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. 2023 Oct 26;11(11):2893.
doi: 10.3390/biomedicines11112893.

Follow-Up Findings in Multiple System Atrophy from [123I]Ioflupane Single-Photon Emission Computed Tomography (SPECT): A Prospective Study

Javier Villena-Salinas  1 , Simeón José Ortega-Lozano  1 , Tomader Amrani-Raissouni  1 , Eduardo Agüera  2   3 , Javier Caballero-Villarraso  3   4   5
Affiliations

Follow-Up Findings in Multiple System Atrophy from [123I]Ioflupane Single-Photon Emission Computed Tomography (SPECT): A Prospective Study

Javier Villena-Salinas et al. Biomedicines. .

Abstract

Background: Multiple system atrophy (MSA) is subdivided into two types: MSA-P (parkinsonian) and MSA-C (cerebellar). Brain SPECT allows for the detection of nigrostriatal involvement, even in the early stages. To date, the scientific literature does not show a consensus on how to follow-up MSA, especially MSA-C. Our aim was to analyze the diagnostic effectiveness of repeat [123I]Ioflupane SPECT for the follow-up of MSA.

Methods: A longitudinal observational study on 22 MSA patients (11 males and 11 females).

Results: Significant changes were obtained in the quantitative SPECT assessments in the three Striatum/Occipital indices. The qualitative SPECT diagnosis did not show differences between the initial and evolving SPECT, but the neurologist's clinical suspicion did. Our results showed a brain deterioration of around 31% at 12 months, this being the optimal cut-off for differentiating a diseased subject (capable of solving diagnostic error rate). Previous imaging tests were inconclusive, as they showed less deterioration in the SPECT and quantitative assessments with respect to the group of confirmed patients. Repeated SPECT increased the diagnostic sensitivity (50% vs. 75%) and positive predictive value (72.73% vs. 77%). In addition, repeated SPECT proved decisive in the diagnosis of initial inconclusive cases.

Conclusion: Repeat SPECT at 12 months proves useful in the diagnosis and follow-up of MSA.

Keywords: Ioflupane-123; diagnostic accuracy; dysautonomia; follow-up study; functional neuroimaging testing; multiple system atrophy.

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Conflict of interest statement

This study has no sponsors or incentives, nor does it require funding for its development. Neither the participating investigators nor the hospital center have received any financial compensation. The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Follow-up of patient with MSA-C. A 62-year-old woman with MSA-C with dysautonomic, parkinsonian, and cerebellar symptoms, unresponsive to levodopa treatment. The evolutionary SPECT allowed the detection of bilateral striatal disease. (A) Anodyne basal SPECT. (B) Evolutionary SPECT at 12 months with noticeable bilateral striatal dysfunction. (C) MRI showed the characteristic “hot cross bun” sign in the cerebellum. The SPECT images are at 5 cm and the MRI image is at 10 cm.
Figure 2
Figure 2
SPECT evolution of striatal involvement in two patients (A,B) with MSA. (A) Seventy-one-year-old male with MSA-P, studies performed at baseline (A1), 11 months (A2), and 3 years (A3). (B) Forty-eight-year-old male with MSA-C. SPECT at baseline (B1), 9 months (B2), and 2 years (B3). The SPECT images are at 5 cm.
See this image and copyright information in PMC

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