Comparison of brain MRI and ¹⁸F‐FDG PET in the differential diagnosis of multiple system atrophy from Parkinson's disease

Abstract

To investigate the diagnostic value of brain magnetic resonance image (MRI) and (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) in the differentiation of multiple system atrophy (MSA) from Parkinson's disease (PD). Thirty-five patients with MSA (23 MSA-P and 12 MSA-C) and 17 patients with PD were included in this study. Overall correct diagnosis rates between clinical and imaging diagnosis among MSA-P, MSA-C, and PD patients were 80% for visual MRI analysis, 88.5% for visual (18)F-FDG PET analysis, and 84.3% for SPM-supported analysis of (18)F-FDG PET. The sensitivity of brain MRI, and visual and SPM analysis of (18)F-FDG PET in differentiating MSA from PD was 72.7%, 90.9%, and 95.5%, respectively, the specificity was 100% for each imaging analysis, the positive predictive value was 100% for each imaging analysis, and the negative predictive value was 60%, 81.8%, and 90%, respectively. Our results suggest that brain MRI and (18)F-FDG PET are diagnostically useful in differentiating MSA (MSA-P and MSA-C) from PD, and indicate that (18)F-FDG PET has a tendency toward higher sensitivity compared to brain MRI, but a larger longitudinal study including pathological data will be required to confirm our findings.

Differential Diagnosis of Parkinsonism Using Dual-Phase F-18 FP-CIT PET Imaging

“…On early phase images, a decrease or increase of regional uptake is shown in MSA-P, MSA-C, PSP, and DLB groups compared with the IPD group. These findings generally correspond with several previous studies that have identified characteristic DAT binding of neurodegenerative parkinsonism [32][33][34] and glucose metabolism patterns with IPD, MSA, PSP, and DLB [11,23,26,27], respectively. NA not applicable…”

“…They classified these images as normal, MSA-P, MSA-C, PSP, or DLB, based on previous criteria of their glucose metabolism or brain perfusion, decreased regional uptake of the putamen, pons and cerebellum in MSA-P, decreased regional uptake of the cerebellum in MSA-C, decreased regional uptake of the caudate nucleus, the thalamus, midbrain and the cingulate gyrus in PSP, and decreased regional uptake of the occipital area, posterior cingulate cortex and temporo-parietal association area in DLB [11,22,[26][27][28]. The interobserver agreement and rate of correct classification were measured.…”

The utility of susceptibility-weighted imaging for differentiating Parkinsonism-predominant multiple system atrophy from Parkinson’s disease: Correlation with 18F-flurodeoxyglucose positron-emission tomography

“…Recently, Kwon et al, observed that MSA-P patients showed significant hypometabolism in the putamen [36]. In agreement with the results of this previous study, our results showed significantly decreased metabolic activity of the bilateral putamen in MSA-P compared with PD.…”

Neuroimaging of Rapidly Progressive Dementias, Part 1: Neurodegenerative Etiologies

“…26,34 In the pons, there is the classic imaging finding of the "hot cross bun sign" (Fig 4). [35][36][37] With this atrophy, there may be a surrounding hyperintense rim seen on T2 images, which may appear before the hot cross bun sign, but it is unfortunately nonspecific, with atrophy being more important in distinguishing MSA from Parkinson disease. 36,38 T2* gradient-echo signal loss within the dorsolateral putamen reflective of increased iron deposition is highly specific for MSA, but not always present.…”