Implementation of the European multicentre database of healthy controls for [123I]FP-CIT SPECT increases diagnostic accuracy in patients with clinically uncertain parkinsonian syndromes
Implementation of the European multicentre database of healthy controls for [123I]FP-CIT SPECT increases diagnostic accuracy in patients with clinically uncertain parkinsonian syndromes
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DOI：
10.1007/s00259-015-3304-2
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发表时间：
2016-07-01
影响因子：
9.1
通讯作者：
la Fougere, Christian
中科院分区：
文献类型：
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作者：
Albert, Nathalie L.;Unterrainer, Marcus;la Fougere, Christian
尽管[I-123]FP-CIT SPECT在检测神经退行性帕金森综合征（PS）的黑质纹状体细胞损失方面提供了很高的准确性，但一些患者的诊断仍然不确定。我们研究了是否可以通过使用迭代重建算法和改进的半定量评估来提高临床不确定的PS患者的诊断准确性，该算法另外实施了针对患者年龄和伽马相机依赖性的校正算法（EARL-BRASS; Hermes Medical Solutions，瑞典）。方法：在2003年至2010年期间，作为疑似PS诊断过程的一部分，在慕尼黑大学进行了101例[I-123]FP-CIT SPECT检查，结果不确定，并使用迭代重建算法和新校正的EARL-BRASS重新评估这些扫描结果。101例患者中有62例获得了临床随访，这构成了重新评估诊断准确性可能提高的金标准。结果62例患者中11例经临床随访确诊为PS。在视觉和半定量分析结果一致的患者（48例）中，发现高阴性预测值（93%），阳性预测值（100%）和准确率（94%），因此在48例患者中有45例获得正确诊断。在14例发现不一致的患者中，额外的半定量分析正确地识别了9例患者中的5例，即在视觉病理或不确定扫描中通过非病理性半定量发现无PS。相比之下，其余5名患者中有4名半定量值下降，但视觉扫描正常，随访期间未显示PS。结论EARL-BRASS的年龄校正和相机校正评估模式显著提高了[I-123]FP-CIT SPECT对先前未确定发现的PS患者的诊断准确性。准确性的提高可能通过更好地区分由于年龄相关的多巴胺转运体丢失或病理性的结合丢失而导致的生理低纹状体[I-123]FP-CIT结合来实现。
Purpose Even though [I-123]FP-CIT SPECT provides high accuracy in detecting nigrostriatal cell loss in neurodegenerative parkinsonian syndromes (PS), some patients with an inconclusive diagnosis remain. We investigated whether the diagnostic accuracy in patients with clinically uncertain PS with previously inconclusive findings can be improved by the use of iterative reconstruction algorithms and an improved semiquantitative evaluation which additionally implemented a correction algorithm for patient age and gamma camera dependency (EARL-BRASS; Hermes Medical Solutions, Sweden).Methods We identified 101 patients with inconclusive findings who underwent an [I-123]FP-CIT SPECT between 2003 and 2010 as part of the diagnostic process of suspected PS at the University of Munich, and re-evaluated these scans using iterative reconstruction algorithms and the new corrected EARL-BRASS. Clinical follow-up was obtained in 62 out of the 101 patients and constituted the gold standard for the re-evaluation to assess the possible improvement in diagnostic accuracy.Results Clinical follow-up confirmed the diagnosis of PS in 11 of the 62 patients. In patients in whom both visual and semiquantitative analysis showed concordant findings (48 patients), a high negative predictive value (93 %), positive predictive value (100 %) and accuracy (94 %) were found, and thus a correct diagnosis was obtained in 45 of the 48 patients. Among the 14 patients with discordant findings, the additional semiquantitative analysis correctly identified all five of nine patients patients without PS by nonpathological semiquantitative findings in visually pathological or inconclusive scans. In contrast, four of the remaining five patients with decreased semiquantitative values but visually normal scans did not show a PS during follow-up.Conclusion The age-corrected and camera-corrected mode of evaluation using EARL-BRASS provided a notable improvement in the diagnostic accuracy of [I-123]FP-CIT SPECT in PS patients with previously inconclusive findings. The gain in accuracy might be achieved by better discrimination between physiological low striatal [I-123]FP-CIT binding due to age-related loss of the dopamine transporter or pathological loss of binding.