Abstract
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Objectives: To investigate the 18F-FDG and 11C-CFT PET features and differential diagnose in the brain of patients with different grade of Parkinson’s disease and essential tremor by PET imaging.
Methods: Sixty-three patients with early Parkinson’s disease (Hoehn-Yahr stage 1~2), 8 with advanced PD (Hoehn-Yahr stage 3~5) and 9 essential tremor patients underwent 11C-methyl-N-2β-carbomethoxy-3β-(4-fluorophenyl)-tropanel (11C-CFT) and 18F-fludeoxyglucose (18F-FDG) PET/CT scans. 18F-FDG (11C-CFT) PET studies were analyzed using BIONALYX (TM) Cerebrum to quantify and conduct statistical analysis. We also use self-built normal human PET brain template for analysis and comparison. Finally, we identified areas of the brain that are abnormally metabolized and obtained relevant quantitative information.
Results: There were obvious high uptake in the frontal lobe, occipital lobe, limbic system, precuneus, lentiform nucleus, middle frontal gyrus, precentral gyrus, insula and thalamus in the software analysis results between early Parkinson’s disease and normal controls (Figure: A). The BIONALYX (TM) analysis revealed a significant and asymmetric increase of 18F-FDG uptake in the frontal lobe, limbic lobe, occipital lobe, precuneus, parietal lobe, lentiform nucleus and putamen in early PD (H-Y 1~2) patients compared with the essential tremor patients. (Figure: B). Nearly the same results between the early PD and normal controls. Compared with advanced PD patients, the metabolic of 18F-FDG was higher in bilateral limbic lobe, precuneus and putamen in the early PD patients. (Figure: C). Compared with the essential tremor patients, the increase of 11C-CFT was more significantly in bilateral putamen (603voxels), lentiform nucleus (601voxels) and caudate (561voxels) in patients with early PD. (Figure: D). In those with advanced PD, the similar results were found in bilateral lentiform nucleus (479voxels), putamen (471voxels) and caudate (349voxels). (Figure: E) But the results are not such obvious like the last results from the statistical analysis. The above results were consistent with the changes of relative metabolic voxels in the subregions of brain. The voxels were significantly different in lentiform nucleus, caudate, putamen, frontal lobe, parietal lobule and occipital lobe among the 5 groups (18F-FDG features between early Parkinson’s disease and normal controls, 18F-FDG features between early PD patients compared with the essential tremor patients, 18F-FDG features between early PD patients compared with advanced PD patients. 11C-CFT features between early PD patients compared with the essential tremor patients. 11C-CFT features between early PD patients compared with advanced PD patients.). Conclusions: The 18F-FDG and 11C-CFT features are different between PD and essential tremor patients from the software statistical results, which are the sensitive biomarkers in the diagnosis and assessment of disease severity of PD patients. Otherwise, 11C-CFT images are easier to observe than the 18F-FDG images through the visual evaluation.