Differential Diagnosis of Parkinsonism Using Dual-Phase F-18 FP-CIT PET Imaging
- 440 Downloads
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.
Ninety-eight subjects [five normal, seven drug-induced 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.
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.
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.
KeywordsAtypical parkinsonism Dual-phase F-18 FP-CIT Positron emission tomography PET
Conflicts of Interest
The authors declare no conflict of interest
- 18.Kim JS. Practical Approach for the Clinal Use of Dopamine Transporter Imaging. Nucl Med Mol Imaging. 2008;42(6):425–34.Google Scholar
- 20.Kim JS. Quantitative analysis and reproducibility of dopamine transporter density using [18 F]FPCIT positron emission tomography. Ph.D. Thesis, Seoul National University, February 2006.Google Scholar
- 27.Kasanuki K, Iseki E, Fujishiro H, Yamamoto R, Higashi S, Minegishi M, et al. Neuropathological investigation of the hypometabolic regions on positron emission tomography with [(18)F] fluorodeoxyglucose in patients with dementia with Lewy bodies. J Neurol Sci. 2012;314:111–9.PubMedCrossRefGoogle Scholar
- 30.Oh SW, Kim YK, Lee BC, Kim BS, Kim JS, Kim JM, et al. Evaluation of Multiple System Atrophy and Early Parkinson’s Disease Using 123I-FP-CIT SPECT. Nucl Med Mol Imaging. 2009;43:10–8.Google Scholar
- 31.Kim BS, Jang SJ, Eo JS, Park EK, Kim YK, Kim JM, et al. The Discriminating Nature of Dopamine Transporter Image in Parkinsonism: The Competency of Dopaminergic Transporter Imaging in Differential Diagnosis Of Parkinsonism: 123I-FP-CIT SPECT Study. Nucl Med Mol Imaging. 2007;41:272–9.Google Scholar
- 34.Antonini A, Benti R, De Notaris R, Tesei S, Zecchinelli A, Sacilotto G, et al. 123I-Ioflupane/SPECT binding to striatal dopamine transporter (DAT) uptake in patients with Parkinson’s disease, multiple system atrophy, and progressive supranuclear palsy. Neurol Sci. 2003;24:149–50.PubMedCrossRefGoogle Scholar