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Differential diagnosis of parkinsonian syndromes using F-18 fluorodeoxyglucose positron emission tomography

  • Functional Neuroradiology
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Abstract

Introduction

Positron emission tomography (PET) imaging with F-18 fluorodeoxyglucose (FDG) has been used to identify characteristic patterns of regional glucose metabolism in patients with idiopathic Parkinson's disease (IPD) and the atypical parkinsonian syndromes of progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal syndrome (CBS). We undertook this study to assess the utility of fluorodeoxyglucose-PET in the differential diagnosis of individual patients with clinical parkinsonism. “Visual” and “computer-supported” reading of the fluorodeoxyglucose-PET scans were used for image interpretation and compared with each other.

Methods

One hundred thirty-six parkinsonian patients were referred from movement disorder clinics in specialty neurology centers for the fluorodeoxyglucose-PET study. Imaging-based diagnosis was obtained by visual assessment of individual scans by a PET physician blinded to the clinical diagnosis and also by computer-assisted interpretation using statistical parametric mapping (SPM) analysis. The results were compared with a 2-year follow-up clinical assessment made by a movement disorder specialist.

Results

Concordance of visual evaluation of fluorodeoxyglucose-PET with clinical diagnosis was achieved in 91.7 % of patients scanned, 97.6 % IPD, 80 % MSA, 76.6 % PSP, and 100 % CBS. Blinded computer assessment using SPM was concordant with the clinical diagnosis in 91 % of cases evaluated (90.4 % IPD, 80 % MSA, 93.3 % PSP, and 100 % CBS).

Conclusions

Fluorodeoxyglucose-PET performed at the time of initial referral for parkinsonism is useful for the differential diagnosis of IPD, PSP, MSA, and CBS. Computer-assisted methods can be used for objective evaluation especially when expert readers are not available.

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Acknowledgments

This work was funded by a fellowship grant to Dr. Madhavi Tripathi from the Indo-US Science and Technology Form. We are grateful to Dr. David Eidelberg and Dr. Yilong Ma of the Functional Imaging Laboratory, The Feinstein Institute for Medical Research, NSLIJHS, New York, for their critical review and expert guidance. We wish to acknowledge Dr. RP Tripathi, Director INMAS, and the entire team of Division of PET Imaging, INMAS for feasibility of patient studies. The authors also wish to thank Dr. Deepak Gupta for his initial contribution to this study.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Nuclear Medicine & PET, All India Institute of Medical Sciences, New Delhi, 110029, India

    Madhavi Tripathi

  2. The Feinstein Institute for Medical Research, Manhasset, NY, USA

    Vijay Dhawan & Shichun Peng

  3. Institute of Human Behaviour and Allied Sciences, Delhi, India

    Suman Kushwaha

  4. Sobell Department of Motor Neuroscience and Movement Disorder, UCL Institute of Neurology, London, UK

    Amit Batla

  5. Institute of Nuclear Medicine and Allied Sciences, New Delhi, India

    Abhinav Jaimini, Maria M. D’Souza, Rajnish Sharma, Sanjiv Saw & Anupam Mondal

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  1. Madhavi Tripathi
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  2. Vijay Dhawan
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Correspondence to Madhavi Tripathi.

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Tripathi, M., Dhawan, V., Peng, S. et al. Differential diagnosis of parkinsonian syndromes using F-18 fluorodeoxyglucose positron emission tomography. Neuroradiology 55, 483–492 (2013). https://doi.org/10.1007/s00234-012-1132-7

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  • DOI: https://doi.org/10.1007/s00234-012-1132-7

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