背景:多系统萎缩(MSA)是一种快速进展的神经退行性疾病,没有治愈性治疗。诊断基于Gilman(1998年和2008年)建立的一组标准,最近由Wenning(2022年)更新。我们的目标是确定[123I]碘氟平SPECT在MSA中的有效性,特别是在最初的临床怀疑。
方法:对最初临床怀疑MSA的患者进行的横断面研究,参考[123I]碘氟平SPECT。
结果:总体而言,139名患者(68名男性,包括71名妇女),104可能是MSA,35可能是MSA。MRI正常89.2%,SPECT阳性占78.45%。SPECT显示高敏感性(82.46%)和阳性预测值(86.24),在MSA-P中达到最大灵敏度(97.26%)。在健康-患病和不确定-患病组中的两种SPECT评估相关时,发现显着差异。我们还发现,当将SPECT与亚型(MSA-C或MSA-P)相关联时,以及帕金森症状的存在。检测到纹状体受累的侧化(左侧)。
结论:[123I]碘氟平SPECT是诊断MSA的有用且可靠的工具,具有良好的有效性和准确性。定性评估在区分健康-患病类别时显示出明显的优势,以及最初临床怀疑时的帕金森病(MSA-P)和小脑(MSA-C)亚型之间。
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.