Quantification and discriminative power of 18F-FE-PE2I PET in patients with Parkinson’s disease

  • Aline DelvaEmail author
  • Donatienne Van Weehaeghe
  • June van Aalst
  • Jenny Ceccarini
  • Michel Koole
  • Kristof Baete
  • Johan Nuyts
  • Wim Vandenberghe
  • Koen Van Laere
Original Article
Part of the following topical collections:
  1. Neurology



Dopamine transporter (DAT) imaging is an important adjunct in the diagnostic workup of patients with Parkinsonism. 18F-FE-PE2I is a suitable PET radioligand for DAT quantification and imaging with good pharmacokinetics. The aim of this study was to determine a clinical optimal simplified reference tissue-based image acquisition protocol and to compare the discriminatory value and effect size for 18F-FE-PE2I to that for 123I-FP-CIT scan currently used in clinical practice.


Nine patients with early Parkinson’s disease (PD, 64.3 ± 6.8 years, 3M), who had previously undergone a 123I-FP-CIT scan as part of their diagnostic workup, and 34 healthy volunteers (HV, 47.7 ± 16.8 years, 13M) underwent a 60-min dynamic 18F-FE-PE2I PET-MR scan on a GE Signa 3T PET-MR. Based on dynamic data and MR-based VOI delineation, BPND, semi-quantitative uptake ratio and SUVR[t1–t2] images were calculated using either occipital cortex or cerebellum as reference region. For start-and-end time of the SUVR interval, three time frames [t1t2] were investigated: [15–40] min, [40–60] min, and [50–60] min postinjection. Data for putamen (PUT) and caudate nucleus-putamen ratio (CPR) were compared in terms of quantification bias versus BPND and discriminative power.


Using occipital cortex as reference region resulted in smaller bias of SUVR with respect to BPND + 1 and higher correlation between SUVR and BPND + 1 compared with using cerebellum, irrespective of SUVR [t1t2] interval. Smallest bias was observed with the [15–40]-min time window, in accordance with previous literature. The correlation between BPND + 1 and SUVR was slightly better for the late time windows. Discriminant analysis between PD and HV using both PUT and CPR SUVRs showed an accuracy of ≥ 90%, for both reference regions and all studied time windows. Semi-quantitative 123I-FP-CIT and 18F-FE-PE2I values and relative decrease in the striatum for patients were highly correlated, with a higher effect size for 18F-FE-PE2I for PUT and CPR SUVR.


18F-FE-PE2I is a suitable radioligand for in vivo DAT imaging with high discriminative power between early PD and healthy controls. Whereas a [15–40]-min window has lowest bias with respect to BPND, a [50–60]-min time window at pseudoequilibrium can be advocated in terms of clinical feasibility with optimal discriminative power. The occipital cortex may be slightly preferable as reference region because of the higher time stability, stronger correlation of SUVR with BPND + 1, and lower bias. Moreover, the data suggest that the diagnostic accuracy of a 10-min static 18F-FE-PE2I scan is non-inferior compared with 123I-FP-CIT scan used in standard clinical practice.


Parkinson’s disease DAT (dopamine transporter) PET (positron emission tomography) 18F-FE-PE2I 123I-FP-CIT 



The authors explicitly want to thank Mr. Kwinten Porters and Mr. Jef Van Loock for their contributions to the scanning and data handling, and the PET radiopharmacy and medical physics teams of UZ Leuven for their skilled contributions.

Compliance with ethical standards

Conflict of interest

Koen Van Laere and Wim Vandenberghe are Senior Clinical Investigators of the Fund for Scientific Research, Flanders, Belgium (FWO). Donatienne Van Weehaeghe and Aline Delva are PhD fellows of the FWO. Jenny Ceccarini is a postdoctoral fellow of the FWO. There are no other conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (UZ/KU Leuven Ethical Committee Belgium) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosciencesKU LeuvenLeuvenBelgium
  2. 2.Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
  3. 3.Division of Nuclear MedicineUniversity Hospitals LeuvenLeuvenBelgium
  4. 4.Nuclear Medicine and Molecular Imaging, Department of Imaging and PathologyKU LeuvenLeuvenBelgium

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