Διερεύνηση των εξωπυραμιδικών νοσημάτων με την μέθοδο FP-CIT spect (DAT-SCAN)

Abstract

We examined 61 patients using FP-CIT SPECT in order to differentiate their extrapyramidal disorder. The patients presented with a variety of tremor syndromes with varying degrees of other extrapyramidal features. We tested the ability of DaTSCAN to differentiate pregagglionic from postganglionic tremor disorders and the sensitivity and specificity of the method. We tried to correlate the disability of the patients with Parkinson’s disease with the basal ganglia integrity as it was measured with the uptake ratio of FP-CIT to the head of caudate nucleus and the putamen. The ability of the method to reliably evaluate the rate of decline of basal ganglia uptake of the radioligand was tested in order to reply to the question if the method can be used as a marker of neuroprotection or as a predictor of motor deterioration. Last of the primary end points was the correlation of basal ganglia uptake and the cognitive decline as it was measured with MMSE. Using multivariate statistical analysis we found significant correlations between FP-CIT uptake ratios and MMSE, Hoehn and Yahr, UPDRS. The results of the study were: 1. DaTSCAN is a reliable method of differentiating pregagglionic from postganglionic parkinsonism and atypical tremor syndromes with sensitivity >91,2% and specificity up to 100% with positive predictive value up to 100% and negative predictive value 46,2% -80% depending on the structure that we used as measure 2. basal ganglia uptake correlates linearly with the motor disability as it is quantified with the motor subscale of UPDRS and with Hoehn and Yahr staging 3. finally there was statistically significant correlation of the left caudate uptake with cognitive decline in our patients