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The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.ORCID-id: 0000-0002-2167-2450
Uppsala University, Sweden.
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2015 (Engelska)Ingår i: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 262, nr 9, s. 2154-2163Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The aim of the study was to compare the efficacy of olfactory testing and presynaptic dopamine imaging in diagnosing Parkinsons disease (PD) and atypical parkinsonian syndromes (APS); to evaluate if the combination of these two diagnostic tools can improve their diagnostic value. A prospective investigation of 24 PD patients, 16 APS patients and 15 patients with non-parkinsonian syndromes was performed during an 18-month period. Single photon emission computed tomography with the presynaptic radioligand I-123-FP-CIT (DaTSCAN (R)) and olfactory testing with the Brief 12-item Smell Identification Test (B-SIT) were performed in all patients. DaTSCAN was analysed semi-quantitatively, by calculating two different striatal uptake ratios, and visually according to a predefined ranking scale. B-SIT score was significantly lower for PD patients, but not significantly different between APS and non-parkinsonism. The visual assessment of DaTSCAN had higher sensitivity, specificity and diagnostic accuracy compared to olfactory testing. Most PD patients (75 %) had visually predominant dopamine depletion in putamen, while most APS patients (56 %) had visually severe dopamine depletion both in putamen and in caudate nucleus. The combination of DaTSCAN and B-SIT led to a higher rate of correctly classified patients. Olfactory testing can distinguish PD from non-parkinsonism, but not PD from APS or APS from non-parkinsonism. DaTSCAN is more efficient than olfactory testing and can be valuable in differentiating PD from APS. However, combining olfactory testing and DaTSCAN imaging has a higher predictive value than these two methods separately.

Ort, förlag, år, upplaga, sidor
Springer Berlin/Heidelberg, 2015. Vol. 262, nr 9, s. 2154-2163
Nyckelord [en]
Parkinsons disease; Atypical parkinsonism; Parkinsonian syndromes; Olfaction; I-123-FP-CIT SPECT
Nationell ämneskategori
Klinisk medicin
Identifikatorer
URN: urn:nbn:se:liu:diva-122669DOI: 10.1007/s00415-015-7830-4ISI: 000363035400018PubMedID: 26122543OAI: oai:DiVA.org:liu-122669DiVA, id: diva2:871691
Anmärkning

Funding Agencies|Ostergotland County Council (ALF); Swedish Parkinsons Foundation

Tillgänglig från: 2015-11-16 Skapad: 2015-11-13 Senast uppdaterad: 2019-03-05Bibliografiskt granskad
Ingår i avhandling
1. Imaging Studies of Olfaction in Health and Parkinsonism
Öppna denna publikation i ny flik eller fönster >>Imaging Studies of Olfaction in Health and Parkinsonism
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Olfactory loss is a common non-motor symptom of Parkinson’s disease (PD), often preceding the cardinal motor symptoms of the disease. The aim of this thesis was to: (a) evaluate whether olfactory examination can increase diagnostic accuracy, and (b) study the structural and functional neural basis of olfactory dysfunction in PD with different applications of Magnetic Resonance Imaging (MRI).

Paper I was a comparison of the diagnostic accuracy between a simple smell identification test and DaTSCAN Single Photon Emission Computerized Tomography (SPECT), a nuclear medicine tomographic imaging technique that is commonly used in patients with suspected parkinsonism. The results indicate that smell test is inferior to DaTSCAN SPECT, but the combination of these two methods can lead to improved diagnostic accuracy.

Paper II showed that diffusion MRI could detect discrete microstructural changes in the white matter of brain areas that participate in higher order olfactory neurotransmission, whereas MRI with Magnetization Transfer contrast could not.

Paper III was a methodological study on how two different acquisition parameters can affect the activation pattern of olfactory brain areas, as observed with functional MRI (fMRI). The results indicate that brief olfactory stimulation and fast sampling rate should be preferred on olfactory fMRI studies.

Paper IV used olfactory fMRI and resting-state fMRI in order to elucidate potentially altered activation patterns and functional connectivity within olfactory brain areas, between PD patients and healthy controls. Olfactory fMRI showed that olfactory impairment in PD is associated with significantly lower recruitment of the olfactory network. Resting-state fMRI did not detect any significant changes in the functional connectivity within the olfactory network of PD patients.

In conclusion, the included studies provide evidence of: (a) disease-related structural and functional changes in olfactory brain areas, and (b) beneficial addition of olfactory tests in the clinical work-up of patients with parkinsonism.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2019. s. 72
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1661
Nationell ämneskategori
Radiologi och bildbehandling Neurologi Medicinsk laboratorie- och mätteknik
Identifikatorer
urn:nbn:se:liu:diva-154919 (URN)10.3384/diss.diva-154919 (DOI)9789176851357 (ISBN)
Disputation
2019-04-05, Granitsalen, Campus US, Linköping, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2019-03-05 Skapad: 2019-03-05 Senast uppdaterad: 2019-03-05Bibliografiskt granskad

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Georgiopoulos, CharalamposDavidsson, AnetteEngström, MariaZachrisson, HeleneDizdar (Dizdar Segrell), Nil

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Georgiopoulos, CharalamposDavidsson, AnetteEngström, MariaZachrisson, HeleneDizdar (Dizdar Segrell), Nil
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Avdelningen för radiologiska vetenskaperMedicinska fakultetenRöntgenkliniken i LinköpingAvdelningen för kardiovaskulär medicinHälsouniversitetetFysiologiska kliniken USCentrum för medicinsk bildvetenskap och visualisering, CMIVFysiologiska kliniken USAvdelningen för neuro- och inflammationsvetenskapNeurologiska kliniken
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