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Research ArticleNeurology

Analysis of Extrastriatal 123I-FP-CIT Binding Contributes to the Differential Diagnosis of Parkinsonian Diseases

Merijn Joling, Chris Vriend, Odile A. van den Heuvel, Pieter G.H.M. Raijmakers, Paul A. Jones, Henk W. Berendse and Jan Booij
Journal of Nuclear Medicine July 2017, 58 (7) 1117-1123; DOI: https://doi.org/10.2967/jnumed.116.182139
Merijn Joling
1Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
2Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
3Amsterdam Neuroscience, Amsterdam, The Netherlands
4Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
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Chris Vriend
1Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
3Amsterdam Neuroscience, Amsterdam, The Netherlands
4Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
5Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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Odile A. van den Heuvel
3Amsterdam Neuroscience, Amsterdam, The Netherlands
4Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
5Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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Pieter G.H.M. Raijmakers
6Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; and
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Paul A. Jones
7GE Healthcare, The Grove Centre, Amersham, United Kingdom
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Henk W. Berendse
1Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
3Amsterdam Neuroscience, Amsterdam, The Netherlands
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Jan Booij
2Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
3Amsterdam Neuroscience, Amsterdam, The Netherlands
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  • FIGURE 1.
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    FIGURE 1.

    Binding ratios per ROI. * = statistically significant difference; + = trend. Striatal regions, including patients using SSRIs.

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    FIGURE 2.

    Binding ratios in hypothalamus, without patients using SSRIs. Data on thalamus and pons are provided in supplemental materials.

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    FIGURE 3.

    Voxel-by-voxel analysis of hypothalamus at (x,y,z), −2,0,−8. (Lower) Quantification per diagnosis.

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    TABLE 1

    Clinical Characteristics

    CharacteristicPDMSA-PMSA-CPSPTest statistic/df/P
    No. of patients309713
    Sexχ2 = 2.986/3/0.394
     Female14746
     Male16237
    Age at DAT SPECT66.39 ± 7.5561.37 ± 9.6167.72 ± 10.6370.46 ± 6.29F = 2.322/3,55/0.085
    Disease duration (y)3.59 ± 2.953.15 ± 2.593.57 ± 1.435.69 ± 4.71Kruskal–Wallis test = 4.98/3/0.173
    UPDRS III26.8 ± 12.441.38 ± 22.8336.50 ± 7.7833.17 ± 12.13Kruskal–Wallis test = 6.58/3/0.087
    SCOPA-AUT35.57 ± 8.4544.88 ± 12.0553,00 ± 11.3136.62 ± 6.62F = 12.662/2,55/0.001*
    SSRI (n)5 (16.7)3 (33.3)0 (0)3 (23.1)
    • ↵* For this analysis MSA-P and MSA-C were pooled into 1 group.

    • df = degree of freedom; UPDRS III = Unified Parkinson's Disease Rating Scale, motor evaluation; SCOPA-AUT = SCale for Outcomes of PArkinson’s Disease–AUTonomic Symptoms.

    • Values are mean ± SD, unless otherwise specified. Data in parentheses are percentages.

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    TABLE 2

    Between-Group Differences in 123I-FP-CIT Binding

    ROIsPDMSA-PMSA-CPSPF/df/P
    Striatal
     Caudate left1.82 ± 0.371.39 ± 0.471.99 ± 0.541.22 ± 0.537.619/3,55/<0.001
     Caudate right1.89 ± 0.411.43 ± 0.542.16 ± 0.551.36 ± 0.566.621/3,55/0.001
     Putamen left1.57 ± 0.331.22 ± 0.512.12 ± 0.511.28 ± 0.527.559/3,55/<0.001
     Putamen right1.49 ± 0.391.08 ± 0.501.95 ± 0.461.18 ± 0.546.588/3,55/0.001
    Extrastriatal
     Hypothalamus0.67 ± 0.160.45 ± 0.280.78 ± 0.300.47 ± 0.284.307/3,43/0.012
     Thalamus left0.79 ± 0.180.58 ± 0.270.80 ± 0.290.70 ± 0.291.576/3,43/0.236
     Thalamus right0.81 ± 0.180.68 ± 0.240.90 ± 0.200.68 ± 0.262.332/3,43/0.087
     Pons0.55 ± 0.030.41 ± 0.090.50 ± 0.050.48 ± 0.070.803/3,43/0.375
    • Extrastriatal groups depicted for patients without SSRI; F, df, and P values given are between-group analysis of covariance results, corrected for age.

    • Values given are mean ± SD, unless otherwise specified.

    • df = degrees of freedom.

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    TABLE 3

    Voxel-by-Voxel Analyses

    RegionGroup 1 > group 2KePFWE peak-voxelTx/y/z (mm)
    Caudate nucleus left (df, 1,54)PDPSP130.0054.80−14/4/20
    MSA-CPSP40.0084.67−12/18/12
    Caudate nucleus right (df, 1,54)PDPSP220.0054.8512/4/20
    MSA-P20.0244.3016/0/24
    MSA-CPSP20.0184.4118/0/18
    Posterior putamen left (df, 1,54)MSA-CPSP410.0044.69−26/−2/4
    MSA-P160.0074.51−26/−2/4
    PD330.0034.83−26/−14/6
    Posterior putamen right (df, 1,54)PDPSP20.0184.1736/−16/−8
    MSA-CPSP300.0044.7328/−10/2
    MSA-P280.0015.2228/−10/2
    130.0024.8832/−12/8
    PD20<0.0015.7328/−10/2
    Hypothalamus* (df, 1,43)PDPSP17<0.0015.93−4/0/−10
    MSA-P60.0024.79−6/0/−10
    MSA-CPSP8<0.0015.47−2/0/−8
    MSA-P40.0024.79−6/0/−10
    • ↵* For this analysis, patients not on SSRIs were included.

    • Difference between 2 diagnoses for specific cluster.

    • df =degrees of freedom; Ke = cluster extent in no. of voxels; PFWE = familywise error–corrected P values; T = T statistic; x/y/z = location of significantly most different between-groups cluster from midpoint in millimeter.

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Journal of Nuclear Medicine: 58 (7)
Journal of Nuclear Medicine
Vol. 58, Issue 7
July 1, 2017
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Analysis of Extrastriatal 123I-FP-CIT Binding Contributes to the Differential Diagnosis of Parkinsonian Diseases
Merijn Joling, Chris Vriend, Odile A. van den Heuvel, Pieter G.H.M. Raijmakers, Paul A. Jones, Henk W. Berendse, Jan Booij
Journal of Nuclear Medicine Jul 2017, 58 (7) 1117-1123; DOI: 10.2967/jnumed.116.182139

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Analysis of Extrastriatal 123I-FP-CIT Binding Contributes to the Differential Diagnosis of Parkinsonian Diseases
Merijn Joling, Chris Vriend, Odile A. van den Heuvel, Pieter G.H.M. Raijmakers, Paul A. Jones, Henk W. Berendse, Jan Booij
Journal of Nuclear Medicine Jul 2017, 58 (7) 1117-1123; DOI: 10.2967/jnumed.116.182139
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Keywords

  • Parkinson’s disease
  • multiple system atrophy
  • progressive supranuclear palsy
  • 123I-FP-CIT SPECT
  • DAT
  • SERT
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