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临床诊断多系统性缩现状:从2008年到2022年的15年分析

Hiroaki Sekiya¹, Philip W Tipton¹, Miki Kawazoe¹

¹From the Department of Neuroscience (H.S., M.K., S.K., A.M., A.R.M., D.W.D.), and Department of Neurology (P.W.T., R.J.U., W.P.C., Z.K.W.), Mayo Clinic, Jacksonville, FL.

|November 12, 2024

概括

在2008-2017年和2018-2022年期间,诊断多系统缩 (MSA) 的积极预测值 (PPV) 显著改善. 增加脑部MRI的使用可能有助于MSA的诊断准确度的提高.

科学领域:

神经学神经学
病理学病理学病理学
诊断成像诊断成像诊断成像

背景情况:

多重系统缩 (MSA) 的临床诊断具有挑战性,在2022年提出新的标准.
临床MSA诊断的积极预测值 (PPV) 需要评估,特别是诊断工具的进步.

研究的目的:

为了调查临床MSA诊断的PPV的时间变化.
评估先进的诊断工具,特别是大脑MRI对MSA诊断准确性的影响.

主要方法:

从2008年到2022年在梅奥诊所对临床MSA诊断和可用的脑尸检的患者进行了回顾性分析.
两个时期 (2008-2017年和2018-2022年) 的PPV比较,并使用4年移动平均线分析趋势.
对MSA亚型的PPV的评估:帕金森症类型 (MSA-P) 和小脑类型 (MSA-C).

主要成果:

对MSA的总体PPV为70% (225/321确诊病例),其中30%具有替代诊断.
PPV从63% (2008-2017) 显著改善到78% (2018-2022) (或2.0,p=0.005) 的时间.
大脑MRI使用率增加 (91% vs 80%) 与PPV高 (73% vs 52%),特别是对于MSA-P.相关.

结论:

近年来,临床MSA诊断的PPV有所改善,这可能是由于大脑MRI利用率增加.
尽管有所改善,但对一些患者来说,MSA的准确临床诊断仍然具有挑战性.
这些发现为MSA的未来临床病理学研究奠定了基础.

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