Purpose Metaiodobenylguanidine (MIBG) scintigraphy has been shown to enhance the probability of correct diagnosis in patients with parkinsonian syndromes (PS). Thus far, studies of the clinical usefulness of MIBG have been confined to cross-sectional assessments, which are inevitably associated with diagnostic uncertainty during the early stages of these syndromes. In this study, the initial clinical diagnosis was reevaluated longitudinally to assess the sensitivity and specificity of clinical and MIBG parameters in the early diagnosis of PS. Methods 167 patients with PS (age 67.03 ± 8.92 years (mean ± standard deviation), duration of symptoms 2.48 ± 5.27 years, median Hoehn and Yahr score 2) underwent an initial clinical assessment and MIBG scintigraphy. Eighty seven of those patients (56 with Parkinson’s disease (PD), 1 with multiple system atrophy (MSA), 23 with atypical PS, 7 with tremor syn- drome) were clinically reevaluated a mean of 3 years later in order to verify their initial diagnosis. Results The use of a lower limit of normal value of 1.74 for the heart-to-mediastinum ratio (HMR) achieved the best dis- crimination between PD and other PS. The sensitivity of MIBG scintigraphy to PD was 94%; it also had a specificity of 65%, a positive predictive value of 88%, and
Clinical Autonomic Research – Springer Journals
Published: Jun 5, 2018
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