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Athanasio BS, Oliveira ACDS, Pedrosa AL, Borges RS, Neto AOM, Oliveira RA, de Resende EDPF, de Moraes RF, Caramelli P, de Souza LC. The role of brain perfusion SPECT in the diagnosis of frontotemporal dementia: A systematic review. J Neuroimaging 2024; 34:308-319. [PMID: 38192155 DOI: 10.1111/jon.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND AND PURPOSE Frontotemporal dementia (FTD) is the second most common cause of presenile dementia. The clinical distinction between FTD, Alzheimer's disease (AD), and other dementias is a clinical challenge. Brain perfusion SPECT may contribute to the diagnosis of FTD, but its value is unclear. METHODS We performed a systematic review to investigate the diagnostic accuracy of the brain SPECT in (1) distinguishing FTD from AD and other dementias and (2) differentiating FTD variants. RESULTS Overall, 391 studies were retrieved on the initial search and 35 studies composed the final selection, comprising a total number of 3142 participants of which 1029 had FTD. The sensitivity and the specificity for the differential diagnosis of FTD versus AD ranged from 56% to 88% and from 51% to 93%, respectively. SPECT is not superior to the clinical method of diagnosis, but the combination of SPECT with clinical data seems to improve the diagnostic accuracy. CONCLUSION Brain perfusion SPECT has a limited value in the diagnostic framework of FTD. SPECT can be performed when FDG-PET is not available. SPECT is recommended only for selected cases when the diagnosis is challenging using conventional methods.
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Affiliation(s)
- Bruno S Athanasio
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Ana Luísa Pedrosa
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Rafael S Borges
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Avelar O M Neto
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Rafael A Oliveira
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Elisa de Paula França de Resende
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina da UFMG, Belo Horizonte, Brazil
| | - Renata Freire de Moraes
- Instituto Hermes Pardini, Belo Horizonte, Brazil
- Programa de Pós-Graduação em Neurociências, UFMG, Belo Horizonte, Brazil
| | - Paulo Caramelli
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina da UFMG, Belo Horizonte, Brazil
- Programa de Pós-Graduação em Neurociências, UFMG, Belo Horizonte, Brazil
| | - Leonardo Cruz de Souza
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina da UFMG, Belo Horizonte, Brazil
- Programa de Pós-Graduação em Neurociências, UFMG, Belo Horizonte, Brazil
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Lei Z, Lou J, Wu H, Chen X, Ou Y, Shi X, Xu Q, Shi K, Zhou Y, Zheng L, Yin Y, Liu X. Regional cerebral perfusion in patients with amnestic mild cognitive impairment: effect of cerebral small vessel disease. Ann Nucl Med 2021; 36:43-51. [PMID: 34664230 DOI: 10.1007/s12149-021-01682-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the effort of cerebral small vessel disease (CSVD) on regional cerebral perfusion in patients with mild cognitive impairment (MCI) using NeuroGam™ software and evaluate the capability of brain perfusion single photon emission computed tomography (SPECT) in distinguishing MCI with and without CSVD. METHODS 34 amnestic MCI subjects entered this study, conducting neuropsychological tests, MRI and 99mTechnetium ethyl cystine dimer brain perfusion SPECT imaging. All subjects were divided into those with CSVD and those without CSVD. Perfusion value was measured with Brodmann area (BA) mapping in these two groups. Automated software (NeuroGam™) was used for semi-quantitative analyses of perfusion value and comparison with normal database. RESULTS Compared with normal database, perfusion levels in BAs 23-left, 28 and 36-left of MCI without CSVD group had great deviations, while perfusion levels in BAs 21, 23, 24, 25, 28, 36, 38 and 47-left of MCI with CSVD group had great deviations. Furthermore, compared with CSVD group, there was significantly lower perfusion value in BA 7-left (P < 0.001) in MCI without CSVD group. CONCLUSIONS CSVD could interact with pathological changes related to AD, exacerbating hypoperfusion in BAs 21, 23, 28, 36, 38 while compensating for cerebral blood perfusion disorder in BA 7-left in MCI patients. Meanwhile, MCI patients with CSVD shared similar hypoperfusion with vascular cognitive impairment (VCI) in BAs 24, 25 and 47L. Brain perfusion SPECT may help improve our ability to differentiate MCI with and without CSVD.
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Affiliation(s)
- Zhe Lei
- Department of Nuclear Medicine, Huashan Hopstial, Fudan University, No. 12 Urumqi M. Road, Shanghai, 200040, China.,Department of Nuclear Medicine, Fudan University Pudong Medical Center, Shanghai, China
| | - Jingjing Lou
- Department of Nuclear Medicine, Fudan University Pudong Medical Center, Shanghai, China
| | - Han Wu
- Department of Nuclear Medicine, Huashan Hopstial, Fudan University, No. 12 Urumqi M. Road, Shanghai, 200040, China
| | - Xiaohan Chen
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yinghui Ou
- Department of Nuclear Medicine, Huashan Hopstial, Fudan University, No. 12 Urumqi M. Road, Shanghai, 200040, China
| | - Xin Shi
- Department of Nuclear Medicine, Huashan Hopstial, Fudan University, No. 12 Urumqi M. Road, Shanghai, 200040, China
| | - Qian Xu
- Department of Nuclear Medicine, Huashan Hopstial, Fudan University, No. 12 Urumqi M. Road, Shanghai, 200040, China
| | - Keqing Shi
- Department of Nuclear Medicine, Huashan Hopstial, Fudan University, No. 12 Urumqi M. Road, Shanghai, 200040, China
| | - Yujing Zhou
- Department of Nuclear Medicine, Huashan Hopstial, Fudan University, No. 12 Urumqi M. Road, Shanghai, 200040, China
| | - Lingling Zheng
- Department of Nuclear Medicine, Huashan Hopstial, Fudan University, No. 12 Urumqi M. Road, Shanghai, 200040, China
| | - You Yin
- Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xingdang Liu
- Department of Nuclear Medicine, Huashan Hopstial, Fudan University, No. 12 Urumqi M. Road, Shanghai, 200040, China. .,Department of Nuclear Medicine, Fudan University Pudong Medical Center, Shanghai, China.
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Alster P, Nieciecki M, Koziorowski D, Cacko A, Charzyńska I, Królicki L, Friedman A. Is brain perfusion a differentiating feature in the comparison of Progressive Supranuclear Palsy Syndrome (PSPS) and Corticobasal Syndrome (CBS)? J Clin Neurosci 2020; 77:123-127. [PMID: 32389545 DOI: 10.1016/j.jocn.2020.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/02/2020] [Indexed: 12/01/2022]
Abstract
The aim of this work is to present whether SPECT 99mTc-HMPAO can be a method of examination to possibly differentiate the syndromes. 21 patients with PSP syndrome and 14 patients with corticobasal syndrome (CBS) were examined using SPECT 99mTc-HMPAO. Perfusion single photon emission computed tomography (SPECT) as a method of examination of progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) has not been extensively analyzed in contemporary literature. Recent criteria of PSP and CBS do not describe this method of examination as primary or additional. Extended analysis was done in the context of regions of interest affected by significant average hypoperfusion (>2 standard deviations). Differences between the syndromes were subsequently evaluated using the U-Mann-Whitney test. Lack of significant differences (p < 0.05) were observed in 92 out of 94 regions of interest. However, certain asymmetries were observed in a minority of regions in both of the syndromes. Additionally, the authors of the study verified possible differences of asymmetry of perfusion of both of the syndromes. The overlapping of clinical manifestations and locations of hypoperfusion leads to a question of whether the syndromes should be interpreted as separate entities or variants of the same disease.
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Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, Poland.
| | | | | | - Andrzej Cacko
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Poland
| | | | - Leszek Królicki
- Department of Nuclear Medicine, Medical University of Warsaw, Poland
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Valotassiou V, Malamitsi J, Papatriantafyllou J, Dardiotis E, Tsougos I, Psimadas D, Alexiou S, Hadjigeorgiou G, Georgoulias P. SPECT and PET imaging in Alzheimer’s disease. Ann Nucl Med 2018; 32:583-593. [PMID: 30128693 DOI: 10.1007/s12149-018-1292-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Varvara Valotassiou
- Nuclear Medicine Department, University Hospital of Larissa, Mezourlo, 41110, Larissa, Thessaly, Greece.
| | - Julia Malamitsi
- Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Ioannis Tsougos
- Nuclear Medicine Department, University Hospital of Larissa, Mezourlo, 41110, Larissa, Thessaly, Greece
| | - Dimitrios Psimadas
- Nuclear Medicine Department, University Hospital of Larissa, Mezourlo, 41110, Larissa, Thessaly, Greece
| | - Sotiria Alexiou
- Nuclear Medicine Department, University Hospital of Larissa, Mezourlo, 41110, Larissa, Thessaly, Greece
| | - George Hadjigeorgiou
- Neurology Department, University Hospital of Larissa, Thessaly, Greece
- Department of Neurology, Medical School, University of Cyprus, Nicosia, Greece
| | - Panagiotis Georgoulias
- Nuclear Medicine Department, University Hospital of Larissa, Mezourlo, 41110, Larissa, Thessaly, Greece
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Cuberas-Borrós G, Roca I, Boada M, Tárraga L, Hernández I, Buendia M, Rubio L, Torres G, Bittini Á, Guzmán-de-Villoria JA, Pujadas F, Torres M, Núñez L, Castell J, Páez A. Longitudinal Neuroimaging Analysis in Mild-Moderate Alzheimer's Disease Patients Treated with Plasma Exchange with 5% Human Albumin. J Alzheimers Dis 2018; 61:321-332. [PMID: 29154283 PMCID: PMC5734124 DOI: 10.3233/jad-170693] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Recently, modifications of Aβ1-42 levels in CSF and plasma associated with improvement in memory and language functions have been observed in patients with mild-moderate Alzheimer’s disease (AD) treated with plasma exchange (PE) with albumin replacement. Objective: To detect structural and functional brain changes in PE-treated AD patients as part of a Phase II clinical trial. Methods: Patients received between 3 and 18 PE with albumin (Albutein® 5%, Grifols) or sham-PE (controls) for 21 weeks (divided in one intensive and two maintenance periods) followed by 6-month follow-up. Brain perfusion assessed by SPECT scans using an automated software (NeuroGam®) and brain structural changes assessed by MRI were performed at weeks 0 (baseline), 21, and 44 (with additional SPECT at weeks 9 and 33). Statistical parametric mapping (voxel-based analysis, SPM) and Z-scores calculations were applied to investigate changes to baseline. Results: 42 patients were recruited (39 evaluable; 37 analyzed: 18 PE-treated; 19 controls). There was a trend toward decreasing hippocampi and total intracranial volume for both patient groups during the study (p < 0.05). After six months, PE-treated patients had less cerebral perfusion loss than controls in frontal, temporal, and parietal areas, and perfusion stabilization in Brodmann area BA38-R during the PE-treatment period (p < 0.05). SPM analysis showed stabilization or absence of progression of perfusion loss in PE-treated patients until week 21, not observed in controls. Conclusions: Mild-moderate AD patients showed decreased brain volume and impairment of brain perfusion as expected for the progression of the disease. PE-treatment with albumin replacement favored the stabilization of perfusion.
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Affiliation(s)
- Gemma Cuberas-Borrós
- Department of Nuclear Medicine, Institut de Diagnòstic per la Imatge (IDI), Hospital General Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Roca
- Department of Nuclear Medicine, Institut de Diagnòstic per la Imatge (IDI), Hospital General Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Nuclear Medicine, Gammagrafía Corachan, Barcelona, Spain
| | - Mercè Boada
- Department of Neurology, Hospital General Universitari Vall d'Hebrón, Barcelona, Spain.,Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Lluís Tárraga
- Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Isabel Hernández
- Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Mar Buendia
- Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Lourdes Rubio
- Department of Nuclear Medicine, Gammagrafía Corachan, Barcelona, Spain
| | - Gustavo Torres
- Department of Nuclear Medicine, Gammagrafía Corachan, Barcelona, Spain
| | - Ángel Bittini
- Department of Nuclear Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Francesc Pujadas
- Department of Neurology, Hospital General Universitari Vall d'Hebrón, Barcelona, Spain
| | - Mireia Torres
- Department of Clinical, Instituto Grifols, S.A., Barcelona, Spain
| | - Laura Núñez
- Department of Clinical, Instituto Grifols, S.A., Barcelona, Spain
| | - Joan Castell
- Department of Nuclear Medicine, Institut de Diagnòstic per la Imatge (IDI), Hospital General Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Páez
- Department of Clinical, Instituto Grifols, S.A., Barcelona, Spain
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Fu P, Wei L, Zhang F, Gao J, Jing J, Wu W, Liu H. Added Value of NeuroGam Software Analysis in Single Photon Emission Computed Tomography Localization Diagnosis of Epilepsy in Interictal Stage. Med Sci Monit 2018. [PMID: 29531211 PMCID: PMC5861764 DOI: 10.12659/msm.908437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to investigate the added value of NeuroGam software analysis in the localization diagnosis of epileptogenic zone during interictal phase of seizures. Material/Methods The clinical data of 67 patients, clinically diagnosed as epilepsy, were analyzed retrospectively. Visual analysis and NeuroGam software analysis were used for independent analysis. The 2 methods were used to compare the efficacy indicator of the diagnosis of epileptogenic zone, and the receiver operating characteristic (ROC) curve evaluated the diagnostic efficacy. Results Through the final clinical diagnostic comprehensive localization, among 67 epilepsy patients, the epileptogenic zone in 51 cases could be located distinctly, and those in 16 cases could not be located. Compared to the visual analysis, the NeuroGam software analysis was more sensitive in the location of epileptogenic zone (χ2=4.876, P=0.027). The area under the ROC curve (AUC) and 95% confidence interval (CI) of the NeuroGam software and visual analyses was 0.760 and 0.689, (0.613, 0.908) and (0.547, 0.832), respectively. However, the consistency of the 2 methods was poor (Kappa=0.367, P=0.001). Compared to visual analysis, the NeuroGam software analysis exerted more advantages in the localization diagnosis of the epileptogenic zone (P<0.001). Conclusions In the location diagnosis of brain perfusion, single photon emission computed tomography (SPECT) epileptogenic zone was used in interictal phase of seizures, and NeuroGam software analysis exerted a distinct added value for visual analysis.
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Affiliation(s)
- Peng Fu
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lingge Wei
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Fang Zhang
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jianqing Gao
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Jianmin Jing
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Weijie Wu
- Department of Nuclear Medicine, 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Huaijun Liu
- Department of Medical Imaging, 2nd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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7
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Whitwell JL, Höglinger GU, Antonini A, Bordelon Y, Boxer AL, Colosimo C, van Eimeren T, Golbe LI, Kassubek J, Kurz C, Litvan I, Pantelyat A, Rabinovici G, Respondek G, Rominger A, Rowe JB, Stamelou M, Josephs KA. Radiological biomarkers for diagnosis in PSP: Where are we and where do we need to be? Mov Disord 2017; 32:955-971. [PMID: 28500751 PMCID: PMC5511762 DOI: 10.1002/mds.27038] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/11/2022] Open
Abstract
PSP is a pathologically defined neurodegenerative tauopathy with a variety of clinical presentations including typical Richardson's syndrome and other variant PSP syndromes. A large body of neuroimaging research has been conducted over the past two decades, with many studies proposing different structural MRI and molecular PET/SPECT biomarkers for PSP. These include measures of brainstem, cortical and striatal atrophy, diffusion weighted and diffusion tensor imaging abnormalities, [18F] fluorodeoxyglucose PET hypometabolism, reductions in striatal dopamine imaging and, most recently, PET imaging with ligands that bind to tau. Our aim was to critically evaluate the degree to which structural and molecular neuroimaging metrics fulfill criteria for diagnostic biomarkers of PSP. We queried the PubMed, Cochrane, Medline, and PSYCInfo databases for original research articles published in English over the past 20 years using postmortem diagnosis or the NINDS-SPSP criteria as the diagnostic standard from 1996 to 2016. We define a five-level theoretical construct for the utility of neuroimaging biomarkers in PSP, with level 1 representing group-level findings, level 2 representing biomarkers with demonstrable individual-level diagnostic utility, level 3 representing biomarkers for early disease, level 4 representing surrogate biomarkers of PSP pathology, and level 5 representing definitive PSP biomarkers of PSP pathology. We discuss the degree to which each of the currently available biomarkers fit into this theoretical construct, consider the role of biomarkers in the diagnosis of Richardson's syndrome, variant PSP syndromes and autopsy confirmed PSP, and emphasize current shortfalls in the field. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Günter U. Höglinger
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, IRCCS Hospital San Camillo, Venice and Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
| | - Thilo van Eimeren
- German Center for Neurodegenerative Diseases (DZNE), Germany
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Lawrence I. Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Carolin Kurz
- Psychiatrische Klinik, Ludwigs-Maximilians-Universität, München, Germany
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, CA, USA
| | | | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Gesine Respondek
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Axel Rominger
- Deptartment of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - James B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Maria Stamelou
- Second Department of Neurology, Attikon University Hospital, University of Athens, Greece; Philipps University, Marburg, Germany; Movement Disorders Dept., HYGEIA Hospital, Athens, Greece
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Armstrong RA. Visual signs and symptoms of corticobasal degeneration. Clin Exp Optom 2016; 99:498-506. [PMID: 27553583 DOI: 10.1111/cxo.12429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/23/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022] Open
Abstract
Corticobasal degeneration is a rare, progressive neurodegenerative disease and a member of the 'parkinsonian' group of disorders, which also includes Parkinson's disease, progressive supranuclear palsy, dementia with Lewy bodies and multiple system atrophy. The most common initial symptom is limb clumsiness, usually affecting one side of the body, with or without accompanying rigidity or tremor. Subsequently, the disease affects gait and there is a slow progression to influence ipsilateral arms and legs. Apraxia and dementia are the most common cortical signs. Corticobasal degeneration can be difficult to distinguish from other parkinsonian syndromes but if ocular signs and symptoms are present, they may aid clinical diagnosis. Typical ocular features include increased latency of saccadic eye movements ipsilateral to the side exhibiting apraxia, impaired smooth pursuit movements and visuo-spatial dysfunction, especially involving spatial rather than object-based tasks. Less typical features include reduction in saccadic velocity, vertical gaze palsy, visual hallucinations, sleep disturbance and an impaired electroretinogram. Aspects of primary vision such as visual acuity and colour vision are usually unaffected. Management of the condition to deal with problems of walking, movement, daily tasks and speech problems is an important aspect of the disease.
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Valotassiou V, Papatriantafyllou J, Sifakis N, Tzavara C, Tsougos I, Psimadas D, Fezoulidis I, Kapsalaki E, Hadjigeorgiou G, Georgoulias P. Clinical Evaluation of Brain Perfusion SPECT with Brodmann Areas Mapping in Early Diagnosis of Alzheimer's Disease. J Alzheimers Dis 2016; 47:773-85. [PMID: 26401711 DOI: 10.3233/jad-150068] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early diagnosis of Alzheimer's disease (AD) based on clinical criteria alone may be problematic, while current and future treatments should be administered earlier in order to be more effective. Thus, various disease biomarkers could be used for early detection of AD. We evaluated brain perfusion with 99mTc-HMPAO single photon emission computed tomography (SPECT) and Brodmann areas (BAs) mapping in mild AD using an automated software (NeuroGam) for the semi-quantitative evaluation of perfusion in BAs and the comparison with the software's normal database. We studied 34 consecutive patients with mild AD: 9 men, 25 women, mean age 70.9 ± 8.1 years, mean Mini-Mental State Examination 22.6 ± 2.5. BAs 25L, 25R, 38L, 38R, 28L, 28R, 36L, and 36R had the lower mean perfusion values, while BAs 31L, 31R, 19R, 18L, 18R, 17L, and 17R had the higher mean values. Compared with healthy subjects of the same age, perfusion values in BAs 25L, 25R, 28R, 28L, 36L, and 36R had the greatest deviations from the healthy sample, while the lowest deviations were found in BAs 32L, 32R, 19R, 24L, 17L, 17R, 18L, and 18R. A percentage of ≥94% of patients had perfusion values more than -2SDs below the mean of healthy subjects in BAs 38R, 38L, 36L, 36R, 23L, 23R, 22L, 44L, 28L, 28R, 25L, and 25R. The corresponding proportion was less than 38% for BAs 11L, 19R, 32L, 32R, 18L, 18R, 24L, and 17R. In conclusion, brain SPECT studies with automated perfusion mapping could be useful as an ancillary tool in daily practice, revealing perfusion impairments in early AD.
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Affiliation(s)
- Varvara Valotassiou
- Department of Nuclear Medicine, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - John Papatriantafyllou
- Memory & Cognitive Disorders Clinic, Department of Neurology, "G.Gennimatas" Hospital, Athens, Greece
| | - Nikolaos Sifakis
- Department of Nuclear Medicine, "Alexandra" University Hospital, Athens, Greece
| | - Chara Tzavara
- Department of Nuclear Medicine, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Ioannis Tsougos
- Department of Nuclear Medicine, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Dimitrios Psimadas
- Department of Nuclear Medicine, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Ioannis Fezoulidis
- Department of Radiology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Eftychia Kapsalaki
- Department of Radiology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - George Hadjigeorgiou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Panagiotis Georgoulias
- Department of Nuclear Medicine, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
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Archer HA, Smailagic N, John C, Holmes RB, Takwoingi Y, Coulthard EJ, Cullum S. Regional cerebral blood flow single photon emission computed tomography for detection of Frontotemporal dementia in people with suspected dementia. Cochrane Database Syst Rev 2015; 2015:CD010896. [PMID: 26102272 PMCID: PMC6464981 DOI: 10.1002/14651858.cd010896.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the UK, dementia affects 5% of the population aged over 65 years and 25% of those over 85 years. Frontotemporal dementia (FTD) represents one subtype and is thought to account for up to 16% of all degenerative dementias. Although the core of the diagnostic process in dementia rests firmly on clinical and cognitive assessments, a wide range of investigations are available to aid diagnosis.Regional cerebral blood flow (rCBF) single-photon emission computed tomography (SPECT) is an established clinical tool that uses an intravenously injected radiolabelled tracer to map blood flow in the brain. In FTD the characteristic pattern seen is hypoperfusion of the frontal and anterior temporal lobes. This pattern of blood flow is different to patterns seen in other subtypes of dementia and so can be used to differentiate FTD.It has been proposed that a diagnosis of FTD, (particularly early stage), should be made not only on the basis of clinical criteria but using a combination of other diagnostic findings, including rCBF SPECT. However, more extensive testing comes at a financial cost, and with a potential risk to patient safety and comfort. OBJECTIVES To determine the diagnostic accuracy of rCBF SPECT for diagnosing FTD in populations with suspected dementia in secondary/tertiary healthcare settings and in the differential diagnosis of FTD from other dementia subtypes. SEARCH METHODS Our search strategy used two concepts: (a) the index test and (b) the condition of interest. We searched citation databases, including MEDLINE (Ovid SP), EMBASE (Ovid SP), BIOSIS (Ovid SP), Web of Science Core Collection (ISI Web of Science), PsycINFO (Ovid SP), CINAHL (EBSCOhost) and LILACS (Bireme), using structured search strategies appropriate for each database. In addition we searched specialised sources of diagnostic test accuracy studies and reviews including: MEDION (Universities of Maastricht and Leuven), DARE (Database of Abstracts of Reviews of Effects) and HTA (Health Technology Assessment) database.We requested a search of the Cochrane Register of Diagnostic Test Accuracy Studies and used the related articles feature in PubMed to search for additional studies. We tracked key studies in citation databases such as Science Citation Index and Scopus to ascertain any further relevant studies. We identified 'grey' literature, mainly in the form of conference abstracts, through the Web of Science Core Collection, including Conference Proceedings Citation Index and Embase. The most recent search for this review was run on the 1 June 2013.Following title and abstract screening of the search results, full-text papers were obtained for each potentially eligible study. These papers were then independently evaluated for inclusion or exclusion. SELECTION CRITERIA We included both case-control and cohort (delayed verification of diagnosis) studies. Where studies used a case-control design we included all participants who had a clinical diagnosis of FTD or other dementia subtype using standard clinical diagnostic criteria. For cohort studies, we included studies where all participants with suspected dementia were administered rCBF SPECT at baseline. We excluded studies of participants from selected populations (e.g. post-stroke) and studies of participants with a secondary cause of cognitive impairment. DATA COLLECTION AND ANALYSIS Two review authors extracted information on study characteristics and data for the assessment of methodological quality and the investigation of heterogeneity. We assessed the methodological quality of each study using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool. We produced a narrative summary describing numbers of studies that were found to have high/low/unclear risk of bias as well as concerns regarding applicability. To produce 2 x 2 tables, we dichotomised the rCBF SPECT results (scan positive or negative for FTD) and cross-tabulated them against the results for the reference standard. These tables were then used to calculate the sensitivity and specificity of the index test. Meta-analysis was not performed due to the considerable between-study variation in clinical and methodological characteristics. MAIN RESULTS Eleven studies (1117 participants) met our inclusion criteria. These consisted of six case-control studies, two retrospective cohort studies and three prospective cohort studies. Three studies used single-headed camera SPECT while the remaining eight used multiple-headed camera SPECT. Study design and methods varied widely. Overall, participant selection was not well described and the studies were judged as having either high or unclear risk of bias. Often the threshold used to define a positive SPECT result was not predefined and the results were reported with knowledge of the reference standard. Concerns regarding applicability of the studies to the review question were generally low across all three domains (participant selection, index test and reference standard).Sensitivities and specificities for differentiating FTD from non-FTD ranged from 0.73 to 1.00 and from 0.80 to 1.00, respectively, for the three multiple-headed camera studies. Sensitivities were lower for the two single-headed camera studies; one reported a sensitivity and specificity of 0.40 (95% confidence interval (CI) 0.05 to 0.85) and 0.95 (95% CI 0.90 to 0.98), respectively, and the other a sensitivity and specificity of 0.36 (95% CI 0.24 to 0.50) and 0.92 (95% CI 0.88 to 0.95), respectively.Eight of the 11 studies which used SPECT to differentiate FTD from Alzheimer's disease used multiple-headed camera SPECT. Of these studies, five used a case-control design and reported sensitivities of between 0.52 and 1.00, and specificities of between 0.41 and 0.86. The remaining three studies used a cohort design and reported sensitivities of between 0.73 and 1.00, and specificities of between 0.94 and 1.00. The three studies that used single-headed camera SPECT reported sensitivities of between 0.40 and 0.80, and specificities of between 0.61 and 0.97. AUTHORS' CONCLUSIONS At present, we would not recommend the routine use of rCBF SPECT in clinical practice because there is insufficient evidence from the available literature to support this.Further research into the use of rCBF SPECT for differentiating FTD from other dementias is required. In particular, protocols should be standardised, study populations should be well described, the threshold for 'abnormal' scans predefined and clear details given on how scans are analysed. More prospective cohort studies that verify the presence or absence of FTD during a period of follow up should be undertaken.
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Affiliation(s)
- Hilary A Archer
- University of BristolDepartment of Clinical NeurosciencesLearning and Research BuildingSouthmead HospitalBristolUKBS10 5NB
| | - Nadja Smailagic
- University of CambridgeInstitute of Public HealthForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Christeena John
- Southmead Hospital, NHS TrustDepartment of NeuropsychologySouthmead WayAvonBristolUKBS10 5NB
| | - Robin B Holmes
- University Hospitals BristolMedical Physics and BioengineeringSusan Britton Wills Unit, Bristol General Hospital, Guinea StreetBristolUKBS16SY
| | - Yemisi Takwoingi
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - Elizabeth J Coulthard
- University of Bristol and North Bristol NHS trustNeurologyFrenchay Park RoadBristolUKBS16 1LE
| | - Sarah Cullum
- University of BristolSchool of Social and Community MedicineOakfield HouseOakfield GroveBristolUKBS8 2PS
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