Abstract
P1343
Introduction: Parkinsonian syndromes are group of movement disorders characterized by tremor, bradykinesia, and rigidity.They are most frequently due to primary neurodegenerative disease, resulting in loss of dopaminergic nerve terminals along nigrostriatal pathway, as occurs in idiopathic Parkinson disease (IPD),and atypical parkinson diseases(APD) like multiple system atrophy(MSA),progressive supranuclear palsy(PSP), corticobasal degeneration(CBD), and dementia with Lewy bodies(DLB). Other causes of parkinsonism that do not involve nigrostriatal degeneration include drug-induced,autoimmune , vascular, or toxic insult and psychogenic disease .Herein we share our KMCH experience of TRODAT and FDG imaging in 65 patients and how it helped in identifying and helped neurlogists to come for proper diagnosis .
Methods: 65 patients with parkinson features are refered either to confirm diagnosis or to differentiate IPD vs APD .Study period is 2022 for one year .Proper history and clinical examination were done before imaging .99mTc-TRODAT SPECT CT was performed first day after IV injection of 20 mCi and imaging done after 4 hours for 1 hour duration without any head movement SPECT CT images were analysed visuallly to see uptake in caudate and putamen. F -18 FDG PET CT was done next day in seimens PET CT TOF and image analysis were done visually and also in scenium neuro software to see hypometabolism in caudate ,putamen ,frontal lobe ,precentral gyus ,midbrain ,pons ,thalamus and cerebellum .
Results: Total 65 patients(Male -25 ,female -40) were refered with symptoms of tremors ,rigidity ,walking difficulty and falls .Age group between 40 -70 yrs .youngest age is 17 yr old .Imaging showed IPD in 35 cases with either aymmetric or symmetric reduced TRODAT uptake in caudate and putamen(fig 1) ,with findings matching with clinically involved side more and first reduced uptake noted in putamen .Many patients clincal staging was not correlating with imaging severity and helped neurologist to decide treatment .FDG showed normal metabolism in basal ganglia in all cases .7 patients showed symmteric reduced TRODAT uptake and FDG showing hypometabolism in anterior midline frontal cortex ,caudate ,midbrain(fig 2) and some cases cerebellum .2 patients showed bilateral reduced TRODAT and FDG uptake in putamen only suggestive of MSA -P .2 patients showed asymmteric TRODAT reduced putamen uptake contralateral to side of symptoms and FDG showing asymmteric hypometabolism in basal ganglia ,precentral gyrus and parietal lobe ,suggestive of CBD .17 patients were normal TRODAT scan suggesting drug induced in 8 cases ,other 4 showed essential tremor ,normal pressure hydrocephalus ,frontotemproal dementia and osmotic demyelination syndrome .4 patients showed reduced TRODAT uptake symmtericaly and FDG showed hypermetabolism in medial temporal lobe ,suggestive of autoimmune parkinson .post immunoglobulin and steroids ,complete improvement in symptoms noted .
Conclusions: In our KMCH experience of 65 patients done in one year ,TRODAT and FDG really helped in confirming diagnosis of parkinsonism and helped in differentiating IPD vs APD and helped neurologist in treating patients and inform prognosis .Autoimmune parkinson was also diagnosed and helped in treating with immunoglobulins .
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