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Input Functions for 6-[Fluorine-18]Fluorodopa Quantitation in Parkinsonism: Comparative Studies and Clinical Correlations

Departments of Neurology, Research, Medicine and Biostatistics, North Shore University Hospital/Cornell University Medical College, Manhasset, New York

Correspondence: For correspondence or reprints contact: Dr. David Eidelberg, Dept. of Neurology, North Shore University Hospital/Cornell University Medical College, 300 Community Dr., Manhasset, New York 11030.

ABSTRACT

PET has been used to quantify striatal 6-[¹⁸F]fluoro-L-dopa (FDOPA) uptake as a measure of presynaptic dopaminergic function. Striatal FDOPA uptake rate constants (K₁) can be calculated using dynamic PET imaging with measurements of the plasma FDOPA input function determined either directly or by several estimation procedures. Methods: We assessed the comparative clinical utility of these methods by calculating the striato-occipital ratio (SOR) and striatal K₁ values in 12 patients with mild to moderate PD and 12 age-matched normal volunteers. The plasma FDOPA time-activity curve (K₁^FD); the plasma ¹⁸F time-activity curve (K₁^P); the occipital time-activity curve (K₁^OCC); and a simplified population-derived FDOPA input function (K₁^EFD) were used to calculate striatal K₁. Results: Mean values for all striatal K₁ estimates and SOR were significantly lower in the PD group. Although all measured parameters discriminated PD patients from normals, K₁^FD and K₁^EFD provided the best between-group separation. K₁^FD, K₁^EFD and K₁^OCC measures correlated significantly with quantitative disease severity ratings, although K₁^FD predicted quantitative clinical disability most accurately. Conclusion: These results suggest that K₁^FD may be an optimal marker of the parkinsonian disease process. K₁^EFD may be a useful alternative to K₁^FD for most clinical research applications.

Key Words: PET • 6-[¹⁸F]fluoro-L-dopa • input function • multiple time graphical approach • Parkinson's disease • discriminant analysis • nigrostriatal dopaminergic function

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