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3.106 Additional value of SPECT imaging in comparison with clinical diagnosis in 248 patients with parkinsonism
S154
Wednesday, 12 December 2007
Conclusion: Taken together, these results might reflect an impaired enrollment of brain regions specifically engaged in the conflict response task in PD patients with cognitive performance yet comparable to that of age-matched controls.
3.105 Diffusion tensor tractography of the frontopontine tract in parkinsonian disorders B. Eriksson1° , D. Van Westen, J. L¨att, S. Brockstedt, K. Markenroth Block, C. Nilsson 1 Lund, Sweden Objective: In an ongoing project we explore the possibilities of diffusion tensor imaging (DTI) and tractography (DTT) for differential diagnosis and monitoring of disease progression in atypical parkinsonian disorders. Using this methodology, selective degeneration of the middle cerebellar peduncle in MSA and degeneration of the superior cerebellar peduncle in PSP has been demonstrated. The objective of the present study was to investigate the frontopontine tract (fpt) by DTT in various parkinsonian disorders and healthy controls. Method: A 3.0 Tesla Philips Intera MR scanner was used. DTI was performed of the whole brain using a single shot-EPI sequence with diffusion encoding in 48 directions. Voxel size was 2×2×2 mm. DTI was transferred to a workstation and analyzed using the PRIDE fibre tracking tool supplied by Philips Medical Systems. Scans were obtained in patients (n = 9) and healthy age-matched controls (n = 6). The fpt conveys fibres from the frontal cortex, through the anterior limb of internal capsule and ventromedial mesencephalon to the pontine nuclei. For tracking the fpt, ROIs (regions of interest) were placed in the coronal plane in the anterior limb of internal capsule and in the ventral mesencephalon. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated. Results: DTT demonstrated moderate to severe atrophy of the fpt in all patients with PSP compared to healthy controls. In advanced MSA, a less pronounced degeneration was seen. All patients with PSP had higher ADC and lower FA in the fpt, compared with patients with other parkinsonian disorders and healthy controls, although the groups were too small for statistical analysis.
Conclusion: We have developed a new sequence for DTI and DTT of the whole brain and demonstrated its use for visualizing the frontopontine tract. Early atrophy of this tract might become a valuable diagnostic tool in the diagnosis of PSP.
3.106 Additional value of SPECT imaging in comparison with clinical diagnosis in 248 patients with parkinsonism
Method: Between 2001 and 2006 248 patients with parkinsonism of unclear origin were subjected to a SPECT with the presynaptic radiotracer 123 I-ioflupane (FP-CIT) and/or postsynaptic tracer 123 I-iodobenzamide (IBZM). The initial most probable diagnosis of the neurologist was compared with the clinical diagnosis after follow-up. SPECT-results were classified as abnormal if the ratio of striatal FP-CIT and/or IBZM uptake to the occipital activity was below normal limits. Gold standard was the clinical diagnosis derived from the latest available clinical record, or, when this was not possible, new complete physical and neurological examination by a blinded movement disorder specialist. Mean follow-up was 18 months (range 3 months–5 years). Results: FP-CIT SPECT scores higher diagnostic accuracy than the initial diagnosis of the clinician in distinguishing patients with IPD from essential tremor; IPD from vascular parkinsonism and patients with IPD from drug-induced parkinsonism. The accuracy to differentiate IPD patients from those with atypical parkinsonian syndromes (APS: i.e. MSA, PSP) was as low for FP-CIT and/or IBZM SPECT as for the initial clinical view of the clinician. Conclusion: To differentiate patients with IPD from essential tremor, vascular parkinsonism and drug-induced parkinsonism the FP-CIT SPECT seems to have an additional value as compared to the initial clinical view. To differentiate patients with IPD from those with APS both SPECT scans have no additional value to the initial most probable diagnosis of the clinician.
3.107 Diagnostic accuracy of SPECT in parkinsonian syndromes: A meta-analysis A. Vlaar1° , A. Kessels, M. van Kroonenburgh, W. Weber Netherlands
1 Maastricht,
Objective: Parkinson’s disease (PD) is the second most common neurodegenerative disorder. One of the most employed techniques to diagnose PD is a Single Photon Emission Computer Tomography (SPECT) scan to visualise the integrity of the dopaminergic pathways in the brain. Despite of its widespread use, discussion remains on the value of SPECT in the differential diagnosis of PD. We performed a meta-analysis of all existing literature on the diagnostic accuracy of both pre- and post-synaptic SPECT in the differential diagnosis of PD. Method: Relevant studies were searched in Medline, EMBASE and Cochrane databases with back-searching of their reference lists. We limited our analysis to studies with a clinically relevant methodology: i.e. when they assessed the ability of the SPECT to provide differentiation between: 1. PD in an early phase vs. normalcy; 2. PD vs. essential tremor; 3. PD vs. vascular parkinsonism; 4. PD vs. atypical parkinsonian syndromes (i.e. MSA, PSP). Gold standard was clinical examination at initial visit or follow-up, and/or response to dopaminergic agents. Results: The search gave 185 hits, of which we deemed 32 suitable for our analysis. From these we recalculated the diagnostic power of SPECT for the clinical questions (see above). For the results see table 1. Mean odds ratio (95% CI)
Early PD vs normalcy PD vs essential tremor PD vs vascular parkinsonism PD vs atypical parkinsonian syndromes
Presynaptic tracer
Postsynaptic tracer
60 210 105 2
– 2 (0.5–5) 8 (2–30) 19 (9–36)
(13–277) (79–562) (32–348) (1–4)
A. Vlaar1° 1 Maastricht,
Netherlands
Objective: Single Photon Emission Computer Tomography (SPECT) is one of the most employed techniques in the differential diagnosis of idiopathic Parkinson’s disease (IPD). Despite of its widespread use, the exact diagnostic accuracy of this technique in parkinsonian syndromes remains controversial. In the present study we investigated whether SPECT has an additional value to the initial clinical diagnosis in parkinsonian patients.
Conclusion: 1. SPECT with presynaptic radiotracers is relatively accurate to differentiate patients with PD in an early phase from normalcy, and patients with PD from those with essential tremor or vascular parkinsonism. 2. The accuracy of SPECT with both presynaptic and postsynaptic tracers to differentiate between PD and atypical parkinsonian syndromes is relatively low.
Wednesday, 12 December 2007
Conclusion: Taken together, these results might reflect an impaired enrollment of brain regions specifically engaged in the conflict response task in PD patients with cognitive performance yet comparable to that of age-matched controls.
3.105 Diffusion tensor tractography of the frontopontine tract in parkinsonian disorders B. Eriksson1° , D. Van Westen, J. L¨att, S. Brockstedt, K. Markenroth Block, C. Nilsson 1 Lund, Sweden Objective: In an ongoing project we explore the possibilities of diffusion tensor imaging (DTI) and tractography (DTT) for differential diagnosis and monitoring of disease progression in atypical parkinsonian disorders. Using this methodology, selective degeneration of the middle cerebellar peduncle in MSA and degeneration of the superior cerebellar peduncle in PSP has been demonstrated. The objective of the present study was to investigate the frontopontine tract (fpt) by DTT in various parkinsonian disorders and healthy controls. Method: A 3.0 Tesla Philips Intera MR scanner was used. DTI was performed of the whole brain using a single shot-EPI sequence with diffusion encoding in 48 directions. Voxel size was 2×2×2 mm. DTI was transferred to a workstation and analyzed using the PRIDE fibre tracking tool supplied by Philips Medical Systems. Scans were obtained in patients (n = 9) and healthy age-matched controls (n = 6). The fpt conveys fibres from the frontal cortex, through the anterior limb of internal capsule and ventromedial mesencephalon to the pontine nuclei. For tracking the fpt, ROIs (regions of interest) were placed in the coronal plane in the anterior limb of internal capsule and in the ventral mesencephalon. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated. Results: DTT demonstrated moderate to severe atrophy of the fpt in all patients with PSP compared to healthy controls. In advanced MSA, a less pronounced degeneration was seen. All patients with PSP had higher ADC and lower FA in the fpt, compared with patients with other parkinsonian disorders and healthy controls, although the groups were too small for statistical analysis.
Conclusion: We have developed a new sequence for DTI and DTT of the whole brain and demonstrated its use for visualizing the frontopontine tract. Early atrophy of this tract might become a valuable diagnostic tool in the diagnosis of PSP.
3.106 Additional value of SPECT imaging in comparison with clinical diagnosis in 248 patients with parkinsonism
Method: Between 2001 and 2006 248 patients with parkinsonism of unclear origin were subjected to a SPECT with the presynaptic radiotracer 123 I-ioflupane (FP-CIT) and/or postsynaptic tracer 123 I-iodobenzamide (IBZM). The initial most probable diagnosis of the neurologist was compared with the clinical diagnosis after follow-up. SPECT-results were classified as abnormal if the ratio of striatal FP-CIT and/or IBZM uptake to the occipital activity was below normal limits. Gold standard was the clinical diagnosis derived from the latest available clinical record, or, when this was not possible, new complete physical and neurological examination by a blinded movement disorder specialist. Mean follow-up was 18 months (range 3 months–5 years). Results: FP-CIT SPECT scores higher diagnostic accuracy than the initial diagnosis of the clinician in distinguishing patients with IPD from essential tremor; IPD from vascular parkinsonism and patients with IPD from drug-induced parkinsonism. The accuracy to differentiate IPD patients from those with atypical parkinsonian syndromes (APS: i.e. MSA, PSP) was as low for FP-CIT and/or IBZM SPECT as for the initial clinical view of the clinician. Conclusion: To differentiate patients with IPD from essential tremor, vascular parkinsonism and drug-induced parkinsonism the FP-CIT SPECT seems to have an additional value as compared to the initial clinical view. To differentiate patients with IPD from those with APS both SPECT scans have no additional value to the initial most probable diagnosis of the clinician.
3.107 Diagnostic accuracy of SPECT in parkinsonian syndromes: A meta-analysis A. Vlaar1° , A. Kessels, M. van Kroonenburgh, W. Weber Netherlands
1 Maastricht,
Objective: Parkinson’s disease (PD) is the second most common neurodegenerative disorder. One of the most employed techniques to diagnose PD is a Single Photon Emission Computer Tomography (SPECT) scan to visualise the integrity of the dopaminergic pathways in the brain. Despite of its widespread use, discussion remains on the value of SPECT in the differential diagnosis of PD. We performed a meta-analysis of all existing literature on the diagnostic accuracy of both pre- and post-synaptic SPECT in the differential diagnosis of PD. Method: Relevant studies were searched in Medline, EMBASE and Cochrane databases with back-searching of their reference lists. We limited our analysis to studies with a clinically relevant methodology: i.e. when they assessed the ability of the SPECT to provide differentiation between: 1. PD in an early phase vs. normalcy; 2. PD vs. essential tremor; 3. PD vs. vascular parkinsonism; 4. PD vs. atypical parkinsonian syndromes (i.e. MSA, PSP). Gold standard was clinical examination at initial visit or follow-up, and/or response to dopaminergic agents. Results: The search gave 185 hits, of which we deemed 32 suitable for our analysis. From these we recalculated the diagnostic power of SPECT for the clinical questions (see above). For the results see table 1. Mean odds ratio (95% CI)
Early PD vs normalcy PD vs essential tremor PD vs vascular parkinsonism PD vs atypical parkinsonian syndromes
Presynaptic tracer
Postsynaptic tracer
60 210 105 2
– 2 (0.5–5) 8 (2–30) 19 (9–36)
(13–277) (79–562) (32–348) (1–4)
A. Vlaar1° 1 Maastricht,
Netherlands
Objective: Single Photon Emission Computer Tomography (SPECT) is one of the most employed techniques in the differential diagnosis of idiopathic Parkinson’s disease (IPD). Despite of its widespread use, the exact diagnostic accuracy of this technique in parkinsonian syndromes remains controversial. In the present study we investigated whether SPECT has an additional value to the initial clinical diagnosis in parkinsonian patients.
Conclusion: 1. SPECT with presynaptic radiotracers is relatively accurate to differentiate patients with PD in an early phase from normalcy, and patients with PD from those with essential tremor or vascular parkinsonism. 2. The accuracy of SPECT with both presynaptic and postsynaptic tracers to differentiate between PD and atypical parkinsonian syndromes is relatively low.