Valoración funcional de la vía nigro-estriada mediante N-v-fluoropropil-2ßcarbometoxi-3ß-(4-Iodofenil) nortropano (FP-CIT) en pacientes con atrofia multisistémica subtipo cerebelosa / Functional assessment of nigro-striatal pathway with FP-CIT in patients with multiple system atrophy subtype C

Fundamento y objetivo: Evaluar el estado funcional de la vía nigro-estriada utilizando N-ω-fluoropropil-2ß-carbometoxi-3ß-(4-Iodofenil) nortropano (FP-CIT-I-123) en pacientes con diagnóstico clínico de atrofia multisistémica (AMS) subtipo C. Pacientes y método: Se incluyen 10 pacientes con diagnóstico clínico de AMS-C y se comparan con 10 diagnosticados de temblor esencial (controles) y otros 10 con enfermedad de Parkinson (EP). Los estudios son valorados mediante el índice estriado/occipital (E/O), calculando la validez diagnóstica del procedimiento mediante curvas ROC. Resultados: El valor medio (DE) del índice E/O fue de 1,48 (0,23), 1,59 (0,17) y 1,22 (0,16), correspondientes, respectivamente, a AMS-C, controles (p=0,25) y EP (p=0,00). Curva ROC: Az: 0,650; sensibilidad: 0,50; especificidad: 0,80. La correlación del estudio con FP-CIT y la clínica predominante mostró 4 pacientes con clínica parkinsoniana y estudio patológico, 4 sin clínica parkinsoniana y estudio normal, uno con clínica parkinsoniana y estudio normal, y uno sin clínica parkinsoniana y estudio patológico. Conclusiones: El estudio con FP-CIT no permite descartar totalmente la existencia de una AMS-C. Desde el punto de vista funcional, no siempre parece existir congruencia entre el estado de la vía nigro-estriada y la existencia de parkinsonismo (AU)

Background and objective: To assess the functional state of nigro-striatal pathway using FP-CIT-I-123 in patients with clinical diagnosis of Multiple System Atrophy (MSA) subtype C. Patients and methods: We included 10 patients with a clinical diagnosis of MSA-C and compared them with 10 patients diagnosed with essential tremor (controls) and 10 with Parkinson Disease (PD). The studies are evaluated by the striatum/occipital index (S/O). We calculated the diagnostic validity of the procedure by ROC curve analysis. Results: The average value of the S/O index showed a mean of 1.48 (0.23), 1.59 (0.17) and 1.22 (0.16) respectively for MSA-C, control group (p=0.25) and PD (p=0.00). ROC curve analysis: Az: 0.650; sensitivity: 0.50; specificity: 0.80. The comparison between the results of FP-CIT and clinical manifestations showed: 4 patients with parkinsonism (PK) and pathological study; 4 without PK and normal study; 1 with PK and normal study and 1 without PK and pathological study. Conclusions: FP-CIT study does not exclude completely the existence of an MSA-C. From a functional point of view, there does not always seem to be a consistency between the state of the nigro-striatal pathway and the existence of parkinsonism (AU)

[Functional assessment of nigro-striatal pathway with FP-CIT in patients with multiple system atrophy subtype C]. / Valoración funcional de la vía nigro-estriada mediante N-v-fluoropropil-2ßcarbometoxi-3ß-(4-Iodofenil) nortropano (FP-CIT) en pacientes con atrofia multisistémica subtipo cerebelosa.

BACKGROUND AND OBJECTIVE: To assess the functional state of nigro-striatal pathway using FP-CIT-I-123 in patients with clinical diagnosis of Multiple System Atrophy (MSA) subtype C. PATIENTS AND METHODS: We included 10 patients with a clinical diagnosis of MSA-C and compared them with 10 patients diagnosed with essential tremor (controls) and 10 with Parkinson Disease (PD). The studies are evaluated by the striatum/occipital index (S/O). We calculated the diagnostic validity of the procedure by ROC curve analysis. RESULTS: The average value of the S/O index showed a mean of 1.48 (0.23), 1.59 (0.17) and 1.22 (0.16) respectively for MSA-C, control group (p=0.25) and PD (p=0.00). ROC curve analysis: Az: 0.650; sensitivity: 0.50; specificity: 0.80. The comparison between the results of FP-CIT and clinical manifestations showed: 4 patients with parkinsonism (PK) and pathological study; 4 without PK and normal study; 1 with PK and normal study and 1 without PK and pathological study. CONCLUSIONS: FP-CIT study does not exclude completely the existence of an MSA-C. From a functional point of view, there does not always seem to be a consistency between the state of the nigro-striatal pathway and the existence of parkinsonism.

Thallium-201 SPECT in brain gliomas: Quantitative assessment in differential diagnosis between tumor recurrence and radionecrosis.

OBJECTIVE: To compare various published thallium-201 uptake indexes in the differential diagnosis in recurrent brain gliomas. MATERIAL AND METHODS: Thallium-201 SPECT studies were performed in 79 patients previously treated for glial tumor with clinical or radiologic suspicion of recurrence. Regions of interest were established in the tumor area and in other sites with normal uptake. RESULTS: A high linear correlation was found among indices, with significant differences between all index pairs. Logistic regression analysis confirmed high colinearity among indexes, with index 3 (mean counts in tumor/mean counts in contralateral hemisphere) showing a slightly superior predictive power to differentiate tumor absence from tumor presence and tumor absence from low-grade recurrence. These findings were supported by analysis of areas under the ROC curve. CONCLUSIONS: The uptake indices studied behave similarly in the evaluation of a possible recurrence of a glial brain lesion and should be considered complementary to visual evaluation as a semi-objective tool.