Meta-analysis of the literature on diagnostic accuracy of SPECT in parkinsonian syndromes

Vlaar, Annemarie; Kroonenburgh, M.J.P.G. van; Kessels, Alfons G.H.; Weber, Waylon

doi:10.1186/1471-2377-7-27

Cited by 119 publications

(83 citation statements)

References 68 publications

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“…These results are in accordance with one meta-analysis on the diagnostic accuracy of DaTSCAN [9] and two previously published studies on the same topic [10,34]. However, the putamen/caudate ratio is greater in APS than in PD, suggesting a more uniform dopamine depletion both in putamen and in caudate nucleus in APS patients; this result concurs with the previously discussed visual assessment.…”

Section: Datscansupporting

confidence: 82%

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The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

et al. 2015

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The aim of the study was to compare the efficacy of olfactory testing and presynaptic dopamine imaging in diagnosing Parkinsons disease (PD) and atypical parkinsonian syndromes (APS); to evaluate if the combination of these two diagnostic tools can improve their diagnostic value. A prospective investigation of 24 PD patients, 16 APS patients and 15 patients with non-parkinsonian syndromes was performed during an 18-month period. Single photon emission computed tomography with the presynaptic radioligand I-123-FP-CIT (DaTSCAN (R)) and olfactory testing with the Brief 12-item Smell Identification Test (B-SIT) were performed in all patients. DaTSCAN was analysed semi-quantitatively, by calculating two different striatal uptake ratios, and visually according to a predefined ranking scale. B-SIT score was significantly lower for PD patients, but not significantly different between APS and non-parkinsonism. The visual assessment of DaTSCAN had higher sensitivity, specificity and diagnostic accuracy compared to olfactory testing. Most PD patients (75 %) had visually predominant dopamine depletion in putamen, while most APS patients (56 %) had visually severe dopamine depletion both in putamen and in caudate nucleus. The combination of DaTSCAN and B-SIT led to a higher rate of correctly classified patients. Olfactory testing can distinguish PD from non-parkinsonism, but not PD from APS or APS from non-parkinsonism. DaTSCAN is more efficient than olfactory testing and can be valuable in differentiating PD from APS. However, combining olfactory testing and DaTSCAN imaging has a higher predictive value than these two methods separately.

Funding Agencies|Ostergotland County Council (ALF); Swedish Parkinsons Foundation

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Section: Datscansupporting

confidence: 82%

“…DaTSCAN imaging has high diagnostic performance in separating patients with PD from patients with non-parkinsonian syndromes [5,6]. However, the efficacy of DaTSCAN imaging in separating PD from APS has been a matter of controversy [4,[7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

et al. 2015

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Funding Agencies|Ostergotland County Council (ALF); Swedish Parkinsons Foundation

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“…For example, imaging of dopamine transporter (DAT) binding with 123 I-N-v-fluoropropyl2b-carbomethoxy-3b-(4-iodophenyl)nortropan (FP-CIT) successfully visualizes presynaptic dopaminergic degeneration of the nigrostriatal tract. This procedure allows differentiation of degenerative parkinsonism from movement disorders that are not associated with dopaminergic deficit, such as essential tremor (4,5,10). DAT imaging alone, however, does not differentiate the various types of degenerative parkinsonism (PD vs. APD) with sufficient accuracy (5,11).…”

mentioning

confidence: 99%

Diagnostic Accuracy of Combined FP-CIT, IBZM, and MIBG Scintigraphy in the Differential Diagnosis of Degenerative Parkinsonism: A Multidimensional Statistical Approach

Südmeyer

Antke²,

Zizek³

et al. 2011

J Nucl Med

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In vivo molecular imaging of pre-and postsynaptic nigrostriatal neuronal degeneration and sympathetic cardiac innervation with SPECT is used to distinguish idiopathic Parkinson disease (PD) from atypical parkinsonian disorder (APD). However, the diagnostic accuracy of these imaging approaches as standalone procedures is often unsatisfying. The aim of this study was therefore to evaluate to which extent diagnostic accuracy can be increased by their combined use together with a multidimensional statistical algorithm. Methods: The SPECT radiotracers 123 , and meta-123 I-iodobenzylguanidine (MIBG) were used to assess striatal postsynaptic D 2 receptor binding, striatal presynaptic dopamine transporter binding, and myocardial adrenergic innervation, respectively. Thirty-one PD and 17 APD patients were prospectively investigated. PD and APD diagnoses were established using consensus criteria and reevaluated after 37.4 6 12.4 and 26 6 11.6 mo in PD and APD, respectively. Test accuracy (TA) for PD-APD differentiation was computed for all logical (Boolean) combinations of imaging modalities by receiver-operating-characteristic analysis-that is, after multidimensional optimization of cutoff values. Results: Analysis showed moderate TA for PD-APD differentiation using each molecular approach alone (IBZM, 79%; MIBG, 73%; and FP-CIT, 73%). For combined use, the highest TA resulted under the assumption that at least 2 of the 3 biologic markers had to be positive for APD using the following cutoff values: 1.46 or less for IBZM, less than 2.10 for FP-CIT, and greater than 1.43 for MIBG. This algorithm distinguished APD from PD with a sensitivity of 94%, specificity of 94% (TA, 94%), positive predictive value of 89%, and negative predictive value of 97%. Conclusion: Results suggest that the multidimensional combination of FP-CIT, IBZM, and MIBG scintigraphy is likely to significantly increase TA in differentiating PD from APD. The differential diagnosis of degenerative parkinsonism may thus be facilitated.

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“…In fact, various authors have shown reduced striatal binding of D2 receptor ligands in patients with Parkinson-plus syndromes and increased binding in untreated patients with early PD [69][70][71]. Even though international guidelines recommend post-synaptic imaging to distinguish PD from Parkinson-plus syndromes [69], a recent meta-analysis on the role of SPECT in parkinsonian syndromes indicated a low level of diagnostic accuracy in differentiating between PD and Parkinson-plus syndromes [72]. Furthermore, post-synaptic dopaminergic imaging does not discriminate among Parkinson-plus syndrome subgroups.…”

Section: Movement Disordersmentioning

confidence: 99%

Multiagent imaging of the brain

Ciarmiello

Gaeta

Guidotti

et al. 2013

Clin Transl Imaging

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Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are in vivo imaging techniques that, using a wide range of tracers, allow the non-invasive tracking of pathophysiological processes in healthy and diseased brain. One of most promising of the various PET and SPECT applications is the investigation of pathophysiological aspects of neurodegenerative disorders. This is an extremely important area of investigation given the aging of the global population and the high prevalence of brain disorders such as Alzheimer's disease and Parkinson's disease in elderly persons. Clinical translation of advances in molecular imaging research into clinical practice may, by overcoming the limitations of a diagnostic approach that relies exclusively on clinical judgment and structural imaging, lead to better clinical management of affected patients.

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Meta-analysis of the literature on diagnostic accuracy of SPECT in parkinsonian syndromes

Cited by 119 publications

References 68 publications

The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

Diagnostic Accuracy of Combined FP-CIT, IBZM, and MIBG Scintigraphy in the Differential Diagnosis of Degenerative Parkinsonism: A Multidimensional Statistical Approach

Multiagent imaging of the brain

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