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

Abstract

Purpose Dopamine transporter (DAT) imaging can demonstrate presynaptic dopaminergic neuronal loss in Parkinson's disease (PD). However, differentiating atypical parkinsonism (APD) from PD is often difficult. We investigated the usefulness of dual-phase F-18 FP-CIT positron emission tomography (PET) imaging in the differential diagnosis of parkinsonism. Methods Ninety-eight subjects [five normal, seven druginduced parkinsonism (DIP), five essential tremor (ET), 24 PD, 20 multiple system atrophy-parkinson type (MSA-P), 13 multiple system atrophy-cerebellar type (MSA-C), 13 progressive supranuclear palsy (PSP), and 11 dementia with Lewy bodies (DLB)] underwent F-18 FP-CIT PET. PET images were acquired at 5 min (early phase) and 3 h (late phase) after F-18 FP-CIT administration (185 MBq). Regional uptake pattern of cerebral and cerebellar hemispheres was assessed on early phase images and striatal DAT binding pattern was assessed on late phase images, using visual, quantitative, and statistical parametric mapping (SPM) analyses. Results Striatal DAT binding was normal in normal, ET, DIP, and MSA-C groups, but abnormal in PD, MSA-P, PSP, and DLB groups. No difference was found in regional uptake on early phase images among normal DAT binding groups, except in the MSA-C group. Abnormal DAT binding groups showed different regional uptake pattern on early phase images compared with PD in SPM analysis (FDR< 0.05). When discriminating APD from PD, visual interpretation of the early phase image showed high diagnostic sensitivity and specificity (75.4 % and 100 %, respectively). Regarding the ability to distinguish specific APD, sensitivities were 81 % for MSA-P, 77 % for MSA-C, 23 % for PSP, and 54.5 % for DLB. Conclusions Dual-phase F-18 FP-CIT PET imaging is useful in demonstrating striatal DAT loss in neurodegenerative parkinsonism, and also in differentiating APD, particularly MSA, from PD.

Imaging biomarkers in Parkinson’s disease and Parkinsonian syndromes: current and emerging concepts

“…Similar to DAT-SPECT findings, striatal DAT PET studies have also found abnormal uptake in PD, MSA- P , PSP and DLB groups versus controls, whereas normal activity was detected in patients with essential tremor and MSA- C [144, 145]. Using dual-phase 18 F-FP-CIT PET, Jin et al found that visual interpretation of early-phase images (acquired at 5-min) to have a favourable diagnostic potential for distinguishing PD from atypical PS (sensitivity 75.4%, specificity 100%) [144]. Using a recently-developed PET radiotracer, 18 F-(E)-N-(3-iodoprop-2-enyl)-2β-carbofluoroethoxy-3β-(4′-methyl-phenyl)nortropane ( 18 F-FE-PE2I), reduction in DAT in the striatum and SN was replicated in PD patients versus controls.…”

“…In contrast to PD, however, putamen and caudate regions were equally impaired in PSP, and the mean uptakes in these regions among MSA patients were in between that of PD and PSP [141]. Similar to DAT-SPECT findings, striatal DAT PET studies have also found abnormal uptake in PD, MSA- P , PSP and DLB groups versus controls, whereas normal activity was detected in patients with essential tremor and MSA- C [144, 145]. Using dual-phase 18 F-FP-CIT PET, Jin et al found that visual interpretation of early-phase images (acquired at 5-min) to have a favourable diagnostic potential for distinguishing PD from atypical PS (sensitivity 75.4%, specificity 100%) [144].…”

Metabolic network expression in parkinsonism: Clinical and dopaminergic correlations

“…Three-dimensional (3D) emission PET data were acquired for 10 min as described in detail elsewhere. 21 FPCIT PET images were warped into MNI space using an in-house template 22 and SPM5 software. Regions-of-interest for the putamen, caudate and cerebellum (reference region) are placed on each normalized FPCIT PET image using automated anatomical labeling.…”

Nigrosome 1 Detection at 3T MRI for the Diagnosis of Early-Stage Idiopathic Parkinson Disease: Assessment of Diagnostic Accuracy and Agreement on Imaging Asymmetry and Clinical Laterality

“…In this study, we investigated the feasibility of the nigrosome 1 detection at 3T MR imaging for the diagnosis of patients with early-stage IPD with abnormal findings on DAT PET imaging. 12 Additionally, we assessed the agreement of asymmetry between the nigrosome 1 detection and patient symptoms, and the asymmetry between the DAT PET imaging and patient symptoms.…”