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Abstract：
BACKGROUND: Multiple system atrophy (MSA) is a neurodegenerative disease. It has a fast progression, so early diagnosis is decisive. Two functional imaging tests can be involved in its diagnosis: [123I]Ioflupane SPECT and [123I]MIBG scintigraphy. Our aim is to comparatively analyze the diagnostic performance of both techniques.
METHODS: 46 patients (24 males and 22 females) with MSA underwent [123I]Ioflupane SPECT and [123I]MIBG scintigraphy. In each of these techniques, qualitative assessment was compared with quantitative assessment.
RESULTS: SPECT visual assessment was positive in 93.5% of subjects (S = 95.24%; PPV = 93.02%). A cut-off of 1.363 was established for overall S/O index (S = 85.7%, E = 100%). Visual assessment of scintigraphy was positive in 73.1% (S = 78.57%, PPV = 94.29%). For the delayed heart/medistinum ratio (HMR) a cut-off of 1.43 (S = 85.3, E = 100%) was obtained. For each unit increase in delayed HMR, the suspicion of MSA increased by 1.58 (OR = 1.58, p < 0.05). The quantitative assessment showed an association with the visual assessment for each technique (p < 0.05).
CONCLUSIONS: Both tests are useful in MSA diagnosis. Comparatively, we did not observe a clear superiority of either. Striatal and myocardial deterioration do not evolve in parallel. Qualitative assessment is crucial in both techniques, together with the support of quantitative analysis. Delayed HMR shows a direct relationship with the risk of MSA.
METHODS: 46 patients (24 males and 22 females) with MSA underwent [123I]Ioflupane SPECT and [123I]MIBG scintigraphy. In each of these techniques, qualitative assessment was compared with quantitative assessment.
RESULTS: SPECT visual assessment was positive in 93.5% of subjects (S = 95.24%; PPV = 93.02%). A cut-off of 1.363 was established for overall S/O index (S = 85.7%, E = 100%). Visual assessment of scintigraphy was positive in 73.1% (S = 78.57%, PPV = 94.29%). For the delayed heart/medistinum ratio (HMR) a cut-off of 1.43 (S = 85.3, E = 100%) was obtained. For each unit increase in delayed HMR, the suspicion of MSA increased by 1.58 (OR = 1.58, p < 0.05). The quantitative assessment showed an association with the visual assessment for each technique (p < 0.05).
CONCLUSIONS: Both tests are useful in MSA diagnosis. Comparatively, we did not observe a clear superiority of either. Striatal and myocardial deterioration do not evolve in parallel. Qualitative assessment is crucial in both techniques, together with the support of quantitative analysis. Delayed HMR shows a direct relationship with the risk of MSA.
摘要：
背景：多系统萎缩（MSA）是一种神经退行性疾病。它有一个快速的进展，所以早期诊断是决定性的。两种功能影像学检查可用于其诊断：[123I]碘氟烷SPECT和[123I]MIBG闪烁显像。我们的目的是比较分析这两种技术的诊断性能。
方法：46例MSA患者（男24例，女22例）接受了[123I]碘氟平SPECT和[123I]MIBG闪烁显像。在这些技术中，定性评估与定量评估进行了比较。
结果：93.5%的受试者SPECT视觉评估为阳性（S=95.24%；PPV=93.02%）。总体S/O指数的截止值为1.363(S=85.7%，E=100%)。闪烁显像的视觉评估为阳性的73.1％（S=78.57％，PPV=94.29%)。对于延迟的心脏/medstinum比率（HMR），获得了1.43的截止值（S=85.3，E=100％）。对于延迟HMR的每个单位增加，MSA的怀疑增加了1.58（OR=1.58，p<0.05）。定量评估显示每种技术与视觉评估相关(p<0.05)。
结论：这两种测试都可用于MSA诊断。相对而言,我们没有观察到两者的明显优势。纹状体和心肌恶化不平行发展。定性评估在这两种技术中都至关重要，在定量分析的支持下。延迟HMR与MSA风险有直接关系。
方法：46例MSA患者（男24例，女22例）接受了[123I]碘氟平SPECT和[123I]MIBG闪烁显像。在这些技术中，定性评估与定量评估进行了比较。
结果：93.5%的受试者SPECT视觉评估为阳性（S=95.24%；PPV=93.02%）。总体S/O指数的截止值为1.363(S=85.7%，E=100%)。闪烁显像的视觉评估为阳性的73.1％（S=78.57％，PPV=94.29%)。对于延迟的心脏/medstinum比率（HMR），获得了1.43的截止值（S=85.3，E=100％）。对于延迟HMR的每个单位增加，MSA的怀疑增加了1.58（OR=1.58，p<0.05）。定量评估显示每种技术与视觉评估相关(p<0.05)。
结论：这两种测试都可用于MSA诊断。相对而言,我们没有观察到两者的明显优势。纹状体和心肌恶化不平行发展。定性评估在这两种技术中都至关重要，在定量分析的支持下。延迟HMR与MSA风险有直接关系。
