路易体病的交感神经 123I-甲碘代苄基胍指数:基于概率的诊断和识别免于晚期成像的患者。

IF 2.5 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Annals of Nuclear Medicine Pub Date : 2024-06-13 DOI:10.1007/s12149-024-01950-4
Kenichi Nakajima, Takeshi Matsumura, Junji Komatsu, Hiroshi Wakabayashi, Kenjiro Ono, Seigo Kinuya
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引用次数: 0

摘要

目的:我们的目的是在门诊环境中建立路易体疾病(LBD)(如帕金森病和痴呆)的实用诊断指标,以及免除患者晚期成像的标准:我们采集了108例连续的疑似路易体病患者的早期和晚期123I-甲碘苄基胍(MIBG)图像,并对准直器条件下的心脏与中间胸腔(H/M)比率进行了标准化。排除的病例包括年轻帕金森病患者(年龄结果:使用单一 H/M 比率变量的早期或晚期 SMILe 指数可区分枸杞多糖症与非枸杞多糖症。早期和晚期 SMILe 指数的 AUC 值分别为 0.880 和 0.894(p 0.7,代表 84% 的患者),表明无需进行晚期 MIBG 研究即可确诊:123I-MIBG衍生的SMILe指数提供了枸杞多糖症的可能性,50%阈值的指数显示了枸杞多糖症的最佳诊断准确性。指数值在 0.7 或 0.7 以下时,可准确选出不需要后期成像的患者。
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Sympathetic 123I-metaiodobenzylguanidine index for Lewy body disease: probability-based diagnosis and identifying patients exempt from late imaging

Objective

We aimed to establish a practical diagnostic index for Lewy body diseases (LBD), such as Parkinson’s disease and dementia, with Lewy bodies in outpatient settings and criteria for exempting patients from late imaging.

Methods

We acquired early and late 123I-metaiodobenzylguanidine (MIBG) images from 108 consecutive patients with suspected LBD and standardized heart-to-mediastinum (H/M) ratios for collimator conditions. Exclusions included young-onset Parkinson’s disease (age < 50 years) and genetic transthyretin-type amyloidosis. We developed logistic models incorporating H/M ratios with or without age (n = 92). The sympathetic MIBG index for LBD (SMILe index), categorized LBD likelihood from 0 (lowest) to 1 (highest). Diagnostic accuracy was assessed as the area under the receiver operating characteristic (ROC) curve (AUC). The characteristics of the new index were compared with H/M ratios. The need for late imaging was explored using the SMILe index.

Results

Early or late SMILe indexes using a single H/M ratio variable discriminated LBD from non-LBD. The AUC values for early and late SMILe indexes were 0.880 and 0.894 (p < 0.0001 for both), identical to those for early and late H/M ratios. The sensitivity and the specificity of early SMILe indexes with a 0.5 threshold were 76% and 90%, achieving accuracy of accuracy 86%. Similarly, the late SMILe index demonstrated a sensitivity of 76% and specificity of 87%, with an accuracy of 84%. Early SMILe indexes < 0.3 or > 0.7 (representing 84% patients) indicated a diagnosis without a late MIBG study.

Conclusion

The 123I-MIBG-derived SMILe indexes provide likelihood of LBD, and those with a 50% threshold demonstrated optimal diagnostic accuracy for LBD. The index values of either < 0.3 or > 0.7 accurately selected patients who do not need late imaging.

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来源期刊
Annals of Nuclear Medicine
Annals of Nuclear Medicine 医学-核医学
CiteScore
4.90
自引率
7.70%
发文量
111
审稿时长
4-8 weeks
期刊介绍: Annals of Nuclear Medicine is an official journal of the Japanese Society of Nuclear Medicine. It develops the appropriate application of radioactive substances and stable nuclides in the field of medicine. The journal promotes the exchange of ideas and information and research in nuclear medicine and includes the medical application of radionuclides and related subjects. It presents original articles, short communications, reviews and letters to the editor.
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