| 左睿,王政杰,翁宇,刘双,许璐.123I-MIBG及123I-FP-CIT SPECT/CT显像鉴别诊断帕金森病与非典型帕金森综合征:Meta分析[J].中国医学影像技术,2022,38(3):346~352 |
| 123I-MIBG及123I-FP-CIT SPECT/CT显像鉴别诊断帕金森病与非典型帕金森综合征:Meta分析 |
| 123I-MIBG and 123I-FP-CIT SPECT/CT for differential diagnosis of Parkinson disease and atypical Parkinson syndrome: Meta-analysis |
| 投稿时间：2021-06-10 修订日期：2021-11-14 |
| DOI：10.13929/j.issn.1003-3289.2022.03.007 |
| 中文关键词: 帕金森病 非典型帕金森综合征 体层摄影术,发射型计算机,单光子 荟萃分析 |
| 英文关键词:Parkinson disease atypical Parkinson syndrome tomography, emission-computed, single-photon meta-analysis |
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| 中文摘要: |
| 目的 采用Meta分析评价123I-间碘苄胍（123I-MIBG）及N-氟丙基-2b-甲酯基-3b-（4-123I-碘苯基）降托烷（123I-FP-CIT） SPECT/CT显像鉴别诊断帕金森病（PD）与非典型帕金森综合征（APS）的价值。方法 检索PubMed、EMbase、Ovid EBMR、Cochrane Library及中国知网、万方医学网、维普数据库中2000年1月—2020年10月有关123I-MIBG及123I-FP-CIT SPECT/CT显像鉴别PD与APS的文献。筛选文献后，根据显像结果将123I-MIBG SPECT/CT分为早期及延迟显像，评价其鉴别PD与APS的效能；采用Stata 16.0和Metadisc 1.4软件行Meta分析。结果 共纳入20篇文献，包括1 106例PD及365例APS患者。123I-MIBG显像鉴别诊断PD与APS无明显阈值效应（r=0.58，P<0.05），而123I-FP-CIT存在阈值效应引起的异质性（r=0.89，P<0.01）；二者鉴别诊断PD与APS均存在非阈值效应引起的中高度异质性（I2均>50%）；123I-MIBG早期及延迟显像鉴别诊断PD与APS均有较高异质性（I2均>50%），故均以双变量混合效应模型分析数据。123I-MIBG及123I-FP-CIT SPECT/CT显像鉴别诊断PD与APS的合并敏感度分别为0.82[95%CI（0.76，0.86）]及0.90[95%CI（0.84，0.94）]，合并特异度分别为0.84[95%CI（0.68，0.93）]及0.27[95%CI（0.12，0.50）]，综合受试者工作特征（SROC）显示其AUC分别为0.87及0.81；123I-MIBG SPECT/CT早期及延迟显像鉴别诊断PD与APS的合并敏感度分别为0.74[95%CI（0.63，0.82）]及0.82[95%CI（0.77，0.87）]，合并特异度分别为0.94[95%CI（0.78，0.98）]及0.79[95%CI（0.61，0.90）]，SROC的AUC均为0.86。结论 123I-MIBG及123I-FP-CIT SPECT/CT显像可互为补充用于鉴别诊断PD与APS；123I-MIBG早期及延迟显像的鉴别效能均较高。 |
| 英文摘要: |
| Objective To observe the value of 123I-metaiodobenzylguanidine (123I-MIBG) and N-vfluoro-propyl-2b-carbomethoxy-3b-(4-123I-iodophenyl) nortropane (123I-FP-CIT) SPECT/CT imaging for differential diagnosis of Parkinson disease (PD) and atypical Parkinson syndrome (APS) with meta-analysis. Methods Literature concerning differential diagnosis of PD and APS with 123I-MIBG and 123I-FP-CIT imaging were searched in the PubMed, EMbase, Cochrane Library, Ovid EBMR, CNKI, Wanfang Med Online and VIP databases from January 2000 to October 2020. According to imaging results, 123I-MIBG SPECT/CT was divided into early imaging and delayed imaging, and the efficacies of differentiating PD from APS were evaluated. Stata 16.0 and Metadisc 1.4 software were used for meta-analysis of the literature. Results Twenty articles were enrolled, including 1 106 PD and 365 APS patients. There was no significant threshold effect in differential diagnosis of PD and APS with 123I-MIBG imaging (r=0.58, P<0.05), but there was heterogeneity caused by threshold effect in 123I-FP-CIT imaging (r=0.89, P<0.01). There were middle and high heterogeneous caused by non-threshold effect (all I2>50%). The early and delayed 123I-MIBG imaging had high heterogeneity in differential diagnosis of PD and APS (all I2>50%), thus bivariate mixed-effects model was used to analyze the data. The pooled sensitivity and specificity of 123I-MIBG and 123I-FP-CIT SPECT/CT imaging in differential diagnosis of PD and APS was 0.82 (95%CI[0.76, 0.86]) and 0.90 (95%CI[0.84, 0.94]), 0.84 (95%CI[0.68, 0.93]) and 0.27 (95%CI[0.12, 0.50]), respectively, and the area under curve (AUC) of summary receiver operating characteristic (SROC) was 0.87 and 0.81, respectively. The pooled sensitivity and specificity of early and delayed 123I-MIBG SPECT/CT imaging in differential diagnosis of PD and APS was 0.74 (95%CI[0.63, 0.82]) and 0.82 (95%CI[0.77, 0.87]), 0.94 (95%CI[0.78, 0.98]) and 0.79 (95%CI[0.61, 0.90]), and the AUC of SROC was both 0.86. Conclusion Both 123I-MIBG and 123I-FP-CIT SPECT/CT imaging had certain value in differential diagnosis of PD and APS, which could be supplement for each other. Early and delayed phase 123I-MIBG imaging both had high differentiate efficacy. |
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