Parkinson's disease is overdiagnosed clinically at baseline in diagnostically uncertain cases: A 3‐year European multicenter study with repeat [<sup>123</sup>I]FP‐CIT SPECT

Marshall, Vicky; Reininger, Cornelia; Marquardt, Moritz; Patterson, J.; Hadley, Donald M.; Oertel, Wolfgang H.; Benamer, Hani Ts; Kemp, P. M.; Burn, David J.; Tolosa, Eduardo; Kulisevsky, J; Cunha, Luı́s; Costa, Durval C.; Booij, Jan; Tatsch, Klaus; Chaudhuri, K. Ray; Ulm, G.; Pogarell, Oliver; Höffken, H.; Gerstner, A.; Grosset, Donald G.

doi:10.1002/mds.22108

Cited by 192 publications

(146 citation statements)

References 27 publications

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“…A similar conclusion was reached by investigators participating in a European multicenter, prospective, longitudinal study in which clinical diagnosis was compared with 123 I-FP-CIT SPECT findings (38). Serial observations were performed over 3 y on patients in whom there was initial diagnostic uncertainty between degenerative parkinsonism and a benign tremor disorder.…”

Section: Imaging Presynaptic Dopaminergic Function In Pdmentioning

confidence: 74%

Imaging Approaches to Parkinson Disease

Brooks¹

2010

J Nucl Med

190

109

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Parkinson disease (PD) is associated with nigral degeneration and striatal dopamine deficiency. Demonstrating midbrain structural abnormalities with transcranial sonography or diffusionweighted MRI or showing striatal dopamine terminal dysfunction with PET or SPECT supports the diagnosis and rationalizes the use of dopaminergic medications. In atypical PD variants, transcranial sonography can detect striatal hyperechogenicity, and diffusion-weighted imaging can detect increased putamen water diffusion, whereas 18 F-FDG PET reveals reduced lentiform nucleus glucose metabolism. PET and SPECT can detect changes in striatal dopamine levels after levodopa administration and relate these to motor responses. Loss of cortical dopaminergic and cholinergic function is present in demented PD and, on occasion, amyloid deposits can be detected. Loss of cardiac sympathetic innervation can be sensitively detected in PD with 18 F-dopamine PET or 123 I-metaiodobenzylguanidine SPECT. Finally, PET can detect widespread brain inflammation in PD. This review discusses the role of structural and functional imaging for diagnosing and managing different parkinsonian syndromes.

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Section: Imaging Presynaptic Dopaminergic Function In Pdmentioning

confidence: 74%

Imaging Approaches to Parkinson Disease

Brooks¹

2010

J Nucl Med

190

109

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“…lack of specificity of signs and symptoms in the early stages of the disease (1,2). In some clinical situations, definitive diagnosis is only possible through postmortem neuropathology, and all in-life diagnoses are probable.…”

mentioning

confidence: 99%

Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using ¹²³I-Ioflupane Injection (DaTscan) Imaging

et al. 2014

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Establishing an early, accurate diagnosis is fundamental for appropriate clinical management of patients with movement disorders or dementia. Ioflupane 123 I Injection (DaTscan, 123 I-ioflupane) is an important adjunct to support the clinical diagnosis. Understanding individualreader diagnostic performance of 123 I-ioflupane in a variety of clinical scenarios is essential. Methods: Sensitivity, specificity, interreader, and intrareader data from 5 multicenter clinical studies were reviewed. The different study designs offered an assortment of variables to assess the effects on the diagnostic performance of 123 I-ioflupane: on-site versus 3-5 blinded image readers, number of image evaluations, early/uncertain versus late/confirmed clinical diagnosis as reference standard, and subjects with movement disorders versus dementia. Results: Eight hundred eighteen subjects had individualreader efficacy data available for analysis. In general, sensitivity and specificity were high and comparable between on-site versus blinded independent readers. In subjects with dementia, when the clinical diagnosis was made at month 12 versus baseline, specificity improved from 77.4%-91.2% to 81.6%-95.0%. In subjects with movement disorders, this effect was observed to an even greater extent, when diagnostic performance using month-18 diagnosis as a reference standard (sensitivity, 67.0%-73.7%; specificity, 75.0%-83.3%) was compared versus month-36 diagnosis (77.5%-80.3% and 90.3%-96.8%, respectively). Diagnostic performance was similar in subjects with dementia (74.4%-89.9% and 77.4%-95.0%, respectively) and subjects with movement disorders (67.0%-97.9% and 71.4%-98.4%, respectively). In most of the comparisons, betweenreader agreement was very good (almost perfect), with κ ranging from 0.81 to 1.00. Within-reader agreement, measured in 1 study, was 100% for 3 blinded readers. Conclusion: Individual-reader diagnostic performance, as assessed by measuring sensitivity and specificity of 123 I-ioflupane to detect the presence or absence of striatal dopaminergic deficit, using the clinical diagnosis as a reference standard, was high in subjects with either movement disorders or dementia and was similar in on-site readers versus blinded analyses. Between-and within-reader agreements were very good (almost perfect). Longer follow-up between imaging and clinical diagnosis improved the diagnostic accuracy, most likely due to improvement in the clinical diagnosis reference standard, rather than changes in reader accuracy.

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“…Other studies are also reported a high interobserver agreement for visual analysis when using only a dichotomous division of normal versus abnormal SPECT images [22,23]. All of the patients with the clinical diagnosis of PS were visually classified as abnormal by both observers, therefore none of our patients could be considered as so-called SWEDD (Scans Without Evidence of Dopaminergic Deficit) patient; a small specific entity of patients clinically diagnosed with Parkinson's disease but having normal DAT imaging [22].…”

Section: Discussionmentioning

confidence: 68%

Validation of an automated morphological MRI-based 123I-FP-CIT SPECT evaluation method

Perlaki¹,

Szekeres

Orsi³

et al. 2016

Parkinsonism & Related Disorders

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Parkinson's disease is overdiagnosed clinically at baseline in diagnostically uncertain cases: A 3‐year European multicenter study with repeat [¹²³I]FP‐CIT SPECT

Cited by 192 publications

References 27 publications

Imaging Approaches to Parkinson Disease

Imaging Approaches to Parkinson Disease

Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using ¹²³I-Ioflupane Injection (DaTscan) Imaging

Validation of an automated morphological MRI-based 123I-FP-CIT SPECT evaluation method

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Parkinson's disease is overdiagnosed clinically at baseline in diagnostically uncertain cases: A 3‐year European multicenter study with repeat [123I]FP‐CIT SPECT

Cited by 192 publications

References 27 publications

Imaging Approaches to Parkinson Disease

Imaging Approaches to Parkinson Disease

Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using 123I-Ioflupane Injection (DaTscan) Imaging

Validation of an automated morphological MRI-based 123I-FP-CIT SPECT evaluation method

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Product

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Parkinson's disease is overdiagnosed clinically at baseline in diagnostically uncertain cases: A 3‐year European multicenter study with repeat [¹²³I]FP‐CIT SPECT

Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using ¹²³I-Ioflupane Injection (DaTscan) Imaging