Combined DaT imaging and olfactory testing for differentiating parkinsonian disorders

P. Borghammer, K. Knudsen, K. Østergaard, E. H. Danielsen, N. Pavese, A. Arveschoug, H. Bluhme, Matthias Bode, A. Morsing

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

ObjectiveDopamine transporter (DaT) imaging with single photon emission computed tomography (SPECT) detects loss of striatal dopaminergic innervation with very high sensitivity. It cannot readily distinguish idiopathic Parkinson's disease (iPD) and dementia with Lewy bodies (DLB) from atypical disorders (aPD). However, most iPD/DLB patients are hyposmic, whereas the majority of aPD patients were reported to have intact olfaction. For this reason, we conducted a longitudinal follow-up study to investigate the power of combined DaT imaging and olfactory testing to predict the final diagnosis of the patients. Materials and methodsA total of 129 patients received [123I]FP-CIT SPECT and olfactory testing at baseline assessment. Clinical follow-up 3012months later was the diagnostic standard of truth. A normative dataset of 24 healthy controls was used for comparison. ResultsBaseline DaT imaging predicted a dopamine-deficient diagnosis with 98% sensitivity and 98% specificity. The combined DaT/olfactory testing correctly classified 91% of patients as iPD/DLB (PPV 91%). The PPV rose to 97% or greater in anosmic patients. In contrast, only 45% of aPD patients were categorised correctly by combined DaT/olfactory testing - mainly because of the presence of normosmic iPD patients. ConclusionsIn patients with an abnormal DaT SPECT, hyposmia yields an a posteriori likelihood of iPD/DLB of >90%. In contrast, a finding of normosmia only increases the a posteriori likelihood of aPD to approximately the 50%.
OriginalsprogEngelsk
TidsskriftInternational Journal of Clinical Practice
Vol/bind68
Udgave nummer11
Sider (fra-til)1345-1351
ISSN1368-5031
DOI
StatusUdgivet - 2014

Emneord

  • SMELL IDENTIFICATION TEST DOPAMINE TRANSPORTER CLINICAL-DIAGNOSIS DISEASE ACCURACY DYSFUNCTION HYPOSMIA SPECT

Citer dette

Borghammer, P., Knudsen, K., Østergaard, K., Danielsen, E. H., Pavese, N., Arveschoug, A., ... Morsing, A. (2014). Combined DaT imaging and olfactory testing for differentiating parkinsonian disorders. International Journal of Clinical Practice, 68(11), 1345-1351. https://doi.org/10.1111/ijcp.12445
Borghammer, P. ; Knudsen, K. ; Østergaard, K. ; Danielsen, E. H. ; Pavese, N. ; Arveschoug, A. ; Bluhme, H. ; Bode, Matthias ; Morsing, A. / Combined DaT imaging and olfactory testing for differentiating parkinsonian disorders. I: International Journal of Clinical Practice. 2014 ; Bind 68, Nr. 11. s. 1345-1351.
@article{e4ce1894fb6e4eb2bbab24d812cf5966,
title = "Combined DaT imaging and olfactory testing for differentiating parkinsonian disorders",
abstract = "ObjectiveDopamine transporter (DaT) imaging with single photon emission computed tomography (SPECT) detects loss of striatal dopaminergic innervation with very high sensitivity. It cannot readily distinguish idiopathic Parkinson's disease (iPD) and dementia with Lewy bodies (DLB) from atypical disorders (aPD). However, most iPD/DLB patients are hyposmic, whereas the majority of aPD patients were reported to have intact olfaction. For this reason, we conducted a longitudinal follow-up study to investigate the power of combined DaT imaging and olfactory testing to predict the final diagnosis of the patients. Materials and methodsA total of 129 patients received [123I]FP-CIT SPECT and olfactory testing at baseline assessment. Clinical follow-up 3012months later was the diagnostic standard of truth. A normative dataset of 24 healthy controls was used for comparison. ResultsBaseline DaT imaging predicted a dopamine-deficient diagnosis with 98{\%} sensitivity and 98{\%} specificity. The combined DaT/olfactory testing correctly classified 91{\%} of patients as iPD/DLB (PPV 91{\%}). The PPV rose to 97{\%} or greater in anosmic patients. In contrast, only 45{\%} of aPD patients were categorised correctly by combined DaT/olfactory testing - mainly because of the presence of normosmic iPD patients. ConclusionsIn patients with an abnormal DaT SPECT, hyposmia yields an a posteriori likelihood of iPD/DLB of >90{\%}. In contrast, a finding of normosmia only increases the a posteriori likelihood of aPD to approximately the 50{\%}.",
keywords = "SMELL IDENTIFICATION TEST DOPAMINE TRANSPORTER CLINICAL-DIAGNOSIS DISEASE ACCURACY DYSFUNCTION HYPOSMIA SPECT",
author = "P. Borghammer and K. Knudsen and K. {\O}stergaard and Danielsen, {E. H.} and N. Pavese and A. Arveschoug and H. Bluhme and Matthias Bode and A. Morsing",
year = "2014",
doi = "10.1111/ijcp.12445",
language = "English",
volume = "68",
pages = "1345--1351",
journal = "International Journal of Clinical Practice",
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Borghammer, P, Knudsen, K, Østergaard, K, Danielsen, EH, Pavese, N, Arveschoug, A, Bluhme, H, Bode, M & Morsing, A 2014, 'Combined DaT imaging and olfactory testing for differentiating parkinsonian disorders', International Journal of Clinical Practice, bind 68, nr. 11, s. 1345-1351. https://doi.org/10.1111/ijcp.12445

Combined DaT imaging and olfactory testing for differentiating parkinsonian disorders. / Borghammer, P.; Knudsen, K.; Østergaard, K.; Danielsen, E. H.; Pavese, N.; Arveschoug, A.; Bluhme, H.; Bode, Matthias; Morsing, A.

I: International Journal of Clinical Practice, Bind 68, Nr. 11, 2014, s. 1345-1351.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Combined DaT imaging and olfactory testing for differentiating parkinsonian disorders

AU - Borghammer, P.

AU - Knudsen, K.

AU - Østergaard, K.

AU - Danielsen, E. H.

AU - Pavese, N.

AU - Arveschoug, A.

AU - Bluhme, H.

AU - Bode, Matthias

AU - Morsing, A.

PY - 2014

Y1 - 2014

N2 - ObjectiveDopamine transporter (DaT) imaging with single photon emission computed tomography (SPECT) detects loss of striatal dopaminergic innervation with very high sensitivity. It cannot readily distinguish idiopathic Parkinson's disease (iPD) and dementia with Lewy bodies (DLB) from atypical disorders (aPD). However, most iPD/DLB patients are hyposmic, whereas the majority of aPD patients were reported to have intact olfaction. For this reason, we conducted a longitudinal follow-up study to investigate the power of combined DaT imaging and olfactory testing to predict the final diagnosis of the patients. Materials and methodsA total of 129 patients received [123I]FP-CIT SPECT and olfactory testing at baseline assessment. Clinical follow-up 3012months later was the diagnostic standard of truth. A normative dataset of 24 healthy controls was used for comparison. ResultsBaseline DaT imaging predicted a dopamine-deficient diagnosis with 98% sensitivity and 98% specificity. The combined DaT/olfactory testing correctly classified 91% of patients as iPD/DLB (PPV 91%). The PPV rose to 97% or greater in anosmic patients. In contrast, only 45% of aPD patients were categorised correctly by combined DaT/olfactory testing - mainly because of the presence of normosmic iPD patients. ConclusionsIn patients with an abnormal DaT SPECT, hyposmia yields an a posteriori likelihood of iPD/DLB of >90%. In contrast, a finding of normosmia only increases the a posteriori likelihood of aPD to approximately the 50%.

AB - ObjectiveDopamine transporter (DaT) imaging with single photon emission computed tomography (SPECT) detects loss of striatal dopaminergic innervation with very high sensitivity. It cannot readily distinguish idiopathic Parkinson's disease (iPD) and dementia with Lewy bodies (DLB) from atypical disorders (aPD). However, most iPD/DLB patients are hyposmic, whereas the majority of aPD patients were reported to have intact olfaction. For this reason, we conducted a longitudinal follow-up study to investigate the power of combined DaT imaging and olfactory testing to predict the final diagnosis of the patients. Materials and methodsA total of 129 patients received [123I]FP-CIT SPECT and olfactory testing at baseline assessment. Clinical follow-up 3012months later was the diagnostic standard of truth. A normative dataset of 24 healthy controls was used for comparison. ResultsBaseline DaT imaging predicted a dopamine-deficient diagnosis with 98% sensitivity and 98% specificity. The combined DaT/olfactory testing correctly classified 91% of patients as iPD/DLB (PPV 91%). The PPV rose to 97% or greater in anosmic patients. In contrast, only 45% of aPD patients were categorised correctly by combined DaT/olfactory testing - mainly because of the presence of normosmic iPD patients. ConclusionsIn patients with an abnormal DaT SPECT, hyposmia yields an a posteriori likelihood of iPD/DLB of >90%. In contrast, a finding of normosmia only increases the a posteriori likelihood of aPD to approximately the 50%.

KW - SMELL IDENTIFICATION TEST DOPAMINE TRANSPORTER CLINICAL-DIAGNOSIS DISEASE ACCURACY DYSFUNCTION HYPOSMIA SPECT

U2 - 10.1111/ijcp.12445

DO - 10.1111/ijcp.12445

M3 - Journal article

C2 - 24754902

VL - 68

SP - 1345

EP - 1351

JO - International Journal of Clinical Practice

JF - International Journal of Clinical Practice

SN - 1368-5031

IS - 11

ER -

Borghammer P, Knudsen K, Østergaard K, Danielsen EH, Pavese N, Arveschoug A et al. Combined DaT imaging and olfactory testing for differentiating parkinsonian disorders. International Journal of Clinical Practice. 2014;68(11):1345-1351. https://doi.org/10.1111/ijcp.12445