (95% CI NA), and 1.7 (95% CI 1.3-2.5) for MRI only, SPECT only, and MRI and SPECT together, respectively.Conclusions: The clinical utility of MRI and/or SPECT scanning in this study may be broadly superior to the available international evidence, and further research is needed to identify predictors of positive scan outcomes.