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Simple Ratio Analysis of ¹⁸F-Fluorodopa Uptake in Striatal Subregions Separates Patients with Early Parkinson Disease from Healthy Controls

¹ Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland; ² Department of Biostatistics, University of Turku, Turku, Finland; and ³ Radiopharmaceutical Chemistry Laboratory, Turku PET Centre, Turku University Hospital, Turku, Finland

Correspondence: For correspondence or reprints contact: Pekka Jokinen, Turku PET Centre, Kiinamyllynkatu 4-8, 20520 Turku, Finland. E-mail: peanjo{at}utu.fi

6-¹⁸F-fluoro-L-dopa (¹⁸F-FDOPA) is widely used to investigate dopaminergic hypofunction, for instance, in Parkinson disease (PD). Conventionally, a 90-min scan with either a graphical or a metabolite-purified plasma input approach has been used for quantification. In the clinical setting, to increase compliance, especially in patients with more advanced disease, and to increase the efficacy of tracer and scanner time use, a shorter acquisition and a simple quantitative analysis are desirable. Taking into account the asymmetry of clinical symptoms and the uneven distribution of striatal dopaminergic hypofunction may also improve the use of ¹⁸F-FDOPA PET in early disease detection. Therefore, we compared subregional striatal ¹⁸F-FDOPA PET data from a large group of nonmedicated patients with early PD and a set of healthy elderly volunteers to find out whether a simple ratio approach would reliably separate PD patients from healthy controls. Methods: A total of 89 nonmedicated patients with early PD and 21 healthy volunteers were studied with ¹⁸F-FDOPA PET, and both a region-to-reference (striatal-to-occipital) ratio (SOR) calculated from 75 to 90 min after injection and a graphical analysis of data calculated from 15 to 90 min after ¹⁸F-FDOPA injection (yielding the influx constant [K_i^ref]) were used. Results: Both SOR and K_i^ref values in the PD patients were lowest, relative to those in the healthy controls, in the posterior putamen contralateral to the side with predominant clinical symptoms. The contralateral posterior putamen showed the largest areas under the receiver operating characteristic (ROC) curve—0.994 for SOR and 0.998 for K_i^ref—indicating excellent separation of the PD and control groups. The caudate nucleus and the ventral striatum were less impressive in this respect. Conclusion: A single 15-min scan 75 min after tracer injection seems to be sufficient for separating patients with PD from healthy controls in a clinical research environment. This method represents a powerful and economical alternative for research on the disease mechanism and differential diagnosis.

Key Words: ¹⁸F-FDOPA • quantification • Parkinson disease • PET

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JNM 2009 50: 11A-12A. [Full Text]