title: Diagnostic performance of iodine-123-metaiodobenzylguanidine scintigraphy in differential diagnosis between Parkinson's disease and multiple-system atrophy: a systematic review and a meta-analysis.
abstract: OBJECTIVE
  This study was designed to review the diagnostic performance of iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between Parkinson's disease (PD) and multiple-system atrophy (MSA).
  
  
  METHODS
  A comprehensive computer literature search of studies published through March 2011 regarding MIBG scintigraphy in patients with PD and MSA was performed in PubMed/MEDLINE and Embase databases. Only studies in which MIBG scintigraphy was performed for differential diagnosis between PD and MSA were selected. Pooled sensitivity and specificity of MIBG scintigraphy were presented with a 95% confidence interval (CI). The area under the ROC curve was calculated to measure the accuracy of MIBG scintigraphy in differential diagnosis between PD and MSA.
  
  
  RESULTS
  Ultimately, we identified 12 studies comprising a total of 1226 patients (593 patients with PD, 117 patients with other Lewy body disease, 129 patients with MSA, and 387 patients with other diseases). The pooled sensitivity of MIBG scintigraphy to detect PD was 89% (95% CI: 86-91%); the pooled specificity of MIBG scintigraphy to discriminate between PD and MSA was 77% (95% CI: 68-84%). The area under the ROC curve was 0.93.
  
  
  CONCLUSIONS
  MIBG scintigraphy is an accurate test for PD detection and differential diagnosis between PD and MSA; this method shows high sensitivity and adequate specificity in this field. Nevertheless, possible causes of false negative and false positive findings should be considered when interpreting the scintigraphic results.
authors.affiliation: Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Largo Gemelli, 8, Rome 00168, Italy. giorgiomednuc@libero.it
authors.forename: Giorgio
authors.initials: G
authors.lastname: Treglia
authors.forename: Antonella
authors.initials: A
authors.lastname: Stefanelli
authors.forename: Ernesto
authors.initials: E
authors.lastname: Cason
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cocciolillo
authors.forename: Daniela
authors.initials: D
authors.lastname: Di Giuda
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
mesh_terms: D019797:3-Iodobenzylguanidine; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D006801:Humans; D007091:Image Processing, Computer-Assisted; D019578:Multiple System Atrophy / Q000175:diagnosis* / Q000000981:diagnostic imaging; D010300:Parkinson Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012372:ROC Curve; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine