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MRI of the Swallow Tail Sign: A Useful Marker in the Diagnosis of Lewy Body Dementia?
Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Med Imaging & Technol, Stockholm, Sweden.; Karolinska Univ Hosp, Dept Radiol, SE-14186 Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
Univ Nottingham, Radiol Sci, Div Clin Neurosci, Sch Med, Nottingham, England.
Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.; Karolinska Univ Hosp, Div Clin Geriatr, Stockholm, Sweden..
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2017 (English)In: American Journal of Neuroradiology, ISSN 0195-6108, E-ISSN 1936-959X, Vol. 38, no 9, p. 1737-1741Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: There are, to date, no MR imaging diagnostic markers for Lewy body dementia. Nigrosome 1, containing dopaminergic cells, in the substantia nigra pars compacta is hyperintense on SWI and has been called the swallow tail sign, disappearing with Parkinson disease. We aimed to study the swallow tail sign and its clinical applicability in Lewy body dementia and hypothesized that the sign would be likewise applicable in Lewy body dementia.

MATERIALS AND METHODS: This was a retrospective cross-sectional multicenter study including 97 patients (mean age, 65 ± 10 years; 46% women), consisting of the following: controls (n = 21) and those with Lewy body dementia (n = 19), Alzheimer disease (n = 20), frontotemporal lobe dementia (n = 20), and mild cognitive impairment (n = 17). All patients underwent brain MR imaging, with susceptibility-weighted imaging at 1.5T (n = 46) and 3T (n = 51). The swallow tail sign was assessed independently by 2 neuroradiologists.

RESULTS: Interrater agreement was moderate (κ = 0.4) between raters. An abnormal swallow tail sign was most common in Lewy body dementia (63%; 95% CI, 41%-85%; P < .001) and had a predictive value only in Lewy body dementia with an odds ratio of 9 (95% CI, 3-28; P < .001). The consensus rating for Lewy body dementia showed a sensitivity of 63%, a specificity of 79%, a negative predictive value of 89%, and an accuracy of 76%; values were higher on 3T compared with 1.5T. The usefulness of the swallow tail sign was rater-dependent with the highest sensitivity equaling 100%.

CONCLUSIONS: The swallow tail sign has diagnostic potential in Lewy body dementia and may be a complement in the diagnostic work-up of this condition.

Place, publisher, year, edition, pages
2017. Vol. 38, no 9, p. 1737-1741
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Medical and Health Sciences
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URN: urn:nbn:se:uu:diva-327245DOI: 10.3174/ajnr.A5274ISI: 000409827200016PubMedID: 28705819OAI: oai:DiVA.org:uu-327245DiVA, id: diva2:1129848
Funder
Stockholm County CouncilThe Karolinska Institutet's Research FoundationThe Dementia Association - The National Association for the Rights of the DementedAvailable from: 2017-08-07 Created: 2017-08-07 Last updated: 2017-12-06Bibliographically approved

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Fällmar, DavidLarsson, Elna-Marie

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