Diagnostic value of 123I-ioflupane and 123I-iodobenzamide SPECT scans in 248 patients with parkinsonian syndromes.

Item does not contain fulltextBACKGROUND: SPECT is one of the most employed techniques in the diagnostic workup of idiopathic Parkinson's disease (IPD). Despite its widespread use, the exact diagnostic accuracy of this technique in parkinsonian syndromes remains controversial. METHODS: In this study, we investigated the diagnostic accuracy of an initial (123)I-ioflupane (FP-CIT) and/or (123)I-iodobenzamide (IBZM) SPECT to differentiate between IPD and other parkinsonian disorders. 248 patients underwent a SPECT scan because of an as yet unclassified parkinsonian syndrome in our clinic between 2001 and 2006. Gold standard was the clinical diagnosis derived from the latest available clinical record, or, when this was not possible, a new complete physical and neurological examination by a blinded movement disorder specialist neurologist. Mean follow-up between SPECT and the latest clinical information was 18 months (range 3 months to 5 years). RESULTS: 223 of the 248 patients were clinically definitely diagnosed after follow-up: IPD 127, atypical parkinsonian syndromes (APS) 27, essential tremor (ET) 22, vascular parkinsonism (VP) 16, drug-induced parkinsonism (DIP) 5, doubt between PD and APS 2, other diseases without dopaminergic involvement 24. The mean odds ratio (95% CI) for FP-CIT SPECT's ability to distinguish between IPD and ET was 82 (11-674); between IPD and VP 61 (8-490); between IPD and DIP 36 (2-697) and between IPD and APS was 1 (0-4). The odds ratio for the IBZM SPECT tracer to differentiate between IPD and APS was 7 (2-17). CONCLUSIONS: FP-CIT SPECT is accurate to differentiate patients with IPD from those with ET, and IPD from VP and DIP. The accuracy of both FP-CIT and IBZM SPECT scans to differentiate between IPD and APS is low

ApoB versus non-HDL-cholesterol: Diagnosis and cardiovascular risk management

Item does not contain fulltextAbstract The most recent guidelines released by the EAS/ESC and the Canadian Cardiovascular Society (CCS) retain low-density lipoprotein cholesterol (LDL-C) as the primary measure of the atherogenic risk of the apolipoprotein B (apoB) lipoproteins and the primary target of LDL-C lowering therapy. Both organizations endorse non-high-density lipoprotein cholesterol (non-HDL-C) and apoB as "alternate/secondary" targets, but neither group offers evidence supporting the continued preference of LDL-C as the primary target over non-HDL-C and apoB. Further, both suggest that non-HDL-C and apoB more or less measure the same thing and, therefore, are essentially interchangeable. But what is the evidence that LDL-C should remain the primary target, and are apoB and non-HDL-C mirror images of one another? Furthermore, are estimation of risk and establishment of treatment targets the only relevant issues, or is diagnosis also an essential objective? These are the questions this article will address. Our principal objectives are: (1) to clarify the differences between LDL-C, non-HDL-C, and apoB and to distinguish what they measure; (2) to summarize the evidence relating to LDL-C, non-HDL-C, and apoB as predictors of cardiovascular risk and as targets for treatment; and (3) to demonstrate that diagnosis of atherogenic dyslipoproteinemias should be a fundamental clinical priority

The predictive value of transcranial duplex sonography for the clinical diagnosis in undiagnosed parkinsonian syndromes: comparison with SPECT scans

<p>Abstract</p> <p>Background</p> <p>Transcranial duplex sonography (TCD) of the substantia nigra has emerged as a promising, non-invasive tool to diagnose idiopathic Parkinson's disease (IPD). However, its diagnostic accuracy in patients with undefined parkinsonism remains to be determined.</p> <p>In this study we determined the predictive value of TCD for the clinical diagnosis in undiagnosed parkinsonian syndromes. Additionally we compared the predictive value of TCD with that of presynaptic and postsynaptic single photon emission computer tomography (SPECT) scans.</p> <p>Methods</p> <p>We studied 82 patients with an unclassified parkinsonian syndrome. All 82 patients were subjected to a TCD, 59 of them underwent a presynaptic SPECT scans and 32 underwent a postsynaptic SPECT scan.</p> <p>We determined the diagnostic accuracy of TCD and SPECT scans in differentiating:</p> <p>1) IPD patients from patients without nigrostriatal degeneration and 2) IPD patients from patients with atypical parkinsonian syndromes (APS).</p> <p>To compare the diagnostic accuracy of TCD and SPECT scans, we used the clinical diagnosis after follow-up according to generally accepted clinical criteria as the gold standard. This clinical diagnosis was determined by a movement disorder specialist.</p> <p>3) Finally, we ascertained the predictive value of the TCD for the SPECT result.</p> <p>Results</p> <p>The clinical diagnoses after follow-up resulted in 51 cases of IPD, 7 patients with APS and 17 patients without nigrostriatal degeneration. In total 7 patients remained undiagnosed.</p> <p>1) The accuracy of TCD, assessed by sensitivity and specificity, to differentiate IPD patients from patients without nigrostriatal degeneration was 50% and 82% respectively.</p> <p>For the presynaptic SPECT scans sensitivity was 97% and specificity 100%.</p> <p>2) In differentiating IPD patients from APS patients, the sensitivity and specificity of TCD was 50% and 43% respectively. For presynaptic SPECT scans this was 97% and 0%. For the postsynaptic SPECT scans the sensitivity was 75% and the specificity 81%.</p> <p>3) The positive predictive value (PPV) of an abnormal TCD for an abnormal presynaptic SPECT scan was 88%.</p> <p>Conclusion</p> <p>Presynaptic SPECT scanning has a higher predictive value for the clinical diagnosis than TCD. However, since the PPV of an abnormal TCD for parkinsonism with nigrostriatal degeneration is high, TCD might be used as screening tool, before ordering a presynaptic SPECT.</p