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Dual-Tracer Dopamine Transporter and Perfusion SPECT in Differential Diagnosis of Parkinsonism Using Template-Based Discriminant Analysis

Koenraad Van Laere, MD, PhD, DrSc1, Cindy Casteels, MSc1, Liesbet De Ceuninck, MD1, Bert Vanbilloen, PhD2, Alex Maes, MD, PhD3, Luc Mortelmans, MD, PhD1, Wim Vandenberghe, MD, PhD4, Alfons Verbruggen, MD, PhD2 and René Dom, MD, PhD4

1 Division of Nuclear Medicine, University Hospital Gasthuisberg and K.U. Leuven, Leuven, Belgium; 2 Laboratory for Radiopharmaceutical Chemistry, K.U. Leuven, Leuven, Belgium; 3 Division of Nuclear Medicine, A.Z. Groeninghe, Kortrijk, Belgium; and 4 Department of Neurology, University Hospital Gasthuisberg and K.U. Leuven, Leuven, Belgium


Figure 1
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  		FIGURE 1.  Perfusion SPM t-maps with respect to IPD of atypical parkinsonism and ET. In hot scale reductions in relative 99mTc-ECD uptake are given, in winter colors the increases with respect to IPD (extent threshold kE = 50; cutoff T statistic as indicated; t = 2.5 corresponds to a voxel intensity P value of 0.007).

 

Figure 2
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  		FIGURE 2.  DAT binding index SPM t-maps with respect to ET. Reductions (T statistic) in uptake are given for an extent threshold kE = 50 (t = 3 corresponds to a voxel intensity P value of 0.001).

 

Figure 3
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  		FIGURE 3.  (A) 2-Dimensional projection plot of discriminant canonical functions for differentiation of neurodegenerative parkinsonism using DAT (123I-FP-CIT) and perfusion imaging (99mTc-ECD). (B) Discriminant canonical functions for differentiation of atypical neurodegenerative parkinsonism using DAT (123I-FP-CIT) and perfusion imaging (99mTc-ECD). Ellipses show minimal extent of contours that cover all plotted group data.

 

Figure 4
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  		FIGURE 4.  The 95% confidence intervals of most discriminating regions between IPD, MSA, PSP, LBD, and ET for combined perfusion and DAT imaging. Perfusion values are relative to the whole-brain gray matter average; 123I-FP-CIT binding indices are calculated as (uptake/occipital uptake – 1). R = right; L = left; THAL = thalamus; CBL = cerebellum; Post = posterior; Put = putamen; CNC = caudate head; MSA-p = striatal (parkinsonian) variant of MSA; MSA-c = cerebellar variant of MSA.

 




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