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The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).ORCID iD: 0000-0002-2167-2450
Uppsala University, Sweden.
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2015 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 262, no 9, p. 2154-2163Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2015. Vol. 262, no 9, p. 2154-2163
Keywords [en]
Parkinsons disease; Atypical parkinsonism; Parkinsonian syndromes; Olfaction; I-123-FP-CIT SPECT
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-122669DOI: 10.1007/s00415-015-7830-4ISI: 000363035400018PubMedID: 26122543OAI: oai:DiVA.org:liu-122669DiVA, id: diva2:871691
Note

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

Available from: 2015-11-16 Created: 2015-11-13 Last updated: 2019-03-05Bibliographically approved
In thesis
1. Imaging Studies of Olfaction in Health and Parkinsonism
Open this publication in new window or tab >>Imaging Studies of Olfaction in Health and Parkinsonism
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. p. 72
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1661
National Category
Radiology, Nuclear Medicine and Medical Imaging Neurology Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:liu:diva-154919 (URN)10.3384/diss.diva-154919 (DOI)9789176851357 (ISBN)
Public defence
2019-04-05, Granitsalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-03-05 Created: 2019-03-05 Last updated: 2019-12-12Bibliographically approved

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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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Division of Radiological SciencesFaculty of Medicine and Health SciencesDepartment of Radiology in LinköpingDivision of Cardiovascular MedicineFaculty of Health SciencesDepartment of Clinical Physiology in LinköpingCenter for Medical Image Science and Visualization (CMIV)Department of Clinical Physiology in LinköpingDivision of Neuro and Inflammation ScienceDepartment of Neurology
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