Re: Scans - my comments and opinion

September 12, 2002

Pam,

That sounds like a reasonable assessment at this time. There is one

additional note however, all of these studies were done on patients who

were diagnosed by conventional methods ) and therefore we will not

know for sure how well the tests work until patients who have been

assessed by these methods die and have autopsies.

Most of the papers did NOT claim perfect diagnostic powers of any of

the tests and several papers questioned the valisity of other papers -

as far as I could tell - because of the same type of question I posed

above. Therefore I feel that while the tests may help with an exact

diagnoses, they are not perfect.

Now comes the big question of how many tests do you need? Since there

is no cure for PSP, GBGD, PD, MSA or any of these brain disorders - is

it worth the effort and expense. We all know how hard it is to get a

MSA patient to a doctor's appointment much less a 90 minute PET scan.

Can your patient lay still for 90 minutes? Can you afford it -

certainly ask first if your insurance will cover it. These are

questions you must ask before deciding if it is right for you. I don't

know, but decided against a DNA test they said might narrow down

Charlotte's problems as insurance would not cover it as all suspected

problems were incurable. I felt she had enough.

Take care, Bill Werre

============================================

Pam Bower wrote:

>Note: Most of this is taken word for word or slightly paraphrased

>from

>http://www.emedicine.com/neuro/topic671.htm

>See the section on " Workup " .

>

>The rest I've gleaned from what I posted this morning.

>

>If you agree or disagree with my interpretation, please let's discuss.

>Regards,

>Pam

>

>---------------

>

>Scanning Technologies Available to aid in MSA Diagnosis

>

>1. MRI scans of the brain

> - MRI may be normal in MSA

> - MRI can help to exclude other diseases

> - OPCA, cerebellar atrophy, and the putaminal lesion of

>striatonigral

>degeneration often are detected by MRI

> - In MSA involving the extrapyramidal system (of the brain) a

>T2-weighted MRI shows a characteristic finding

>

>2. PET scans of the brain

> a. L-Dopa PET - determines the presense of a parkinson-like

>disorder

>

> b. FDG PET - For differentiation between MSA and PD, fluoride

>F 18

>fluordeoxyglucose dopa (FDG) positron emission tomography (PET)

>imaging can

>be used.

>The caudate-putamen index, which is calculated by a formula based on

>the

>difference in the uptakes in the caudate and putamen divided by the

>caudate

>uptake, is lower in patients with MSA than in patients with PD.

>

>3. Scintigraphy of the heart

> a. Scintigraphy with MIBG - Scintigraphy with I 123 MIBG

>appears to be

>a useful tool for differentiation between PD and MSA early after

>onset of

>autonomic dysfunction.

>

>4. SPECT scans of the brain

> - Can differentiate Parkinson-like disorders from other

>disorders like

>Essential Tremor

> - Is unable to differentiate between Parkinson's Disease,

>Multiple

>System Atrophy

>and Progressive Supranuclear Palsy.

>

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>unsubscribe by sending a blank email to

>

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>

September 13, 2002

Pam and Bill:

Somehow I missed Pam's Summary but saw it with Bill's post below.

It is refreshing to see some brief and accurate summaries that appear to

make a lot of sense.

Thanks to both of you.

Message: 2

Date: Thu, 12 Sep 2002 18:15:16 -0400

Subject: Re: Scans - my comments and opinion