Evaluación longitudinal con FP-CIT en pacientes con parkinsonismo

Torres, M.D. Martínez del Valle; Lozano, S.J. Ortega; Heredia, Maria Jose Gómez; Raissouni, T. Amrani; Moreno, E. Ramos; Espinosa, Patricia; Jiménez-Hoyuela, J.M.

doi:10.1016/j.nrl.2013.07.006

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…In this context, it would be interesting to perform an evolutionary study in this subgroup of patients, since the rapidly progressive deterioration of the disease could confirm or rule out the existence of MSA at a later stage. In the literature, we found hardly any research on this aspect [16,19,36,37].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Effectiveness of [123I]Ioflupane Single Photon Emission Computed Tomography (SPECT) in Multiple System Atrophy

Villena-Salinas

Ortega-Lozano

Amrani-Raissouni

et al. 2023

JCM

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Background: Multiple system atrophy (MSA) is a rapidly progressive neurodegenerative disorder that has no curative treatment. Diagnosis is based on a set of criteria established by Gilman (1998 and 2008) and recently updated by Wenning (2022). We aim to determine the effectiveness of [123I]Ioflupane SPECT in MSA, especially at the initial clinical suspicion. Methods: A cross-sectional study of patients at the initial clinical suspicion of MSA, referred for [123I]Ioflupane SPECT. Results: Overall, 139 patients (68 men, 71 women) were included, 104 being MSA-probable and 35 MSA-possible. MRI was normal in 89.2%, while SPECT was positive in 78.45%. SPECT showed high sensitivity (82.46%) and positive predictive value (86.24), reaching maximum sensitivity in MSA-P (97.26%). Significant differences were found when relating both SPECT assessments in the healthy–sick and inconclusive–sick groups. We also found an association when relating SPECT to the subtype (MSA-C or MSA-P), as well as to the presence of parkinsonian symptoms. Lateralization of striatal involvement was detected (left side). Conclusions: [123I]Ioflupane SPECT is a useful and reliable tool for diagnosing MSA, with good effectiveness and accuracy. Qualitative assessment shows a clear superiority when distinguishing between the healthy–sick categories, as well as between the parkinsonian (MSA-P) and cerebellar (MSA-C) subtypes at initial clinical suspicion.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Effectiveness of [123I]Ioflupane Single Photon Emission Computed Tomography (SPECT) in Multiple System Atrophy

Villena-Salinas

Ortega-Lozano

Amrani-Raissouni

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…In this context, it would be interesting to perform an evolutionary study in this subgroup of patients, since the rapidly progressive deterioration of the disease, it could confirm or rule out the existence of MSA at a later stage. In the literature, we found hardly any research on this aspect [16,19,36].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Effectiveness of [123I]Ioflupane Single Photon Emission Computed Tomography (SPECT) in Multiple System Atrophy

Villena-Salinas¹,

Ortega-Lozano²,

Amrani-Raissouni³

et al. 2023

Preprint

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Background: Multiple system atrophy (MSA) is a rapidly progressive neurodegenerative disorder that has no curative treatment. Diagnosis is based on a set of criteria established by Gilman (1998 and 2008) and recently updated by Wenning (2022). We aim to determine the effectiveness of [123I]Ioflupane SPECT in MSA, especially at the initial clinical suspicion. Methods: Cross-sectional study of patients at initial clinical suspicion of MSA, referred for [123I]Ioflupane SPECT. Results: 139 patients (68 men, 71 women) were included, 104 being MSA-probable and 35 MSA-possible. MRI was normal in 89.2% while SPECT was positive in 78.45%. SPECT showed high sensitivity (82.46%) and positive predictive value (86.24), reaching maximum sensitivity in MSA-P (97.26%). Significant differences were found when relating both SPECT assessments in the healthy-sick and inconclusive-sick groups. We also found an association when relating SPECT to the subtype (MSA-C or MSA-P), as well as to the presence of parkinsonian symptoms. Lateralization of striatal involvement was detected (left side). Conclusions: [123I]Ioflupane SPECT is a useful and reliable tool for diagnosing MSA, with good effectiveness and accuracy. Qualitative assessment shows a clear superiority when distinguishing between the healthy-sick categories, as well as between the parkinsonian (MSA-P) and cerebellar (MSA-C) subtypes at initial clinical suspicion.

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“…In a previous cross-sectional study by our group, qualitative SPECT assessments were found to be accurate in differentiating between the two subtypes. Given that, in this disease, diagnostic errors can occur in the first SPECT assessment (especially in the MSA-C subtype), a serial study would allow for the detection of false negatives or doubtful results and correctly establish the diagnosis [11,15,16,21]. As an example of this, we found in our casuistry a 62-year-old woman with dysautonomic, parkinsonian, and cerebellar symptoms, unresponsive to treatment with levodopa, and it finally turned out to be a case of MSA-C with bilateral striatal involvement (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

“…This makes patient recruitment very difficult and, above all, difficult to establish loyalty for a possible follow-up. For this reason, there are very few neuroimaging follow-up studies, with some being retrospective [15] or having a smaller sample size [13]. It could have been considered to recruit a cohort of healthy patients (as a control group) to study them comparatively with the MSA patients; however, no ethics committee could approve the administration of radionuclides in healthy patients.…”

Section: Discussionmentioning

confidence: 99%

“…All this, added to the rapid progression of MSA, would allow for its evolution to be monitored using [ 123 I]Ioflupane SPECT [14]. In this regard, while serial studies on patients with PD do not seem to be justified, they would be on patients with suspected MSA, and especially those with MSA-C in its early stages [13,15], although these proposals have not been sufficiently contrasted. In fact, a recent article studied 7 patients with MSA-C, 5 with MSA-P, and 18 with PD, concluding that [ 123 I]Ioflupane SPECT and a semiquantitative analysis with SBR (Specific Binding Ratio) constitutes a specific biomarker of the progression of this disease, as well as of the subtype of dopaminergic degeneration in both MSA and PD [16].…”

Section: Introductionmentioning

confidence: 99%

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Follow-Up Findings in Multiple System Atrophy from [123I]Ioflupane Single-Photon Emission Computed Tomography (SPECT): A Prospective Study

Villena-Salinas,

Ortega-Lozano,

Amrani-Raissouni

et al. 2023

Biomedicines

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Background: Multiple system atrophy (MSA) is subdivided into two types: MSA-P (parkinsonian) and MSA-C (cerebellar). Brain SPECT allows for the detection of nigrostriatal involvement, even in the early stages. To date, the scientific literature does not show a consensus on how to follow-up MSA, especially MSA-C. Our aim was to analyze the diagnostic effectiveness of repeat [123I]Ioflupane SPECT for the follow-up of MSA. Methods: A longitudinal observational study on 22 MSA patients (11 males and 11 females). Results: Significant changes were obtained in the quantitative SPECT assessments in the three Striatum/Occipital indices. The qualitative SPECT diagnosis did not show differences between the initial and evolving SPECT, but the neurologist’s clinical suspicion did. Our results showed a brain deterioration of around 31% at 12 months, this being the optimal cut-off for differentiating a diseased subject (capable of solving diagnostic error rate). Previous imaging tests were inconclusive, as they showed less deterioration in the SPECT and quantitative assessments with respect to the group of confirmed patients. Repeated SPECT increased the diagnostic sensitivity (50% vs. 75%) and positive predictive value (72.73% vs. 77%). In addition, repeated SPECT proved decisive in the diagnosis of initial inconclusive cases. Conclusion: Repeat SPECT at 12 months proves useful in the diagnosis and follow-up of MSA.

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Evaluación longitudinal con FP-CIT en pacientes con parkinsonismo

Abstract: Serial FP-CIT studies are unnecessary in the large majority of cases, but they may be justifiable in certain clinical situations.

Cited by 7 publications

References 21 publications

Diagnostic Effectiveness of [123I]Ioflupane Single Photon Emission Computed Tomography (SPECT) in Multiple System Atrophy

Diagnostic Effectiveness of [123I]Ioflupane Single Photon Emission Computed Tomography (SPECT) in Multiple System Atrophy

Diagnostic Effectiveness of [123I]Ioflupane Single Photon Emission Computed Tomography (SPECT) in Multiple System Atrophy

Follow-Up Findings in Multiple System Atrophy from [123I]Ioflupane Single-Photon Emission Computed Tomography (SPECT): A Prospective Study

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