The Utility of the Combined Use of ¹²³I-FP-CIT and ¹²³I-MIBG Myocardial Scintigraphy in Differentiating Parkinson’s Disease from Other Parkinsonian Syndromes

Abstract

Background 123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and 123 I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) provide specific information that distinguish Parkinson's disease (PD) from parkinsonian syndromes other than PD (non-PD), including atypical parkinsonian disorder (APD) and non-PD other than APD (nPD-nAPD). The purpose of this study was to determine whether combining DAT-SPECT and MIBG myocardial scintigraphy using multiparametric scoring system (MSS) could improve diagnostic test accuracy in discriminating PD from APD or discriminating PD from nPD-nAPD. Methods A total of 52 patients, including 36 PD, eight APD and eight nPD-nAPD, underwent both MIBG myocardial scintigraphy and DAT-SPECT, were evaluated. The heart-to-mediastinum (H/M) ratios (early and delayed), washout-rate (WR), the average (Ave) and asymmetry index (AI) of specific binding ratio (SBR) were calculated. Cutoff values were determined, using ROC analysis, for discriminating PD from APD and for discriminating PD from nPD-nAPD, on five parameters. All cases were scored as either 1 (PD) or 0 (nPD-nAPD or APD) for each parameter according to its threshold in each discrimination. These individual scores were summed for each case, yielding a combined score to obtain a cutoff value for the MSS in each discrimination. Results For discriminating PD from nPD-nAPD, the highest accuracy was 80% at a cutoff value of 19% for the WR and a cut off value of 2 improved diagnostic accuracy to 84% for MSS. For discriminating PD from APD, the highest accuracy was 86% at a cutoff value of 2.8 for the H/M ratio (late) and a cut off value of 2 showed diagnostic accuracy of 86% for MSS. Conclusion A MSS has comparable or better accuracy compared to each parameter of MIBG myocardial scintigraphy and DAT-SPECT in distinguishing PD from nPD-nAPD or distinguishing PD from APD.

A diagnostic strategy for Parkinsonian syndromes using quantitative indices of DAT SPECT and MIBG scintigraphy: an investigation using the classification and regression tree analysis

“…In patients with PD, the uptake of the posterior striatum deteriorated, and the myocardial sympathetic function was abnormal; the PCR and H/M (Delay) indices could be used to interpret these findings. Although the AI index was expected to be useful in differentiating patients with PD [ 4 , 23 ], our analysis did not show that the AI index played a significant role in diagnosing patients with PD, probably because the left-right differences became less noticeable as the symptoms progressed in some PD patients or those with other PS who also had left-right differences to a certain extent (Fig. 3f ).…”

“…To our knowledge, this study is the first to use the CART analysis for comparing the six types of indices from DAT SPECT and MIBG scintigraphy. Although several studies have evaluated the utility of the combined use of DAT SPECT and MIBG scintigraphy [ 23 , 29 – 33 ], no study has applied the six quantitative indices in differentiating patients with NPS, PD, DLB, PSP, and MSA. Some patients included in this study overlapped with those included in our previous study [ 6 ].…”

MRI multiparametric scoring system for pial blood supply of intracranial meningiomas

“…This scoring system can potentially offset an incorrect classification based on any single parameter and is expected to be a more useful indicator than any single parameter. [20][21][22] Thus, the objective of this study was to perform a retrospective study of patients with meningiomas to determine whether conventional MRI using MSS is a useful way to predict PBS.…”