Differential diagnosis of parkinsonian syndromes using F-18 fluorodeoxyglucose positron emission tomography

Tripathi, Madhavi; Dhawan, Vijay; Peng, Shichun; Kushwaha, Suman; Batla, Amit; Jaimini, Abhinav; D’Souza, Maria; Sharma, Rajnish; Saw, Sanjiv; Mondal, Anupam

doi:10.1007/s00234-012-1132-7

Cited by 72 publications

(55 citation statements)

References 26 publications

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“…Aside from multiclass relevance vector machine analysis (74), the specificity of the PET diagnoses for the APS subgroups MSA, PSP, and CBD usually exceeded 90% (as requested for a confirmatory test), whereas sensitivity was 77%-96% for MSA, 74%-100% for PSP, and 75%-91% for CBD (35,(40)(41)(42)70,71,73). Such subgroup classifications will be important for patient enrichment in future trials with disease-or pathology-specific treatments.…”

Section: Diagnostic Value: Preliminary Metaanalysismentioning

confidence: 99%

¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

et al. 2017

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Learning Objectives: On successful completion of this activity, participants should be able to (1) describe the clinical demand and rationale for differential diagnosis in parkinsonism, (2) recognize and differentiate the disease-specific patterns of regional glucose metabolism associated with Parkinson disease and the different atypical parkinsonian syndromes, and (3) identify regional metabolic changes that predict cognitive decline in Parkinson disease.Financial Disclosure: Dr. Meyer receives support from GE and Piramal for a research study outside the present topic. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA category 1 credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through December 2020.Accurate differential diagnosis of parkinsonism is of paramount therapeutic and prognostic importance. In addition, with the development of invasive therapies and novel disease-specific therapies, strategies for patient enrichment in trial populations are of growing importance. Imaging disease-specific patterns of regional glucose metabolism with PET and 18 F-FDG allows for a highly accurate distinction between Parkinson disease (PD) and atypical parkinsonian syndromes, including multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration. On the basis of a preliminary metaanalysis of currently available studies with inclusion of multiple disease groups, we estimated that the diagnostic sensitivity and specificity for visual PET readings supported by voxel-based statistical analyses for diagnosis of atypical parkinsonian syndromes are 91.4% and 90.6%, respectively. The diagnostic specificity of 18 F-FDG PET for diagnosing multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration was consistently shown to be high (.90%), whereas sensitivity was more variable (.75%). It is increasingly acknowledged that cognitive impairment represents a major challenge in PD, with mild cognitive impairment being a prodromal stage of PD with dementia (PDD). In line with clinical and neuropsychologic studies, recent PET studies demonstrated that posterior cortical dysfunction in nondemented PD patients precedes cognitive decline and the development of PDD by several years. Taken together, the current literature underscores the utility of 18 F-FDG PET for diagnostic evaluation of parkinsonism and the promising role of 18 F-FDG PET for assessment and risk stratification of cognitive impairment in PD.

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Section: Diagnostic Value: Preliminary Metaanalysismentioning

confidence: 99%

¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

et al. 2017

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“…This preservation of metabolic activity in the basal ganglia is a defining imaging feature of Parkinson disease and allows differentiation from both PSP and MSA, which commonly demonstrate reduced basal ganglia FDG activity. Occasionally, patients with Parkinson disease may demonstrate cortical hypometabolism in both parieto-occipital association areas (Fig 5b, 5d, 5e) and the dorsolateral prefrontal cortex, similar to the pattern seen in Alzheimer disease (29,30). When a pattern similar to that seen in Alzheimer disease is encountered, amyloid PET can be very useful, since it usually yields normal findings in patients with Parkinson disease (Fig 5c).…”

Section: Imaging Findingsmentioning

confidence: 84%

“…Specifically, patients with MSA-P demonstrate relatively symmetric decreased putaminal FDG activity, and patients with MSA-C show reduced FDG activity in the cerebellar hemispheres and middle cerebellar peduncles (Fig 6c, 6d, 6f, 6g) (29,30,41). Interestingly, cerebellar hypometabolism may be seen in patients without clinical signs of cerebellar dysfunction, and also in patients with MSA-P (29).…”

Section: Progressive Supranuclear Palsy Clinical Featuresmentioning

confidence: 94%

“…The classic finding at FDG PET is asymmetric basal ganglia and cortical glucose hypometabolism contralateral to the affected side (Fig 9d, 9e, 9g-9i) (29,30,41,65). Interestingly, several studies have shown that patients with CBD can have increased FDG activity in the basal ganglia and cortex ipsilateral to the clinically affected side (29,65).…”

Section: Imaging Findingsmentioning

confidence: 96%

“…FDG PET reveals decreased glucose metabolism in the basal ganglia, midbrain, and midline frontal lobes-in particular, the anterior cingulate cortices (Fig 7c, 7d, 7f-7h) (29,30,41). There is no corresponding cortical deposition at amyloid PET (Fig 7e).…”

Section: Imaging Findingsmentioning

confidence: 96%

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Structural and Functional Imaging in Parkinsonian Syndromes

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Hunt²,

Johnson³

et al. 2014

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Cognition in corticobasal syndrome and progressive supranuclear palsy: A review

2014

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Corticobasal syndrome (CBS) and progressive supranuclear palsy (PSP) represent challenging neurodegenerative disorders for clinicians and nonclinical scientists alike. Although initially lumped together as "Parkinson's-Plus" syndromes, CBS and PSP are clinically and pathologically distinct from Parkinson's disease. It is now clear that behavioral and cognitive changes are common in both syndromes and affect impact quality of life and carer burden considerably. We briefly review the clinical, pathological, and neuroradiological features of each syndrome, followed by more detailed descriptions of the behavioral and cognitive deficits encountered in CBS and PSP. Clinically and pathologically heterogeneous, CBS is characterized by a wide range of cognitive and behavioral disturbances. impairments in executive function and memory are common, but nonspecific. In contrast, deficits in language and visuospatial abilities appear to be more distinctive features of CBS; the relevance of specific patterns of impairment to the underlying histopathology, or prognosis, remains to be fully elucidated. As in CBS, behavioral and cognitive changes are almost universal in PSP, with a wide range of reported deficits. Apathy is very common, often paradoxically accompanied by impulsivity. Executive dysfunction is prominent, but memory and visuospatial deficits also occur. An emerging field is the study of social cognition, which appears impaired in both syndromes. As therapeutic strategies for neurodegenerative pathologies emerge, more specific diagnostic tools in CBS and PSP will be required. Careful clinicopathological correlation, and the development of biomarkers for specific histopathologies, will be important milestones on the road to effective treatments.

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Differential diagnosis of parkinsonian syndromes using F-18 fluorodeoxyglucose positron emission tomography

Abstract: Fluorodeoxyglucose-PET performed at the time of initial referral for parkinsonism is useful for the differential diagnosis of IPD, PSP, MSA, and CBS. Computer-assisted methods can be used for objective evaluation especially when expert readers are not available.

Cited by 72 publications

References 26 publications

¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

Structural and Functional Imaging in Parkinsonian Syndromes

Cognition in corticobasal syndrome and progressive supranuclear palsy: A review

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Differential diagnosis of parkinsonian syndromes using F-18 fluorodeoxyglucose positron emission tomography

Abstract: Fluorodeoxyglucose-PET performed at the time of initial referral for parkinsonism is useful for the differential diagnosis of IPD, PSP, MSA, and CBS. Computer-assisted methods can be used for objective evaluation especially when expert readers are not available.

Cited by 72 publications

References 26 publications

18F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

18F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

Structural and Functional Imaging in Parkinsonian Syndromes

Cognition in corticobasal syndrome and progressive supranuclear palsy: A review

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Product

Resources

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¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment