1
|
Frisoni GB, Festari C, Massa F, Cotta Ramusino M, Orini S, Aarsland D, Agosta F, Babiloni C, Borroni B, Cappa SF, Frederiksen KS, Froelich L, Garibotto V, Haliassos A, Jessen F, Kamondi A, Kessels RP, Morbelli SD, O'Brien JT, Otto M, Perret-Liaudet A, Pizzini FB, Vandenbulcke M, Vanninen R, Verhey F, Vernooij MW, Yousry T, Boada Rovira M, Dubois B, Georges J, Hansson O, Ritchie CW, Scheltens P, van der Flier WM, Nobili F. European intersocietal recommendations for the biomarker-based diagnosis of neurocognitive disorders. Lancet Neurol 2024; 23:302-312. [PMID: 38365381 DOI: 10.1016/s1474-4422(23)00447-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 02/18/2024]
Abstract
The recent commercialisation of the first disease-modifying drugs for Alzheimer's disease emphasises the need for consensus recommendations on the rational use of biomarkers to diagnose people with suspected neurocognitive disorders in memory clinics. Most available recommendations and guidelines are either disease-centred or biomarker-centred. A European multidisciplinary taskforce consisting of 22 experts from 11 European scientific societies set out to define the first patient-centred diagnostic workflow that aims to prioritise testing for available biomarkers in individuals attending memory clinics. After an extensive literature review, we used a Delphi consensus procedure to identify 11 clinical syndromes, based on clinical history and examination, neuropsychology, blood tests, structural imaging, and, in some cases, EEG. We recommend first-line and, if needed, second-line testing for biomarkers according to the patient's clinical profile and the results of previous biomarker findings. This diagnostic workflow will promote consistency in the diagnosis of neurocognitive disorders across European countries.
Collapse
Affiliation(s)
- Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
| | - Cristina Festari
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Cotta Ramusino
- Unit of Behavioral Neurology and Dementia Research Center (DRC), IRCCS Mondino Foundation, Pavia, Italy
| | - Stefania Orini
- Alzheimer's Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; UK Dementia Research Institute, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "V Erspamer", Sapienza University of Rome, Rome, Italy; Hospital San Raffaele of Cassino, Cassino, Italy
| | - Barbara Borroni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy
| | - Stefano F Cappa
- Centro Ricerca sulle Demenze, IRCCS Mondino Foundation, Pavia, Italy; University Institute for Advanced Studies (IUSS), Pavia, Italy
| | - Kristian S Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lutz Froelich
- Department of Geriatric Psychiatry, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland; CIBM Center for Biomedical Imaging, Geneva, Switzerland
| | | | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Anita Kamondi
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary; Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Roy Pc Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands; Radboud UMC Alzheimer Center and Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands; Vincent van Gogh Institute for Psychiatry, Venray, Netherlands
| | - Silvia D Morbelli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Markus Otto
- Department of Neurology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | | | - Francesca B Pizzini
- Department of Diagnostic and Public Health, Verona University Hospital, Verona University, Verona, Italy
| | - Mathieu Vandenbulcke
- Department of Neurosciences, KU Leuven, Leuven, Belgium; Department of Geriatric Psychiatry, University Psychiatric Centre KU Leuven, Leuven-Kortenberg, Belgium
| | - Ritva Vanninen
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology-Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Meike W Vernooij
- Department of Epidemiology and Department of Radiology and Nuclear Medicine Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Tarek Yousry
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
| | - Mercè Boada Rovira
- Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Bruno Dubois
- Institut de La Mémoire et de La Maladie d'Alzheimer, Neurology Department, Salpêtrière Hospital, Assistance Publique-Hôpital de Paris, Paris, France; Sorbonne University, Paris, France
| | | | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Western General Hospital, University of Edinburgh, Edinburgh, UK; Brain Health Scotland, Edinburgh, UK
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam Neuroscience-Neurodegeneration, Amsterdam, Netherlands; Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
2
|
Antunovic L, Artesani A, Viganò A, Chiti A, Santoro A, Sollini M, Morbelli SD, De Sanctis R. Imaging Correlates between Headache and Breast Cancer: An [ 18F]FDG PET Study. Cancers (Basel) 2023; 15:4147. [PMID: 37627174 PMCID: PMC10453040 DOI: 10.3390/cancers15164147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
This study aimed to examine brain metabolic patterns on [18F]Fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) in breast cancer (BC), comparing patients with tension-type headache (TTH), migraine (MiG), and those without headache. Further association with BC response to neoadjuvant chemotherapy (NAC) was explored. In this prospective study, BC patients eligible for NAC performed total-body [18F]FDG PET/CT with a dedicated brain scan. A voxel-wise analysis (two-sample t-test) and a multiple regression model were used to compare brain metabolic patterns among TTH, MiG, and no-headache patients and to correlate them with clinical covariates. A single-subject analysis compared each patient's brain uptake before and after NAC with a healthy control group. Primary headache was diagnosed in 39/46 of BC patients (39% TTH and 46% MiG). TTH patients exhibited hypometabolism in specific brain regions before NAC. TTH patients with a pathological complete response (pCR) to NAC showed hypermetabolic brain regions in the anterior medial frontal cortex. The correlation between tumor uptake and brain metabolism varied before and after NAC, suggesting an inverse relationship. Additionally, the single-subject analysis revealed that hypometabolic brain regions were not present after NAC. Primary headache, especially MiG, was associated with a better response to NAC. These findings suggest complex interactions between BC, headache, and hormonal status, warranting further investigation in larger prospective cohorts.
Collapse
Affiliation(s)
- Lidija Antunovic
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
| | - Alessia Artesani
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | | | - Arturo Chiti
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | - Martina Sollini
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | - Silvia D. Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Rita De Sanctis
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy; (L.A.); (A.A.); (A.C.); (A.S.); (R.D.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| |
Collapse
|
3
|
Camellino D, Paparo F, Morbelli SD, Pesce G, Bauckneht M, Bagnasco M, Cutolo M, Sambuceti G, Cimmino MA. Clinical and FDG-PET/CT correlates in patients with polymyalgia rheumatica. Clin Exp Rheumatol 2022; 40:78-85. [DOI: 10.55563/clinexprheumatol/4r78yg] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Dario Camellino
- Division of Rheumatology, La Colletta Hospital, Azienda Sanitaria Locale 3, Arenzano, and Autoimmunology Laboratory, Department of Internal Medicine, University of Genova, Italy
| | | | - Silvia D. Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genova, and Department of Health Sciences, University
of Genova, Italy
| | - Giampaola Pesce
- Autoimmunology Laboratory, Department of Internal Medicine, University of Genova, Italy
| | - Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genova, and Department of Health Sciences, University of Genova, Italy
| | - Marcello Bagnasco
- Autoimmunology Laboratory, Department of Internal Medicine, University of Genova, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genova, and Department of Health Sciences, University of Genova, Italy
| | - Marco Amedeo Cimmino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy.
| |
Collapse
|
4
|
Ramusino MC, Garibotto V, Bacchin R, Altomare D, Dodich A, Assal F, Mendes A, Costa A, Tinazzi M, Morbelli SD, Bauckneht M, Picco A, Dottorini ME, Tranfaglia C, Farotti L, Salvadori N, Moretti D, Savelli G, Tarallo A, Nobili F, Parapini M, Cavaliere C, Salvatore E, Salvatore M, Boccardi M, Frisoni GB. Incremental value of amyloid-PET versus CSF in the diagnosis of Alzheimer's disease. Eur J Nucl Med Mol Imaging 2019; 47:270-280. [PMID: 31388720 DOI: 10.1007/s00259-019-04466-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the incremental diagnostic value of amyloid-PET and CSF (Aβ42, tau, and phospho-tau) in AD diagnosis in patients with mild cognitive impairment (MCI) or mild dementia, in order to improve the definition of diagnostic algorithm. METHODS Two independent dementia experts provided etiological diagnosis and relative diagnostic confidence in 71 patients on 3 rounds, based on (1) clinical, neuropsychological, and structural MRI information alone; (2) adding one biomarker (CSF amyloid and tau levels or amyloid-PET with a balanced randomized design); and (3) adding the other biomarker. RESULTS Among patients with a pre-biomarker diagnosis of AD, negative PET induced significantly more diagnostic changes than amyloid-negative CSF at both rounds 2 (CSF 67%, PET 100%, P = 0.028) and 3 (CSF 0%; PET 78%, P < 0.001); PET induced a diagnostic confidence increase significantly higher than CSF on both rounds 2 and 3. CONCLUSIONS Amyloid-PET should be prioritized over CSF biomarkers in the diagnostic workup of patients investigated for suspected AD, as it provides greater changes in diagnosis and diagnostic confidence. TRIAL REGISTRATION EudraCT no.: 2014-005389-31.
Collapse
Affiliation(s)
- Matteo Cotta Ramusino
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland. .,Center for Cognitive and Behavioral Disorders, IRCCS Mondino Foundation and Dept of Brain and Behavior, University of Pavia, 27100, Pavia, Italy.
| | - Valentina Garibotto
- NIMTlab, Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, CH1205, Geneva, Switzerland.,Division of Nuclear Medicine, Geneva University Hospitals, CH1205, Geneva, Switzerland
| | - Ruggero Bacchin
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland.,Dept of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology, University of Verona, 34134, Verona, Italy
| | - Daniele Altomare
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland
| | - Alessandra Dodich
- NIMTlab, Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, CH1205, Geneva, Switzerland
| | - Frederic Assal
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland
| | - Aline Mendes
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland
| | - Alfredo Costa
- Center for Cognitive and Behavioral Disorders, IRCCS Mondino Foundation and Dept of Brain and Behavior, University of Pavia, 27100, Pavia, Italy
| | - Michele Tinazzi
- Dept of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology, University of Verona, 34134, Verona, Italy
| | - Silvia D Morbelli
- Nuclear Medicine, Dept of Health Sciences (DISSAL), University of Genoa and IRCCS AOU San Martino-IST, 16132, Genoa, Italy
| | - Matteo Bauckneht
- Nuclear Medicine, Dept of Health Sciences (DISSAL), University of Genoa and IRCCS AOU San Martino-IST, 16132, Genoa, Italy
| | - Agnese Picco
- Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, 16126, Genoa, Italy
| | - Massimo E Dottorini
- Nuclear Medicine Division, "S. Maria della Misericordia" Hospital, 06129, Perugia, Italy
| | - Cristina Tranfaglia
- Nuclear Medicine Division, "S. Maria della Misericordia" Hospital, 06129, Perugia, Italy
| | - Lucia Farotti
- Center for Memory Disturbances, Laboratory of Clinical Neurochemistry, University of Perugia, 06123, Perugia, Italy
| | - Nicola Salvadori
- Center for Memory Disturbances, Laboratory of Clinical Neurochemistry, University of Perugia, 06123, Perugia, Italy
| | - Davide Moretti
- Alzheimer's Disease Operative Unit, IRCCS S, Giovanni di Dio Fatebenefratelli, 25125, Brescia, Italy
| | - Giordano Savelli
- Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, 25124, Brescia, Italy
| | - Anna Tarallo
- LANE-Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS San Giovanni di Dio Fatebenefratelli, 25125, Brescia, Italy
| | - Flavio Nobili
- Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, 16126, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maura Parapini
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland
| | | | | | | | - Marina Boccardi
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland.,LANE-Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS San Giovanni di Dio Fatebenefratelli, 25125, Brescia, Italy
| | - Giovanni B Frisoni
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland
| |
Collapse
|
5
|
Boffa G, Lapucci C, Morbelli SD, Nobili FM. Two-way crossed cerebellar diaschisis in a clinically isolated syndrome suggestive of multiple sclerosis. Q J Nucl Med Mol Imaging 2019; 63:225-226. [PMID: 31089076 DOI: 10.23736/s1824-4785.19.03171-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The term diaschisis refers to a neural dysfunction manifesting in anatomically intact, but functionally related, brain regions distant from a primary lesion. Here we report the diaschisis phenomenon as a consequence of a first demyelinating event in the middle and superior cerebellar peduncles in both the ipsilateral cerebellar hemisphere and in the contralateral thalamus and cerebral cortex (two-way crossed cerebellar diaschisis), resulting in the simultaneous disruption of the afferent cortico-ponto-cerebellar pathway and the efferent cerebellar-thalamo-cortical pathway. The use of 18F-FDG-PET could help clarifying in vivo the distant pathophysiological effect of focal lesions in inflammatory diseases such as multiple sclerosis.
Collapse
Affiliation(s)
- Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy - .,San Martino Hospital and Institute for Cancer Research and Care, Genoa, Italy -
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,San Martino Hospital and Institute for Cancer Research and Care, Genoa, Italy
| | - Silvia D Morbelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,San Martino Hospital and Institute for Cancer Research and Care, Genoa, Italy
| | - Flavio M Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,San Martino Hospital and Institute for Cancer Research and Care, Genoa, Italy
| |
Collapse
|
6
|
Marini C, Bezante G, Gandolfo P, Modonesi E, Morbelli SD, Depascale A, Rollando D, Maggi D, Albertelli M, Armonino R, Balbi M, Brunelli C, Cordera R, Sambuceti G. Optimization of flow reserve measurement using SPECT technology to evaluate the determinants of coronary microvascular dysfunction in diabetes. Eur J Nucl Med Mol Imaging 2009; 37:357-67. [PMID: 19957177 DOI: 10.1007/s00259-009-1316-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 10/23/2009] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to validate a new method to measure regional myocardial perfusion reserve (MPR) with technetium-labelled tracers in patients with type 2 diabetes mellitus (DM2). METHODS A total of 40 consecutive DM2 patients without history of coronary artery disease (CAD) and 7 control subjects were recruited. Dipyridamole myocardial blood flow index (MBF) was assessed by measuring first transit counts in the pulmonary artery and myocardial count rate from gated SPECT images using (99m)Tc-labelled tracers. The corresponding MBF index was estimated 2 h later according to the same procedure. Regional myocardial perfusion reserve (MPR) was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular (LV) model. Coronary flow reserve (CFR) was estimated by transthoracic contrast echo Doppler monitoring of flow velocity in the left anterior descending coronary artery (LAD) during the same session. RESULTS Estimated MPR was higher in control subjects than in patients (3.36 +/- 0.66 vs 1.91 +/- 0.61, respectively, p < 0.01). In patients, LAD CFR and LAD MPR were 2.01 +/- 0.78 vs 1.93 +/- 0.63, respectively (p = ns). The agreement between the two techniques was documented by their close correlation (r = 0.92, p < 0.001) and confirmed by the Bland-Altman analysis. Reversible perfusion defects occurred in 13 patients (32%) who showed similar MPR values as the remaining 27 (2.10 +/- 0.71 vs 1.83 +/- 0.71, respectively, p = ns). Finally, MPR was closely correlated with age (r = -0.50, p < 0.01) and time elapsed from the diagnosis of DM2 (r = -0.51, p < 0.01). CONCLUSION LV regional MPR can be accurately estimated with the broadly available single photon technology. Application of this method to DM2 patients documents the presence of a microvascular dysfunction homogeneously distributed throughout the LV walls and most frequently not associated with reversible perfusion defects.
Collapse
Affiliation(s)
- Cecilia Marini
- CNR Institute of Bioimages and Molecular Physiology, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|