Tc-99m ethylene cysteinate dimer SPECT in the differential diagnosis of parkinsonism.

Positron emission tomography (PET) and network analysis have been used to identify a reproducible pattern of regional metabolic covariation that is associated with idiopathic Parkinson's disease (PD). The activity of this PD-related pattern can be quantified in individual subjects and used to discriminate PD patients from atypical parkinsonians. Because PET is not commonly available, we sought to determine whether similar discrimination could be achieved using more routine single photon emission computed tomography (SPECT) perfusion methods. Twenty-three subjects with PD (age, 63 +/- 9 years), 22 subjects with multiple system atrophy (MSA; age, 64 +/- 7 years), and 20 age-matched healthy controls (age, 62 +/- 13 years) underwent SPECT imaging of regional cerebral perfusion with Tc-99m ethylene cysteinate dimer (ECD). Using network analysis, we determined whether a PD-related pattern existed in the SPECT data, and whether its expression discriminated PD from MSA patients. Additionally, we compared the accuracy of group discrimination achieved by this pattern with that of the PET-derived PD-related pattern applied to the SPECT data. Network analysis of the SPECT data identified a significant pattern characterized by relative increases in cerebellar, lentiform, and thalamic perfusion covarying with decrements in the frontal operculum and in the medial temporal cortex. Subject scores for this pattern discriminated PD patients from controls (P < 0.01) and from MSA patients (P < 0.03). Subject scores for the PET-derived PD-related pattern computed in the individual SPECT scans more accurately distinguished PD patients from controls (P < 0.005) and from MSA patients (P = 0.0002). A significant PD-related covariance pattern can be identified in SPECT perfusion data. Moreover, the disease related pattern identified previously with PET can be applied to individual SPECT perfusion scans to provide group discrimination between PD patients, healthy controls, and individuals with MSA. Because of significant individual subject overlap between groups, however, the clinical utility of this method in the differential diagnosis of Parkinsonism remains uncertain.     

Potential of advanced MR imaging techniques in the differential diagnosis of parkinsonism

The clinical differentiation of parkinsonian syndromes remains challenging not only for neurologists but also for movement disorder specialists. Conventional magnetic resonance imaging (cMRI) with the visual assessment of T2‐ and T1‐weighted imaging as well as different advanced MRI techniques offer objective measures, which may be a useful tool in the diagnostic work‐up of Parkinson's disease and atypical parkinsonian disorders (APDs). In clinical practice, cMRI is a well‐established method for the exclusion of symptomatic parkinsonism due to other pathologies. Over the past two decades, abnormalities in the basal ganglia and infratentorial structures have been shown especially in APDs not only by cMRI but also by different advanced MRI techniques, including methods to assess regional cerebral atrophy quantitatively such as magnetic resonance volumetry, proton magnetic resonance spectroscopy, diffusion‐weighted imaging, and magnetization transfer imaging. This article aims to review recent research findings on the role of advanced MRI techniques in the differential diagnosis of neurodegenerative parkinsonian disorders. © 2009 Movement Disorder Society     

The differential diagnosis of Parkinson's disease

The diagnosis of Parkinson's disease continues to be challenging with misdiagnosis rates as high as 20–30% in early stages. Such diagnostic inaccuracy is largely due to failure to recognize atypical parkinsonian disorders including multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and dementia with Lewy bodies (DLB). These disorders are characterized by distinctive sets of atypical features that have been incorporated into recent consensus diagnostic criteria. Early diagnosis of atypical parkinsonian disorders is important not only because of prognostic implications, but also because of variable therapeutic targets such as autonomic failure, apraxia or dementia.     

药源性帕金森综合征的临床分型及特征

目的 探讨药源性帕金森综合征(Drug-induced parkinsonism, DIP)的临床分型及临床表现。方法 分析2017年1月-2018年12月于本院收集的29例DIP患者,根据停用致病药物1年后病情恢复程度不同将DIP患者分为可逆性DIP(Reversible DIP, rDIP)和持续性DIP(Persistent DIP, pDIP),分析两者临床特征。结果 2组患者均以老年患者为主,女性多见;2组在症状出现前服用致病药物时间、就诊时症状已持续时间、致病药物构成均也无明显差异;同时分别在就诊时和停药1年后对rDIP组患者与pDIP组患者行MDS-UPDRS评分显示,2组症状好转率和左右侧肢体不对称指数均有显著性差异(P<0.05),而2组在上肢症状分数和占比、下肢症状分数和占比、非运动症状等方面均无显著性差异(P>0.05)。结论 rDIP和pDIP组患者的临床特征和预后存在差异,左右侧肢体症状不对称指数有助于鉴别两者。     

X线摄片在脑部疾病诊断中的应用

目的:探讨X线摄片技术在脑部疾病诊断和鉴别诊断中的应用价值。方法:报道1年内我科住院患者中见到的4例较典型病例,依赖CT和MRI误诊神经系统疾病。结果:4例病人分别诊断为面肌痉挛脑梗塞的paget′s病例,初诊意识障碍原因待诊-代谢性脑病?脑干梗死?的多发性骨髓瘤病例;诊断帕金森病的股骨颈骨折病例;诊断脑梗死的肺癌病例。结论:CT和MRI决不能替代以症状和体征为基础的临床诊断学,X线摄片技术在脑部疾病诊断和鉴别诊断仍具有重要价值。     

Transcranial duplex in the differential diagnosis of parkinsonian syndromes

Background   Transcranial duplex scanning (TCD) of the substantia nigra (SN) is increasingly used to diagnose Idiopathic Parkinson’s Disease (IPD). Up until now 70 diagnostic studies have been published, not only on investigation of the SN, but also of the lenticular nucleus (LN) and the Raphe nuclei (RN). Method   We systematically reviewed all diagnostic TCD studies in parkinsonian patients up to June 2008. Results   We found 35 eligible studies. Of the 1534 IPD patients investigated in the 35 studies 200 (13 %) had an inconclusive SN-TCD. An increased echo-intensity of the SN was seen in 1167 (87 %) of the 1334 IPD patients, 276 (12 %) of the 2340 healthy controls and in 41 (30 %) of the 138 patients with an atypical parkinsonian syndrome (APS). On the contrary, a pathological LNTCD was found more often in APS patients (79 %) than in IPD patients (23 %) and healthy controls (6 %). A decreased echo-intensity of the RN was found more often in depressed (46 %) than in non-depressed IPD patients (16 %). Conclusions   SN-TCD accurately differentiates between patients with IPD and healthy controls, but not between patients with IPD and APS. LN-TCD is only moderate accurate to delineate IPD from APS, but combinations of SN- and LN-TCD may be more promising. RN-TCD has only marginal diagnostic accuracy in diagnosing depression in IPD and non-IPD patients. Before TCD can be implicated, more research is needed to standardize the TCD technique, to investigate the TCD in non-research settings and to determine the additional value of TCD compared with currently used clinical techniques like SPECT imaging.     

影像组学在脑肿瘤鉴别诊断的研究进展

影像组学(Radiomics)通过从不同模态的医学影像中提取高通量特征并加以数据挖掘,定量分析隐含在医学图像背后的人体分子与基因变化,可以解决肿瘤异质性的问题,可用于肿瘤鉴别诊断、分子分型、治疗方案选择、疗效检测和预后评估等方面,辅助实现精准诊疗决策。但影像组学存在可解释性较差、重复性较低等不足,尚未在临床应用。近几年影像组学在神经外科领域的研究日新月异,特别是在脑肿瘤鉴别诊断等方面的研究已经取得很大进展。现就其在脑肿瘤鉴别诊断的研究进展做一综述。     

磁共振波谱在脑内肿瘤鉴别诊断中的价值研究

目的探讨磁共振波谱（MRS）在脑内肿瘤鉴别诊断中的应用价值。方法收集75例颅内占位性病变患者术前行磁共振波谱检查的临床资料,对其经临床手术、病理诊断证实的最终结果进行分析。结果MRS提示肿瘤72例,病理证实70例;脑脓肿1例,病理证实1例;MRS提示囊性占位2例。胶质瘤的MRS表现为NAA明显降低或降低,Cho升高,肿瘤周围脑组织呈类似改变;脑膜瘤的MRS表现为NAA消失或降低,Cho升高或明显升高,Cr信号降低,可见到Ala峰,肿瘤周围脑组织相对正常;转移瘤的MRS表现为Cho明显升高,NAA明显降低,而瘤旁脑组织MRS波形基本正常;淋巴瘤的MRS表现为肿瘤区域NAA降低,Cho升高或明显升高,并可见到Lip峰。结论MRS作为无创性的检测手段,对脑内肿瘤的鉴别诊断有较大的参考价值。     

小脓肿型脑囊虫与脑内小脓肿的鉴别

目的:研究小脓肿型脑囊虫的临床、计算机体层摄影(CT)特点及与脑内小脓肿的鉴别。方法:采用回顾性研究手段,对10年间手术证实的14例小脓肿型脑囊虫和16例脑内小脓肿进行了对比分析。结果:小脓肿型脑囊虫病人无高颅压和神经功能缺失症状。而小脓肿病人有3例出现了高颅压或神经功能缺失症状。小脓肿型脑囊虫的CT表现为规则的环形强化灶,小于或等于15mm,灶周水肿较轻,脑室形态正常,中线结构无移位。而小脓肿多为不规则的环形强化灶,多数大于或等于10mm,灶周水肿明显,少数病人脑室受压变形,中线结构移位。结论:小脓肿型脑囊虫和脑内小脓肿的临床表现和CT特征有所不同,认识其特点有利于正确诊断和选择治疗方案。     

Accuracy of the clinical diagnosis of postencephalitic parkinsonism: a clinicopathologic study

The accuracy of the clinical diagnosis of postencephalitic parkinsonism (PEP) is unknown. We determined the validity of the clinical diagnosis of PEP by presenting 105 records with neuropathologic diagnosis of PEP ( n = 7), progressive supranuclear palsy ( n = 24), Parkinson's disease ( n = 15), dementia with Lewy bodies ( n = 14), multiple system atrophy ( n = 16), corticobasal degeneration ( n = 10), Creutzfeldt—Jakob disease ( n = 4), and other dementia disorders ( n = 15), as clinical vignettes to six neurologists unaware of the autopsy findings. The neurologists' own clinical diagnoses were compared with neuropathologic diagnoses for measures of diagnostic accuracy, including reliability (k statistics), sensitivity and positive predictive values for the first and last visits. The group reliability for the diagnosis of PEP was almost perfect ( k = 0.91, 0.9). The mean sensitivity at the first visit was 86% (range, 71–100%) with minimal change at the last visit (83%; range, 71–100%). Positive predictive values remained unchanged (100%). The high reliability, sensitivity and positive predictive values of the clinical diagnosis of PEP indicate that neurologists identify this disorder even when they report that they have never evaluated a case. In our data set, the best predictors for the diagnosis of PEP included onset below middle age; symptom duration lasting more than 10 years, and the presence of oculogyric crisis. History of encephalitis lethargica, present in most PEP cases, was an important individual diagnostic predictor.     

MIBG scintigraphy in differential diagnosis of Parkinsonism: a meta-analysis

Objective  

Differential diagnosis between Parkinson’s disease (PD) and other Parkinsonism using clinical criteria or imaging methods is often difficult. The purpose of this study is to systematically review and meta-analyze published data about the diagnostic performance of myocardial innervation imaging using ¹²³I-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between PD and other Parkinsonism.     

甲基苯丙胺类毒品与帕金森综合征的关系及文献复习（附3例报道）

目的探讨甲基苯丙胺类毒品与帕金森病综合征的关系。方法报道3例与吸食甲基苯丙胺类毒品相关的帕金森综合征患者的临床资料,并复习相关文献进行分析。结果3例患者的病史特征为：年龄均不足50岁;慢性起病,逐渐进展;均长期吸食含有甲基苯丙胺的毒品（冰毒、摇头丸、麻古等）;临床症状和体征主要表现为少动一强直综合征,伴有轻微的震颤;头颅MRI均未见明确能导致继发性帕金森综合征的责任病灶;parkin基因检测均未见突变;病例1和病例3的PET/CT显像示两侧多巴胺转运体（DAT）功能均降低,且不对称。结论3例帕金森综合征的发生可能与吸食含有甲基苯丙胺的毒品有关,吸食甲基苯丙胺类毒品增加罹患帕金森综合征的风险。     

Multivariate spatial covariance analysis of 99mTc-exametazime SPECT images in dementia with Lewy bodies and Alzheimer's disease: utility in differential diagnosis

We examined ^99mTc-exametazime brain blood flow single-photon emission computed tomography (SPECT) images using a spatial covariance analysis (SCA) approach to assess its diagnostic value in distinguishing dementia with Lewy bodies (DLB) from Alzheimer''s disease (AD). Voxel SCA was simultaneously applied to a set of preprocessed images (AD, n=40; DLB, n=26), generating a series of eigenimages representing common intercorrelated voxels in AD and DLB. Linear regression derived a spatial covariance pattern (SCP) that discriminated DLB from AD. To investigate the diagnostic value of the model SCP, the SCP was validated by applying it to a second, independent, AD and DLB cohort (AD, n=34; DLB, n=29). Mean SCP expressions differed between AD and DLB (F_1,64=36.2, P<0.001) with good diagnostic accuracy (receiver operating characteristic (ROC) curve area 0.87, sensitivity 81%, specificity 88%). Forward application of the model SCP to the independent cohort revealed similar differences between groups (F_1,61=38.4, P<0.001), also with good diagnostic accuracy (ROC 0.86, sensitivity 80%, specificity 80%). Multivariate analysis of blood flow SPECT data appears to be robust and shows good diagnostic accuracy in two independent cohorts for distinguishing DLB from AD.     

CT in the differential diagnosis between Alzheimer''s disease and vascular dementia

A prospective series of consecutively admitted patients with Alzheimer's disease (AD) (n = 68), multi-infarct dementia (MID) (n = 79) and probable vascular dementia (PVD) (n = 46) were studied by CT of the head. In MID 88.6% and in PVD 41.3% of the patients had at least one brain infarct on CT, but only one patient (1.5%) with AD. White matter low attenuation (WMLA) also differentiated MID and PVD from AD, especially among patients aged 75 years or less, and with mild or moderate dementia. In all types, brain atrophy on CT had a positive correlation with the degree of dementia. Infarcts and WMLA on CT, but not brain atrophy seem to be of differential diagnostic value between vascular and degenerative dementia.     

Significance of ambulatory electroencephalography for differential diagnosis of epilepsy and syncope★

BACKGROUND： Twenty-four hour ambulatory electroencephatography （AEEG） provides advantages for continuous electroencephalogram, monitoring brief loss of consciousness complicated by suspect or mild limb spasm. OBJECTIVE： To explore the significance of AEEG for differentially diagnosing epilepsy and syncope, compared to EEG. DESIGN, TIME AND SETTING： Sixty patients with brief loss of consciousness, complicated by suspect or mild limb spasm, were selected from Suqian People＇s Hospital between January 2006 and June 2007. PARTICIPANTS： Sixty participants comprised 34 males and 26 females, aged 13-64 years. According to clinical symptoms prior to the study, 36 patients were initially diagnosed with epilepsy and 24 with syncope. METHODS AND MAIN OUTCOME MEASURES： Abnormalities and epileptiform discharge were detected using EEG and AEEG, and the diagnostic value of the two methods for epilepsy and syncope was compared. RESULTS： A total of sixty patients were included in the final analysis. Abnormal AEEGs were observed in 37 cases （62%） and epileptiform discharge AEEGs in 23 cases （38%）, both of which were significantly greater than EEGs [37% （22/60）, 18% （11/60）, respectively, P 〈 0.01, 0.05]. The detection rate of abnormal AEEG and epileptiform discharge in the epilepsy group [75% （27/36）, 47% （17/36）, respectively was significantly greater than in the syncope group [42% （10/24）, 25% （6/24）, respectively, P 〈 0.01, 0.05]. CONCLUSION： AEEG can improve detection probability of epileptiform discharge and exhibits significant differences in the differential diagnosis of epilepsy and syncope.     

Parkinsonism with multiple cysts in the bilateral striata

The present paper reports on a 68‐year‐old man with a 10‐year history of parkinsonism who developed hallucinations and delusions after admission to an intensive care unit for the treatment of organophosphate intoxication. His initial diagnosis was delirium. On the basis of brain computed tomography findings and clinical symptoms, we diagnosed drug‐induced psychosis in parkinsonism with multiple cysts in the bilateral striata.     

Atypical antipsychotic use and risk of fracture in persons with Parkinsonism

Our objective was to estimate the effect of atypical antipsychotics (AAs) on the rate of fractures in a parkinsonism population. We conducted an age‐ and state‐matched nested case‐control study in five states (CA, FL, NY, OH, IL) using the Medicaid analytic extract from 2001 to 2002. Eligible participants had a diagnosis of parkinsonism, excluding persons with secondary parkinsonism, bone cancer, bone infections, schizophrenia, schizoaffective disorder, and those who used conventional antipsychotics. The primary outcome was the occurrence of a fracture of the femur, ankle, fibula, tibia, humerus, radius, or ulna (N = 851). Risk‐set sampling defined controls (N = 4220). We used conditional‐logistic regression to derive adjusted odds ratios (AOR) and 95% confidence intervals of the association between fracture and use of quetiapine, risperidone, or olanzapine in the 60 days before the index date compared to nonuse. After adjustment for confounding, use of quetiapine (AOR 2.4; 95% CI 1.5–3.8), risperidone (AOR 1.2; 95% CI 0.9–1.7), or olanzapine (AOR 1.7; 95% CI 1.2–2.4) was associated with a higher rate of fracture. Use of an AA was associated with a higher rate of fracture in persons with parkinsonism. Prescribers must be cautious when using these agents in elderly persons with parkinsonism. © 2009 Movement Disorder Society     

Role of DAT‐SPECT in the diagnostic work up of Parkinsonism

The diagnosis of idiopathic Parkinson's disease (PD) can be achieved with high degrees of accuracy in cases with full expression of classical clinical features. However, diagnostic uncertainty remains in early disease with subtle or ambiguous signs. Functional imaging has been suggested to increase the diagnostic yield in parkinsonian syndromes with uncertain clinical classification. Loss of striatal dopamine nerve terminal function, a hallmark of neurodegenerative Parkinsonism, is strongly related to decreases of dopamine transporter (DAT) density, which can be measured by single photon emission computed tomography (SPECT). The use of DAT‐SPECT facilitates the differential diagnosis in patients with isolated tremor symptoms not fulfilling PD or essential tremor criteria, drug‐induced, psychogenic and vascular Parkinsonism as well as dementia when associated with Parkinsonism. This review addresses the value of DAT‐SPECT in early differential diagnosis, and its potential as a screening tool for subjects at risk of developing PD as well as issues around the assessment of disease progression. © 2007 Movement Disorder Society