The cingulate island sign in a mixed memory clinical cohort: Prevalence and diagnostic accuracy

INTRODUCTION

Visual rating of the cingulate island sign (CIS) on [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) has a high specificity for dementia with Lewy bodies (DLB) in selected cohorts such as DLB versus Alzheimer's disease (AD). In a mixed memory clinical population this study aimed to uncover the prevalence of CIS, the diagnostic accuracy for DLB, and the relationship between CIS and disease severity.

METHODS

CIS on [18F]FDG-PET was retrospectively assessed with the visual CIS rating scale (CISRs) in 1000 patients with a syndrome diagnosis of mild cognitive impairment (MCI) or dementia with no restrictions in etiological diagnosis.

RESULTS

In this cohort 24.3 % had a CISRs score ≥1 and 3.5 % had a CISRs score = 4. The prevalence of a CISRs score ≥1 was highest in DLB (74.0 %, n = 57). A CISRs score ≥1 was present in at least 9 % in other diagnostic groups. The prevalence of CIS across disease severities showed no statistically significant difference (p = 0.23). To differentiate DLB from non-DLB the optimal cut-off was a CISRs score ≥1 (balanced accuracy = 77.1 %) in MCI/mild dementia and a CISRs score ≥2 (balanced accuracy = 80.6 %) in moderate/severe dementia. The positive predictive value of a CISRs score = 4 for DLB was 57.7 % in MCI/mild dementia and 33.3 % in moderate/severe dementia.

CONCLUSION

The CISRs is useful in differentiating DLB from other etiologies in a mixed memory clinical population. Balanced accuracy and positive predictive value may vary across disease severities in the population studied.

Clinical validation of the cingulate island sign visual rating scale in dementia with Lewy bodies

INTRODUCTION

The cingulate island sign (CIS) is a metabolic pattern on [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography (PET) associated with dementia with Lewy bodies (DLB). The aim of this study was to validate the visual CIS rating scale (CISRs) for the diagnosis of DLB and to explore the clinical correlates.

METHODS

This single-center study included 166 DLB patients and 161 patients with Alzheimer's disease (AD). The CIS on [¹⁸F]FDG-PET scans was rated using the CISRs independently by three blinded raters.

RESULTS

The optimal cut-off to differentiate DLB from AD was a CISRs score ≥ 1 (sensitivity = 66%, specificity = 84%) whereas a CISRs score ≥ 2 (sensitivity = 58%, specificity = 92%) was optimal to differentiate amyloid positive DLB (n = 43 (82.7%)) and AD. To identify DLB with abnormal (n = 53 (72.6%)) versus normal (n = 20 (27.4%)) dopamine transporter imaging, a CISRs cut-off of 4 had a specificity of 95%. DLB with a CISRs score of 4 performed significantly better in tests on free verbal recall and picture based cued recall, but worse on processing speed compared to DLB with a CISRs score of 0.

CONCLUSION

This study confirms the CISRs as a valid marker for the diagnosis of DLB with a high specificity and a lower, but acceptable, sensitivity. Concomitant AD pathology does not influence diagnostic accuracy of the CISRs. In DLB patients, presence of CIS is associated with relative preserved memory function and impaired processing speed.

[Treatment of non-invasive aspergillosis of maxillary sinus by functional endoscopic sinus surgery]

OBJECTIVE

To evaluate the treatment of non-invasive aspergillosis of the maxillary sinus by using functional endoscopic sinus surgery (FESS) and the correlated factors that affect the treatment.

METHOD

41 cases of local, non-invasive aspergillosis of the maxillary sinus undergone FESS were studied.

RESULT

The period of convalescence of double pathway (via ostium of maxillary sinus and canine fossa) was 4.7 weeks while single pathway (via ostium of maxillary sinus only) was 9.3 weeks. There was significant difference (P < 0.01). The period of convalescence of group using anti-fungal drugs to wash the operative cavity was 6.4 weeks while the group without using drugs was 6.7 weeks. There was no statistic significance (P > 0.05).

CONCLUSION

FESS is effective in treating of non-invasive aspergillosis of the maxillary sinus. The operation of double pathway is superior to that of single pathway. Whether to use antifungal drugs to wash the operative cavity has no obvious effect on the efficacy.