Evidence Table DIAG4cHow effective is magnetic resonance spectroscopy vs long-term clinical follow-up in determining an accurate diagnosis in patients with a parkinsonian syndrome?

Author/title/reference/yrClarke, C. E. & Lowry, M. 2001, "Systematic review of proton magnetic resonance spectroscopy of the striatum in parkinsonian syndromes", European Journal of Neurology., vol. 8, no. 6, pp. 573–577.
N=11 studies
N= 3 – 151 IPD range
N= 4 –97 Control range

Sites=multiple
Research designSystematic review of mixed study designs
Aim(1) Clarifying the role of MRS in the differential diagnosis of parkinsonian syndromes;
(2) Informing decisions about future work.
PopulationParkinsonian syndromes
InterventionMagnetic resonance spectroscopy of striatal structures
ComparisonClinical diagnoses
OutcomeNAA/Cr and N-acetylaspartate/choline levels changes in various parkinsonian sub-groups
CharacteristicsNo details regarding the population characteristics
ResultsOne multinational study with as many IPD patients as the remaining studies combined, failed to identify and difference in NAA/Cr or NAA/Cho ratios between IPD cases and healthy controls (means of defining IPD diagnosis not stated). Subgroups defined on age have not been analysed. 6 further studies found no significant differences between IPD and controls
One study found NAA/Cho ratios were reduced in de novo Vs controls but not significantly reduced in cases with complications, and this was confirmed by 2 other studies one of which also showed reduced NAA/Cr in IPD with or without complications.
Findings of reduced NAA/Cho and NAA/Cr ratios have been made in both MSA and IPD populations.
Authors state that “It is contended that no clear conclusions on the change in metabolite concentrations and ratios should be drawn from such heterogeneous results”.
More research is needed before conclusions can be reached
SIGN quality rating+
Evidence hierarchy gradingDS III
Comments➢ Database searches are limited to Medline, with identified studies reference lists analysed and conference proceedings identified
➢ Short description of research methodology
➢ No formal quality assessment of studies documented
➢ Correspondence with authors confirms that informal evaluation of study quality and description given in discussion
➢ Significant heterogeneity in study methodologies and outcome measures
➢ Population characteristics limited.
Studies IncludedDavie et al. 1995; 1997; Ray Chaudhuri et al., 1996; Ellis et al., 1996; 1997; Hu et al. 1998; Clarke et al., 1997; 2000; Cruz et al., 1997; Tedeschi et al., 1997; Turjanski et al., 1997; Tan et al., 1998; Federico et al., 1999; Ross et al., 1999; Simoes-Ribeiro et al., 1999.
NCC CC ID17

From: Evidence Tables

Cover of Parkinson's Disease
Parkinson's Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care.
NICE Clinical Guidelines, No. 35.
National Collaborating Centre for Chronic Conditions (UK).
Copyright © 2006, Royal College of Physicians of London.

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