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Chunowski P, Madetko-Alster N, Alster P. Asymmetry in Atypical Parkinsonian Syndromes-A Review. J Clin Med 2024; 13:5798. [PMID: 39407856 PMCID: PMC11477316 DOI: 10.3390/jcm13195798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/25/2024] [Accepted: 09/26/2024] [Indexed: 10/20/2024] Open
Abstract
Background/Objectives: Atypical parkinsonian syndromes (APSs) are a group of neurodegenerative disorders that differ from idiopathic Parkinson's disease (IPD) in their clinical presentation, underlying pathology, and response to treatment. APSs include conditions such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and dementia with Lewy bodies (DLB). These disorders are characterized by a combination of parkinsonian features and additional symptoms, such as autonomic dysfunction, supranuclear gaze palsy, and asymmetric motor symptoms. Many hypotheses attempt to explain the causes of neurodegeneration in APSs, including interactions between environmental toxins, tau or α-synuclein pathology, oxidative stress, microglial activation, and vascular factors. While extensive research has been conducted on APSs, there is a limited understanding of the symmetry in these diseases, particularly in MSA. Neuroimaging studies have revealed metabolic, structural, and functional abnormalities that contribute to the asymmetry in APSs. The asymmetry in CBS is possibly caused by a variable reduction in striatal D2 receptor binding, as demonstrated in single-photon emission computed tomography (SPECT) examinations, which may explain the disease's asymmetric manifestation and poor response to dopaminergic therapy. In PSP, clinical dysfunction correlates with white matter tract degeneration in the superior cerebellar peduncles and corpus callosum. MSA often involves atrophy in the pons, putamen, and cerebellum, with clinical symmetry potentially depending on the symmetry of the atrophy. The aim of this review is to present the study findings on potential symmetry as a tool for determining potential neuropsychological disturbances and properly diagnosing APSs to lessen the misdiagnosis rate. Methods: A comprehensive review of the academic literature was conducted using the medical literature available in PubMed. Appropriate studies were evaluated and examined based on patient characteristics and clinical and imaging examination outcomes in the context of potential asymmetry. Results: Among over 1000 patients whose data were collected, PSP-RS was symmetrical in approximately 84% ± 3% of cases, with S-CBD showing similar results. PSP-P was symmetrical in about 53-55% of cases, while PSP-CBS was symmetrical in fewer than half of the cases. MSA-C was symmetrical in around 40% of cases. It appears that MSA-P exhibits symmetry in about 15-35% of cases. CBS, according to the criteria, is a disease with an asymmetrical clinical presentation in 90-99% of cases. Similar results were obtained via imaging methods, but transcranial sonography produced different results. Conclusions: Determining neurodegeneration symmetry may help identify functional deficits and improve diagnostic accuracy. Patients with significant asymmetry in neurodegeneration may exhibit different neuropsychological symptoms based on their individual brain lateralization, impacting their cognitive functioning and quality of life.
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Affiliation(s)
- Patryk Chunowski
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland; (N.M.-A.); (P.A.)
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Du X, Zhao H, Li Y, Dai Y, Gao L, Li Y, Fan K, Sun Z, Zhang Y. The value of PET/CT in the diagnosis and differential diagnosis of Parkinson's disease: a dual-tracer study. NPJ Parkinsons Dis 2024; 10:171. [PMID: 39256393 PMCID: PMC11387816 DOI: 10.1038/s41531-024-00786-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 08/27/2024] [Indexed: 09/12/2024] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) is a molecular imaging method commonly used to diagnose and differentiate Parkinson's disease (PD). This study aimed to evaluate the performance of PET/CT with 11C-2β-Carbomethoxy-3β-(4-fluorophenyl) tropane (11C-CFT) and 18F-fluorodeoxyglucose (18F-FDG) tracers in the differential diagnosis between PD, multiple system atrophy parkinsonian type (MSA-P), progressive supranuclear palsy (PSP) and vascular parkinsonism (VP) using the data of 220 patients with clinical PD-like symptoms. Of the 220 enrolled patients, 166 (PD, n = 80; MSA-P, n = 54; PSP, n = 15; VP, n = 17) completed the motor, cognitive and PET/CT assessment and were included in this study. 11C-CFT and 18F-FDG PET/CT images were analyzed using the SNBPI toolbox and CortexID Suite software. The uptake values of 11C-CFT and 18F-FDG PET/CT were compared among the groups after controlling for covariates using generalized linear models. Receiver operating characteristic (ROC) curves were generated to estimate the diagnostic values. Patients with PSP showed the most significant reduction on 11C-CFT PET/CT, while patients with PD and MSA-P showed similar reductions, and patients with VP did not show any significant reduction in 11C-CFT uptake. The areas under the curve (AUCs) for 11C-CFT PET/CT for distinguishing PD from VP, PSP, and MSA-P were 0.902, 0.830, and 0.580, respectively, and 0.728 for distinguishing advanced-stage PD from PSP. On 18F-FDG PET/CT, the AUCs for distinguishing PD from PSP and MSA-P were 0.968 and 0.963, respectively. These results suggest that 11C-CFT and 18F-FDG PET/CT complement each other in improving the accuracy in differential diagnosis of PD.
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Affiliation(s)
- Xiaoxiao Du
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hongguang Zhao
- Nuclear Medicine Department, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yinghua Li
- Nuclear Medicine Department, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yuyin Dai
- Nuclear Medicine Department, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lulu Gao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yi Li
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Kangli Fan
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhihui Sun
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ying Zhang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin, China.
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Chen Y, Wang H, Wang B, Li W, Ye P, Xu W, Liu P, Chen X, Cen Z, Ouyang Z, Wu S, Dou X, Liao Y, Zhang H, Tian M, Luo W. Retinal Thinning as a Marker of Disease Severity in Progressive Supranuclear Palsy. J Mov Disord 2024; 17:55-63. [PMID: 37748923 PMCID: PMC10846978 DOI: 10.14802/jmd.23102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/18/2023] [Accepted: 09/25/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Progressive supranuclear palsy (PSP) involves a variety of visual symptoms that are thought to be partially caused by structural abnormalities of the retina. However, the relationship between retinal structural changes, disease severity, and intracranial alterations remains unknown. We investigated distinct retinal thinning patterns and their relationship with clinical severity and intracranial alterations in a PSP cohort. METHODS We enrolled 19 patients with PSP (38 eyes) and 20 age-matched healthy controls (40 eyes). All of the participants underwent peripapillary and macular optical coherence tomography. Brain 11C-2β-carbomethoxy-3β-(4-fluorophenyl) tropane (11C-CFT) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography imaging were also performed in patients with PSP. We investigated the association between retinal thickness changes and clinical features, striatal dopamine transporter availability, and cerebral glucose metabolism. RESULTS The peripapillary retinal nerve fiber layer (pRNFL) and macula were significantly thinner in patients with PSP than in controls. The thickness of the superior sector of the pRNFL demonstrated a significant negative relationship with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III and Hoehn and Yahr staging scale scores. A significant negative correlation was found between outer inferior macular thickness and disease duration. Outer temporal macular thickness was positively correlated with Montreal Cognitive Assessment scores. In PSP, lower outer temporal macular thickness was also positively correlated with decreased dopamine transporter binding in the caudate. CONCLUSION The pRNFL and macular thinning may be candidate markers for monitoring disease severity. Additionally, macular thinning may be an in vivo indicator of nigrostriatal dopaminergic cell degeneration in PSP patients.
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Affiliation(s)
- Yueting Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Haotian Wang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bo Wang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenbo Li
- Department of Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China
| | - Panpan Ye
- Department of Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China
| | - Wen Xu
- Department of Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China
| | - Peng Liu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinhui Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhidong Cen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhiyuan Ouyang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Sheng Wu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaofeng Dou
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi Liao
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hong Zhang
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, Zhejiang, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mei Tian
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Huashan Hospital and Human Phenome Institute, Fudan University, Shanghai, China
| | - Wei Luo
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Krismer F, Péran P, Beliveau V, Seppi K, Arribarat G, Pavy-Le Traon A, Meissner WG, Foubert-Samier A, Fabbri M, Schocke MM, Gordon MF, Wenning GK, Poewe W, Rascol O, Scherfler C. Progressive Brain Atrophy in Multiple System Atrophy: A Longitudinal, Multicenter, Magnetic Resonance Imaging Study. Mov Disord 2024; 39:119-129. [PMID: 37933745 DOI: 10.1002/mds.29633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/27/2023] [Accepted: 09/28/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE To determine the rates of brain atrophy progression in vivo in patients with multiple system atrophy (MSA). BACKGROUND Surrogate biomarkers of disease progression are a major unmet need in MSA. Small-scale longitudinal studies in patients with MSA using magnetic resonance imaging (MRI) to assess progression of brain atrophy have produced inconsistent results. In recent years, novel MRI post-processing methods have been developed enabling reliable quantification of brain atrophy in an automated fashion. METHODS Serial 3D-T1-weighted MRI assessments (baseline and after 1 year of follow-up) of 43 patients with MSA were analyzed and compared to a cohort of early-stage Parkinson's disease (PD) patients and healthy controls (HC). FreeSurfer's longitudinal analysis stream was used to determine the brain atrophy rates in an observer-independent fashion. RESULTS Mean ages at baseline were 64.4 ± 8.3, 60.0 ± 7.5, and 59.8 ± 9.2 years in MSA, PD patients and HC, respectively. A mean disease duration at baseline of 4.1 ± 2.5 years in MSA patients and 2.3 ± 1.4 years in PD patients was observed. Brain regions chiefly affected by MSA pathology showed progressive atrophy with annual rates of atrophy for the cerebellar cortex, cerebellar white matter, pons, and putamen of -4.24 ± 6.8%, -8.22 ± 8.8%, -4.67 ± 4.9%, and - 4.25 ± 4.9%, respectively. Similar to HC, atrophy rates in PD patients were minimal with values of -0.41% ± 1.8%, -1.47% ± 4.1%, -0.04% ± 1.8%, and -1.54% ± 2.2% for cerebellar cortex, cerebellar white matter, pons, and putamen, respectively. CONCLUSIONS Patients with MSA show significant brain volume loss over 12 months, and cerebellar, pontine, and putaminal volumes were the most sensitive to change in mid-stage disease. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Vincent Beliveau
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Germain Arribarat
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Anne Pavy-Le Traon
- French Reference Center for MSA, Neurology Department, University Hospital of Toulouse and INSERM-Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, Toulouse, France
| | - Wassilios G Meissner
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, Bordeaux, France
- University of Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Alexandra Foubert-Samier
- CHU Bordeaux, Service de Neurologie des Maladies Neurodégénératives, IMNc, CRMR AMS, Bordeaux, France
- University of Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- INSERM, UMR1219, Bordeaux Population Health Research Center, University of Bordeaux, ISPED, Bordeaux, France
| | - Margherita Fabbri
- French Reference Center for MSA, Clinical Investigation Center CIC1436, Departments of Clinical Pharmacology and Neurosciences, NS-Park/FCRIN Network and NeuroToul Center of Excellence for Neurodegeneration, INSERM, University Hospital of Toulouse and University of Toulouse, Toulouse, France
| | - Michael M Schocke
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | | | - Gregor K Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Olivier Rascol
- French Reference Center for MSA, Clinical Investigation Center CIC1436, Departments of Clinical Pharmacology and Neurosciences, NS-Park/FCRIN Network and NeuroToul Center of Excellence for Neurodegeneration, INSERM, University Hospital of Toulouse and University of Toulouse, Toulouse, France
| | - Christoph Scherfler
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
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Brinia ME, Kapsali I, Giagkou N, Constantinides VC. Planimetric and Volumetric Brainstem MRI Markers in Progressive Supranuclear Palsy, Multiple System Atrophy, and Corticobasal Syndrome. A Systematic Review and Meta-Analysis. Neurol Int 2023; 16:1-19. [PMID: 38392951 PMCID: PMC10892270 DOI: 10.3390/neurolint16010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Various MRI markers-including midbrain and pons areas (Marea, Parea) and volumes (Mvol, Pvol), ratios (M/Parea, M/Pvol), and composite markers (magnetic resonance imaging Parkinsonism Indices 1,2; MRPI 1,2)-have been proposed as imaging markers of Richardson's syndrome (RS) and multiple system atrophy-Parkinsonism (MSA-P). A systematic review/meta-analysis of relevant studies aiming to compare the diagnostic accuracy of these imaging markers is lacking. METHODS Pubmed and Scopus were searched for studies with >10 patients (RS, MSA-P or CBS) and >10 controls with data on Marea, Parea, Mvol, Pvol, M/Parea, M/Pvol, MRPI 1, and MRPI 2. Cohen's d, as a measure of effect size, was calculated for all markers in RS, MSA-P, and CBS. RESULTS Twenty-five studies on RS, five studies on MSA-P, and four studies on CBS were included. Midbrain area provided the greatest effect size for differentiating RS from controls (Cohen's d = -3.10; p < 0.001), followed by M/Parea and MRPI 1. MSA-P had decreased midbrain and pontine areas. Included studies exhibited high heterogeneity, whereas publication bias was low. CONCLUSIONS Midbrain area is the optimal MRI marker for RS, and pons area is optimal for MSA-P. M/Parea and MRPIs produce smaller effect sizes for differentiating RS from controls.
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Affiliation(s)
| | | | | | - Vasilios C. Constantinides
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (M.-E.B.); (I.K.)
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Ishizawa K, Fujita Y, Nagashima K, Nakamura T, Shibata M, Kasahara H, Makioka K, Taketomi-Takahashi A, Hirasawa H, Higuchi T, Tsushima Y, Ikeda Y. Striatal dopamine transporter binding differs between dementia with Lewy bodies and Parkinson's disease with dementia. J Neurol Sci 2023; 451:120713. [PMID: 37441875 DOI: 10.1016/j.jns.2023.120713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023]
Abstract
123I-ioflupane single-photon emission computed tomography (SPECT) is a highly sensitive and established neuroimaging technique for parkinsonian syndromes (PS). However, differentiating PS by visual inspection or analysis of regions of interest is challenging. To date, image analysis has not been able to differentiate dementia with Lewy bodies (DLB) from Parkinson's disease with dementia (PDD). This study aimed to differentiate PS based on the characteristics of striatal dopamine transporter (DAT) binding using voxel-based analysis. We acquired 123I-ioflupane SPECT data from patients with DLB (n = 30), Parkinson's disease (PD; n = 122), PDD (n = 19), multiple system atrophy with predominant parkinsonism (MSA-P; n = 18), and progressive supranuclear palsy (PSP; n = 45). DAT binding was reduced in the posterior striatum of patients with PD and PDD, whereas it was similar in MSA-P, PSP, and DLB. Hippocampal atrophy, visually evaluated by cerebral magnetic resonance imaging, did not affect striatal DAT binding in DLB. DAT binding in the anterior striatum was inversely correlated with the severity of parkinsonism in PD and PDD but not in DLB. Thus, the appearance of striatal DAT binding might indicate different pathological processes in DLB and PDD.
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Affiliation(s)
- Kunihiko Ishizawa
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukio Fujita
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuaki Nagashima
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takumi Nakamura
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Makoto Shibata
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroo Kasahara
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kouki Makioka
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ayako Taketomi-Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiromi Hirasawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan.
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Dopamine transporter SPECT imaging in Parkinson's disease and atypical Parkinsonism: a study of 137 patients. Neurol Sci 2023; 44:1613-1623. [PMID: 36658411 DOI: 10.1007/s10072-023-06628-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Differential diagnosis between Parkinson's disease (PD) and multiple system atrophy-parkinsonian type (MSA-P), corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP), collectively termed atypical Parkinsonism (AP), is challenging. Dopamine transporter density imaging with Ioflupane I123 (DaTscan) is a marker of presynaptic nigrostriatal dysfunction. The primary aim of this study was to investigate the utility of DaTscan in the differential diagnosis of MSA-P, CBD, and PSP. METHODS Patients examined at Eginition Hospital (2011-2021), with available DaTscan data and a diagnosis of probable AP, clinically established PD, as well as a neurological control (NC) group were included. Mean binding specific index (BSI), BSI of the most affected side, asymmetry index, laterality, and caudate/putamen ratio were recorded. Analyses were performed by Kruskal-Wallis and ANCOVA. RESULTS 137 patients were included (CBD: [Formula: see text]; MSA-P: [Formula: see text]; PSP: [Formula: see text]; PD: [Formula: see text]; NC: [Formula: see text]). There were significant differences when comparing CBS, PSP, and NC vs. all other groups combined. Pairwise between-group comparisons revealed significant differences between PSP and CBD (mean striatum BSI>1.95; sensitivity 74.1%; specificity 85.0%), CBD and MSA-P (mean striatum BSI>2.04; sensitivity 70.4%; specificity 86.7%), and CBD and PD (mean striatum BSI>2.11; sensitivity 66.7%; specificity 100.0%). There were no differences between PSP, MSA-P, and PD. PSP, MSA-P, and PD differed from NC subjects, with 100% specificity and high sensitivity. Differentiation of NC from CBD was suboptimal. DISCUSSION CBD patients exhibit relatively mild DaTscan abnormalities. DaTscan may assist in the differentiation of CBD from PSP. DaTscan does not differentiate among PD, MSA-P, and PSP.
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Loftus JR, Puri S, Meyers SP. Multimodality imaging of neurodegenerative disorders with a focus on multiparametric magnetic resonance and molecular imaging. Insights Imaging 2023; 14:8. [PMID: 36645560 PMCID: PMC9842851 DOI: 10.1186/s13244-022-01358-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/13/2022] [Indexed: 01/17/2023] Open
Abstract
Neurodegenerative diseases afflict a large number of persons worldwide, with the prevalence and incidence of dementia rapidly increasing. Despite their prevalence, clinical diagnosis of dementia syndromes remains imperfect with limited specificity. Conventional structural-based imaging techniques also lack the accuracy necessary for confident diagnosis. Multiparametric magnetic resonance imaging and molecular imaging provide the promise of improving specificity and sensitivity in the diagnosis of neurodegenerative disease as well as therapeutic monitoring of monoclonal antibody therapy. This educational review will briefly focus on the epidemiology, clinical presentation, and pathologic findings of common and uncommon neurodegenerative diseases. Imaging features of each disease spanning from conventional magnetic resonance sequences to advanced multiparametric methods such as resting-state functional magnetic resonance imaging and arterial spin labeling imaging will be described in detail. Additionally, the review will explore the findings of each diagnosis on molecular imaging including single-photon emission computed tomography and positron emission tomography with a variety of clinically used and experimental radiotracers. The literature and clinical cases provided demonstrate the power of advanced magnetic resonance imaging and molecular techniques in the diagnosis of neurodegenerative diseases and areas of future and ongoing research. With the advent of combined positron emission tomography/magnetic resonance imaging scanners, hybrid protocols utilizing both techniques are an attractive option for improving the evaluation of neurodegenerative diseases.
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Affiliation(s)
- James Ryan Loftus
- grid.412750.50000 0004 1936 9166Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA
| | - Savita Puri
- grid.412750.50000 0004 1936 9166Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA
| | - Steven P. Meyers
- grid.412750.50000 0004 1936 9166Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA
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Lamotte G, Singer W. Synucleinopathies. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:175-202. [PMID: 37620069 DOI: 10.1016/b978-0-323-98817-9.00032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The α-synucleinopathies include pure autonomic failure, multiple system atrophy, dementia with Lewy bodies, and Parkinson disease. The past two decades have witnessed significant advances in the diagnostic strategies and symptomatic treatment of motor and nonmotor symptoms of the synucleinopathies. This chapter provides an in-depth review of the pathophysiology, pathology, genetic, epidemiology, and clinical and laboratory autonomic features that distinguish the different synucleinopathies with an emphasis on autonomic failure as a common feature. The treatment of the different synucleinopathies is discussed along with the proposal for multidisciplinary, individualized care models that optimally address the various symptoms. There is an urgent need for clinical scientific studies addressing patients at risk of developing synucleinopathies and the investigation of disease mechanisms, biomarkers, potential disease-modifying therapies, and further advancement of symptomatic treatments for motor and nonmotor symptoms.
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Affiliation(s)
- Guillaume Lamotte
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.
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Diagnostic Performance for Differential Diagnosis of Atypical Parkinsonian Syndromes from Parkinson’s Disease Using Quantitative Indices of 18F-FP-CIT PET/CT. Diagnostics (Basel) 2022; 12:diagnostics12061402. [PMID: 35741212 PMCID: PMC9221712 DOI: 10.3390/diagnostics12061402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 01/27/2023] Open
Abstract
We are aimed to evaluate the diagnostic performances of quantitative indices obtained from dual-phase 18F-FP-CIT PET/CT for differential diagnosis of atypical parkinsonian syndromes (APS) from Parkinson’s disease (PD). We analyzed 172 subjects, including 105 non-Parkinsonism, 26 PD, 8 PSP, 1 CBD, 8 MSA-P, 9 MSA-C, and 15 DLB retrospectively. Two sequential PET/CT scans were acquired at 5 min and 3 h. We compared subregional binding potentials, putamen-to-caudate nucleus ratio of the binding potential, asymmetry index, and degree of washout. To differentiate APS, all BPs in both early and late phases (except late BPbrainstem) and all factors of the percent change except for putamen in APS significantly differed from PD. When a cut-off for early BPcerebellum was set as 0.79, the sensitivity, specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy for differentiating APS 73.2%, 91.7%, 93.8%, 66.7%, and 80.0%. The early BPcerebellum showed significantly greater SP and PPV than the late quantitative indices. Combined criteria regarding both early and late indices exhibited only greater NPV. The quantitative indices showed high diagnostic performances in differentiating APS from PD. Our findings provide the dual-phase 18F-FP-CIT PET/CT would be useful for differentiating APS from PD.
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Chen Q, Li X, Li L, Lu J, Sun Y, Liu F, Zuo C, Wang J. Dopamine transporter imaging in progressive supranuclear palsy: Severe but nonspecific to subtypes. Acta Neurol Scand 2022; 146:237-245. [PMID: 35611608 DOI: 10.1111/ane.13653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous studies with a limited sample size suggested more severe dopaminergic transporter (DAT) lesions in the striatum of progressive supranuclear palsy (PSP) than those in Parkinson's disease (PD) and multiple system atrophy-parkinsonism (MSA-P). However, few studies had taken various subtypes of PSP into consideration, making the reanalysis of DAT imaging in larger PSP cohort with various subtypes in need. OBJECTIVES To compare the dopaminergic lesion patterns of PSP with MSA-P and PD, and to explore the specific striatal subregional patterns of different PSP subtypes. METHODS 11 C-CFT positron emission tomography (PET) imaging was conducted in 83 PSP patients consisting of different subtypes, 61 patients with PD, 41 patients with MSA-P, and 43 healthy volunteers. Demographic and clinical data were compared by the chi-squared test or one-way analysis of variance. A generalized linear model was used to examine intergroup differences in tracer uptake values after adjusting for age, disease duration, and disease severity. Areas under the receiver operating characteristic curve were calculated to assess the diagnostic accuracy of subregional DAT binding patterns. RESULTS The patients with PSP presented more severe DAT loss in the striatum than in PD and MSA-P, especially in caudate. In PSP, the subregional lesion was still more severe in putamen than in caudate, similar to that in PD and MSA-P. Among detailed subtypes, no significant difference was detected. CONCLUSION The dopaminergic lesions were more severe in PSP, and no difference was detected among subtypes.
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Affiliation(s)
- Qi‐Si Chen
- Department of Neurology, National Clinical Research Center for Aging and Medicine, National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital Fudan University Shanghai China
| | - Xin‐Yi Li
- Department of Neurology, National Clinical Research Center for Aging and Medicine, National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital Fudan University Shanghai China
| | - Ling Li
- PET Center, National Clinical Research Center for Aging and Medicine, National Center for Neurological Disorders, Huashan Hospital Fudan University Shanghai China
| | - Jia‐Ying Lu
- PET Center, National Clinical Research Center for Aging and Medicine, National Center for Neurological Disorders, Huashan Hospital Fudan University Shanghai China
| | - Yi‐Min Sun
- Department of Neurology, National Clinical Research Center for Aging and Medicine, National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital Fudan University Shanghai China
| | - Feng‐Tao Liu
- Department of Neurology, National Clinical Research Center for Aging and Medicine, National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital Fudan University Shanghai China
| | - Chuan‐Tao Zuo
- PET Center, National Clinical Research Center for Aging and Medicine, National Center for Neurological Disorders, Huashan Hospital Fudan University Shanghai China
| | - Jian Wang
- Department of Neurology, National Clinical Research Center for Aging and Medicine, National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital Fudan University Shanghai China
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Decoding the dopamine transporter imaging for the differential diagnosis of parkinsonism using deep learning. Eur J Nucl Med Mol Imaging 2022; 49:2798-2811. [PMID: 35588012 PMCID: PMC9206631 DOI: 10.1007/s00259-022-05804-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Purpose
This work attempts to decode the discriminative information in dopamine transporter (DAT) imaging using deep learning for the differential diagnosis of parkinsonism. Methods This study involved 1017 subjects who underwent DAT PET imaging ([11C]CFT) including 43 healthy subjects and 974 parkinsonian patients with idiopathic Parkinson’s disease (IPD), multiple system atrophy (MSA) or progressive supranuclear palsy (PSP). We developed a 3D deep convolutional neural network to learn distinguishable DAT features for the differential diagnosis of parkinsonism. A full-gradient saliency map approach was employed to investigate the functional basis related to the decision mechanism of the network. Furthermore, deep-learning-guided radiomics features and quantitative analysis were compared with their conventional counterparts to further interpret the performance of deep learning. Results The proposed network achieved area under the curve of 0.953 (sensitivity 87.7%, specificity 93.2%), 0.948 (sensitivity 93.7%, specificity 97.5%), and 0.900 (sensitivity 81.5%, specificity 93.7%) in the cross-validation, together with sensitivity of 90.7%, 84.1%, 78.6% and specificity of 88.4%, 97.5% 93.3% in the blind test for the differential diagnosis of IPD, MSA and PSP, respectively. The saliency map demonstrated the most contributed areas determining the diagnosis located at parkinsonism-related regions, e.g., putamen, caudate and midbrain. The deep-learning-guided binding ratios showed significant differences among IPD, MSA and PSP groups (P < 0.001), while the conventional putamen and caudate binding ratios had no significant difference between IPD and MSA (P = 0.24 and P = 0.30). Furthermore, compared to conventional radiomics features, there existed average above 78.1% more deep-learning-guided radiomics features that had significant differences among IPD, MSA and PSP. Conclusion This study suggested the developed deep neural network can decode in-depth information from DAT and showed potential to assist the differential diagnosis of parkinsonism. The functional regions supporting the diagnosis decision were generally consistent with known parkinsonian pathology but provided more specific guidance for feature selection and quantitative analysis. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05804-x.
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Jia C, Wu M, Yen TC, Li Y, Cui R. Complementary Utility of Dopamine Transporter and Tau PET Imaging in the Diagnosis of Progressive Supranuclear Palsy: A Case Report. Clin Nucl Med 2022; 47:336-338. [PMID: 35020665 DOI: 10.1097/rlu.0000000000003974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 50-year-old woman developed gait disturbances, tendency to fall backwards, bradykinesia, and memory loss over the previous 6 months. Brain 18F-FDG PET/CT was unable to distinguish among APSs (atypical parkinsonian syndromes); PET investigations of dopamine transporter (DAT) function (11C-CFT) and tau pathology (18F-APN-1607) were performed. 11C-CFT PET revealed severe loss of striatal DAT function, whereas significant tau accumulation was observed in the brainstem, basal ganglia, and globus pallidus on 18F-APN-1607 PET. Such finding suggested diagnosis of PSP (progressive supranuclear palsy). This case highlights the value of DAT and tau PET imaging in diagnosis of PSP and differential diagnosis ofAPSs.
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Affiliation(s)
| | | | | | - Yanfeng Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Xu J, Xu Q, Liu S, Li L, Li L, Yen TC, Wu J, Wang J, Zuo C, Wu P, Zhuang X. Computer-Aided Classification Framework of Parkinsonian Disorders Using 11C-CFT PET Imaging. Front Aging Neurosci 2022; 13:792951. [PMID: 35177974 PMCID: PMC8846284 DOI: 10.3389/fnagi.2021.792951] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the usefulness of a novel computer-aided classification framework for the differential diagnosis of parkinsonian disorders (PDs) based on 11C-methyl-N-2β-carbomethoxy-3β-(4-fluorophenyl)-tropanel (11C-CFT) positron emission tomography (PET) imaging. Methods Patients with different forms of PDs—including Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP)—underwent dopamine transporter (DAT) imaging with 11C-CFT PET. A novel multistep computer-aided classification framework—consisting of magnetic resonance imaging (MRI)-assisted PET segmentation, feature extraction and prediction, and automatic subject classification—was developed. A random forest method was used to assess the diagnostic relevance of different regions to the classification process. Finally, the performance of the computer-aided classification system was tested using various training strategies involving patients with early and advanced disease stages. Results Accuracy values for identifying PD, MSA, and PSP were 85.0, 82.2, and 89.7%, respectively—with an overall accuracy of 80.4%. The caudate and putamen provided the highest diagnostic relevance to the proposed classification framework, whereas the contribution of midbrain was negligible. With the exception of sensitivity for diagnosing PSP, the strategy comprising both early and advanced disease stages performed better in terms of sensitivity, specificity, positive predictive value, and negative predictive value within each PDs subtype. Conclusions The proposed computer-aided classification framework based on 11C-CFT PET imaging holds promise for improving the differential diagnosis of PDs.
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Affiliation(s)
- Jiahang Xu
- School of Data Science, Fudan University, Shanghai, China
| | - Qian Xu
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Shihong Liu
- School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Ling Li
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Li
- School of Data Science, Fudan University, Shanghai, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tzu-Chen Yen
- Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jianjun Wu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chuantao Zuo
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Human Phenome Institute, Fudan University, Shanghai, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Ping Wu
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Ping Wu
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, China
- Xiahai Zhuang
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Brücke T, Brücke C. Dopamine transporter (DAT) imaging in Parkinson's disease and related disorders. J Neural Transm (Vienna) 2021; 129:581-594. [PMID: 34910248 DOI: 10.1007/s00702-021-02452-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022]
Abstract
This review gives an insight into the beginnings of dopamine transporter (DAT) imaging in the early 1990s, focussing on single photon emission tomography (SPECT). The development of the method and its consolidation as a now widely used clinical tool is described. The role of DAT-SPECT in the diagnosis and differential diagnosis of PD, atypical parkinsonian syndromes and several other different neurological disorders is reviewed. Finally the clinical research using DAT-SPECT as a biomarker for the progression of PD, for the detection of a preclinical dopaminergic lesion and its correlation with neuropathological findings is outlined.
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Affiliation(s)
- Thomas Brücke
- Ottakring Clinic, Neurological Department, Verein zur Förderung der Wissenschaftlichen Forschung am Wilhelminenspital (FWFW), Montleartstrasse 37, 1160, Vienna, Austria.
- , Linke Wienzeile 12, 1060, Vienna, Austria.
| | - Christof Brücke
- Department for Neurology, Medical University Vienna, Währingergürtel 18-20, 1090, Vienna, Austria
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Chun K, Kong E, Cho I. Comparison of perfusion 18F-FP-CIT PET and 99mTc-ECD SPECT in parkinsonian disorders. Medicine (Baltimore) 2021; 100:e27019. [PMID: 34449475 PMCID: PMC8389924 DOI: 10.1097/md.0000000000027019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/04/2021] [Indexed: 01/04/2023] Open
Abstract
Early and accurate identification of various conditions that can cause parkinsonian symptoms is important for determining treatment policies. Currently dopamine transporter (DAT) imaging using FP-CIT, glucose metabolism imaging using fluorodeoxyglucose, cerebral blood flow image using ethyl cysteinate dimer (ECD), and others are used for differentiation. However, the use of multiple modalities is inconvenient and costly. In the present retrospective study, we evaluated the correlation between regional brain uptake ratios (URs) in perfusion FP-CIT PET and ECD SPECT images.Twenty patients with Parkinson's symptoms underwent perfusion DAT positron emission tomography (18F-FP-CIT PET/CT) and cerebral blood flow tomography (99mTc-ECD SPECT) within a 2-week period. Perfusion 18F-FP-CIT PET/CT and 99mTc-ECD SPECT URs of 19 brain regions (bilateral frontal, temporal, parietal and occipital lobes, bilateral caudate nucleus, bilateral putamen, bilateral insula, bilateral cingulate gyrus, bilateral thalamus, and brainstem) were directly compared and correlations were analyzed.Average 18F-FP-CIT PET/CT regional perfusion URs were higher than 99mTc-ECD SPECT URs. Uptake ratios were well correlated in all 19 regions (except right putamen), and especially in dopamine poor regions (cerebral cortex). In left putamen, URs were significantly correlated, but the correlation coefficient was lower than those of other regions.A single tracer dual phase N-3-fluoropropyl-2-beta-carboxymethoxy-3-beta-(4-iodophenyl) nortropane test seems to be helpful for differential diagnosis of parkinsonian disorders. Large-scale, longitudinal studies on complementary diseases with parkinsonian patterns are required to investigate differences in correlations between perfusion 18F-FP-CIT PET/CT and 99mTc-ECD SPECT over time.
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Nuvoli S, Tanda G, Stazza ML, Palumbo B, Frantellizzi V, De Vincentis G, Spanu A, Madeddu G. 123I-Ioflupane SPECT and 18F-FDG PET Combined Use in the Characterization of Movement and Cognitive Associated Disorders in Neurodegenerative Diseases. Curr Alzheimer Res 2021; 18:196-207. [PMID: 34102975 DOI: 10.2174/1567205018666210608112302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/21/2021] [Accepted: 04/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Both movement (MD) and cognitive (CD) disorders can occur associated in some neurodegenerative diseases, such as Parkinson's disease (PD) and Alzheimer's disease (AD). OBJECTIVE We further investigated the usefulness of 123I-Ioflupane SPECT and 18F-FDG PET combined use in patients with these disorders in the early stage. METHODS We retrospectively enrolled twenty-five consecutive patients with MD and CD clinical symptoms of recent appearance. All patients had undergone neurologic examination, neuropsychological tests, and magnetic resonance imaging. 123I-Ioflupane SPECT was performed in all cases, followed by 18F-FDG PET two weeks later. In the two procedures, both qualitative (QL) and quantitative (QN) image analyses were determined. RESULTS In patients with both 123I-Ioflupane SPECT and 18F-FDG PET pathologic data, associated dopaminergic and cognitive impairments were confirmed in 56% of cases. Pathologic SPECT with normal PET in 16% of cases could diagnose MD and exclude an associated CD, despite clinical symptoms. On the contrary, normal SPECT with pathologic PET in 28% of cases could exclude basal ganglia damage while confirming CD. QN 123I-Ioflupane SPECT analysis showed better performance than QL since QN correctly characterized two cases of MD with normal QL. Moreover, correct classification of normal metabolism was made only by QN analysis of 18F-FDG PET in four cases, despite suspect areas of hypometabolism at QL. CONCLUSION The combined use of these imaging procedures proved a reliable diagnostic tool to accurately identify and characterize MD and CD in early stage. QN analysis was effective in supporting QL evaluation, and its routine use is suggested, especially with inconclusive QL.
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Affiliation(s)
- Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanna Tanda
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria L Stazza
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | | | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Takahashi R, Ishii K, Sousa K, Marumoto K, Kashibayashi T, Fujita J, Yokoyama K. Distinctive regional asymmetry in dopaminergic and serotoninergic dysfunction in degenerative Parkinsonisms. J Neurol Sci 2021; 423:117363. [PMID: 33640580 DOI: 10.1016/j.jns.2021.117363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to identify regional asymmetry in dopaminergic and serotoninergic dysfunction in degenerative parkinsonisms, using dopamine transporter single-photon emission computed tomography images. MATERIAL AND METHODS This study included 213 consecutive participants (Parkinson's disease [n = 111], dementia with Lewy bodies [n = 64], progressive supranuclear palsy with Richardson's syndrome [n = 18], and healthy participants [n = 20]) who underwent both magnetic resonance imaging and 123I-labelled 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane single-photon emission computed tomography/computed tomography. Using normalized specific binding ratio images, we created voxel-wise regional asymmetry index images to identify the regional specific pattern of regional asymmetries in degenerative parkinsonisms. RESULTS Compared with healthy controls, patients with Parkinson's disease showed a regional asymmetry index increase in the nigrostriatal dopaminergic pathway, and those with dementia with Lewy bodies showed a regional asymmetry index increase confined to the bilateral caudate. Individuals with progressive supranuclear palsy exhibited a distinct regional asymmetry index increase in the pallido-subthalamic pathway. Notably, the regional asymmetry index increase in the subthalamic nucleus was significantly greater in progressive supranuclear palsy than in Parkinson's disease. CONCLUSION The current study revealed distinctive regional asymmetry in dopaminergic and serotoninergic dysfunction in degenerative parkinsonisms. The present findings highlight the potential application of visual diagnosis in degenerative parkinsonisms.
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Affiliation(s)
- Ryuichi Takahashi
- Department of Neurology, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Hyogo, Japan; Dementia-Related Disease Medical Center, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Hyogo, Japan.
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Kaoru Sousa
- Department of Radiology, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Hyogo, Japan
| | - Kohei Marumoto
- Department of Neurology, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Hyogo, Japan
| | - Tetsuo Kashibayashi
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Jun Fujita
- Dementia-Related Disease Medical Center, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Hyogo, Japan
| | - Kazumasa Yokoyama
- Department of Neurology, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Hyogo, Japan
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18F-THK5351 PET imaging in patients with progressive supranuclear palsy: associations with core domains and diagnostic certainty. Sci Rep 2020; 10:19410. [PMID: 33173080 PMCID: PMC7656245 DOI: 10.1038/s41598-020-76339-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022] Open
Abstract
The associations of 18F-THK5351 tau positron emission tomography (PET) findings with core domains of progressive supranuclear palsy (PSP) and its diagnostic certainty have yet to be fully elucidated. The 18F-THK5351 PET patterns of 17 patients with PSP (68.9 ± 6.5 years; 8 women) were compared with those observed in 28 age-matched and sex-matched (66.2 ± 4.5 years, 18 women) control subjects (CS). Tracer accumulation—as reflected by standardized uptake value ratios (SUVRs) and z-scores—was correlated with core domains of PSP and different levels of diagnostic certainty. Compared with CS, patients with PSP showed an increased 18F-THK5351 uptake in the globus pallidus and red nucleus. Patients with PSP and oculomotor dysfunction had significantly higher SUVRs in the midbrain, red nucleus, and raphe nucleus than those without. In addition, cases who meet criteria for level 1 (highest) certainty in the postural instability domain showed significantly higher SUVRs in the frontal, parietal, precuneus, and sensory-motor cortex. Patients with probable PSP had significantly higher SUVR values than those with possible PSP in multiple cortical (i.e., frontal, parietal, temporal, anterior cingulate gyrus, precuneus, and sensory-motor gyrus) and subcortical (i.e., putamen, thalamus, and raphe nucleus) regions. Patterns of 18F-THK5351 uptake were correlated to core domains of PSP—including oculomotor dysfunction and postural instability. Moreover, the degree of diagnostic certainty for PSP was appreciably associated with 18F-THK5351 PET findings.
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Sampedro F, Marín-Lahoz J, Martínez-Horta S, Camacho V, Lopez-Mora DA, Pagonabarraga J, Kulisevsky J. Extrastriatal SPECT-DAT uptake correlates with clinical and biological features of de novo Parkinson's disease. Neurobiol Aging 2020; 97:120-128. [PMID: 33212336 DOI: 10.1016/j.neurobiolaging.2020.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/09/2020] [Accepted: 10/17/2020] [Indexed: 10/23/2022]
Abstract
Striatal dopamine transporter (DAT) uptake assessment through I123-Ioflupane Single-Pphoton Emission Computed Tomography (SPECT) provides valuable information about the dopaminergic denervation occurring in Parkinson's disease (PD). However, little is known about the clinical or biological relevance of extrastriatal DAT uptake in PD. Here, from the Parkinson's Progression Markers Initiative, we studied 623 participants (431 PD and 192 healthy controls) with available SPECT data. Even though striatal denervation was undoubtedly the imaging hallmark of PD, extrastriatal DAT uptake was also reduced in patients with PD. Topographically, widespread frontal but also temporal and posterior cortical regions showed lower DAT uptake in PD patients with respect to healthy controls. Importantly, a longitudinal voxelwise analysis confirmed an active one-year loss of extrastriatal DAT uptake within the PD group. Extrastriatal DAT uptake also correlated with the severity of motor symptoms, cognitive performance, and cerebrospinal fluid α-synuclein levels. In addition, we found an association between the Catechol-O-methyltransferase val158met genotype and extrastriatal DAT uptake. These results highlight the clinical and biological relevance of extrastriatal SPECT-DAT uptake in PD.
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Affiliation(s)
- Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Marín-Lahoz
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Saul Martínez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Valle Camacho
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
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Is There Any Clinical Value of Adding 123I-Metaiodobenzylguanidine Myocardial Scintigraphy to 123I-Ioflupane (DaTscan) in the Differential Diagnosis of Parkinsonism? Clin Nucl Med 2020; 45:588-593. [PMID: 32404715 DOI: 10.1097/rlu.0000000000003098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study is to evaluate the impact of myocardial I-metaiodobenzylguanidine (MIBG) in the diagnosis, clinical management, and differential diagnosis of Parkinson disease (PD) and non-PD parkinsonism. METHODS The study enrolled 41 patients with parkinsonism. An initial diagnosis was reached after thorough clinical and imaging evaluation. After 2 to 5 years of follow-up, a final diagnosis was established. All patients underwent, soon after their initial visit, presynaptic striatal DaT scintigraphy with I-FP-CIT (DaTscan) and I-MIBG myocardial scintigraphy. DaTscan is not specific to distinguish among different types of neurodegenerative parkinsonism. I-MIBG myocardial scintigraphy displays the functional status of cardiac sympathetic nerves, which is reduced in PD/dementia with Lewy bodies (DLB) and normal in atypical parkinsonian syndromes and secondary or nondegenerative parkinsonism. RESULTS No patients showed adverse effects during or after both scintigraphies. A positive DaTscan was found in all patients in the PD/DLB group (17/17) and in 15 of 24 patients in the non-PD group. Myocardial I-MIBG scintigraphy was associated with lower sensitivity (82% vs 100%) but higher specificity than DaTscan (79% vs 38%) in diagnosis PD/DLB from non-PD parkinsonism. A positive scan result on both techniques, to confirm diagnosis of PD/DLB, significantly improved the specificity of DaTscan, from 38% to 75%, with no reduction in sensitivity. CONCLUSIONS Myocardial I-MIBG imaging provides complementary value to I-FP-CIT in the proper diagnosis, treatment plan, and differential diagnosis between PD and other forms of parkinsonism.
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Laterality of specific binding ratios on DAT-SPECT for differential diagnosis of degenerative parkinsonian syndromes. Sci Rep 2020; 10:15761. [PMID: 32978422 PMCID: PMC7519659 DOI: 10.1038/s41598-020-72321-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/24/2020] [Indexed: 02/01/2023] Open
Abstract
Motor symptoms of Parkinson's disease (PD) occur unilaterally and progress with asymmetry, while progressive supranuclear palsy (PSP) and multiple system atrophy of the parkinsonism subtype (MSA-P) lack this tendency. We assessed the laterality of specific binding ratios (SBRs) on dopamine transporter single-photon emission computed tomography (DAT-SPECT) for the differential diagnosis of these diseases in 311 PD, 33 PSP, 20 MSA-P, and 137 control patients. The average SBR in PD was higher than that in PSP (P = 0.035). Compared with Hoehn-Yahr (HY) stages, the average SBR in PD with HY stage I was only higher than that in PSP (P < 0.001). SBR laterality in PD with HY stage I was significantly higher than that in PSP (P = 0.001). This difference was not observed in PD with HY stage II. The average and laterality of SBRs in MSA-P were similar to those in PD and PSP. The asymmetry indices were similar among PD, PSP, and MSA-P. These data suggest that PSP shows a pattern of SBRs different from that in PD, attributed to HY stage I in PD. The limited usefulness of DAT-SPECT may be explained by the low discrimination between PD with bilateral motor symptoms and PSP.
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Seckin ZI, Whitwell JL, Utianski RL, Botha H, Ali F, Duffy JR, Clark HM, Machulda MM, Jordan LG, Min HK, Lowe VJ, Josephs KA. Ioflupane 123I (DAT scan) SPECT identifies dopamine receptor dysfunction early in the disease course in progressive apraxia of speech. J Neurol 2020; 267:2603-2611. [PMID: 32388831 DOI: 10.1007/s00415-020-09883-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe 123I-FP-CIT (DAT scan) SPECT findings in progressive apraxia of speech (PAOS) patients and to compare those findings with progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). BACKGROUND PAOS is a neurodegenerative syndrome in which patients present with apraxia of speech, a motor speech disorder affecting programming and planning of speech. Patients with PAOS predictably develop Parkinsonism. DAT scan is a neuroimaging tool that assesses the integrity of presynaptic dopamine transporters in striatum and is usually abnormal in PSP and CBS. METHODS As part of an NIH-funded grant, we performed a DAT scan on 17 PAOS patients early in the disease course. DaTQUANT software was used to quantify uptake in the left and right caudate and anterior/posterior putamen, with striatum to background ratios (SBRs). The PAOS cohort was compared to 15 PSP and 8 CBS patients. RESULTS Five PAOS patients (29%) showed abnormalities in at least one striatal region on DAT scan. When the five PAOS patients with abnormal DAT were compared to the PSP and CBS patients, the only difference observed was lower uptake in the posterior putamen in PSP (p = 0.03). There were no differences is putamen/caudate ratio or in symmetry of uptake, across all groups. There was also no difference in MDS-UPDRS-III scores between PAOS patients with and without abnormal DAT scans (p = 0.56). CONCLUSIONS Abnormal DAT scan is observed early in the disease course in approximately 30% of PAOS patients, with striatal abnormalities similar to those in PSP and CBS.
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Affiliation(s)
- Zeynep Idil Seckin
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1st Street S.W., Rochester, MN, 55905, USA
| | | | - Rene L Utianski
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1st Street S.W., Rochester, MN, 55905, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1st Street S.W., Rochester, MN, 55905, USA
| | - Farwa Ali
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1st Street S.W., Rochester, MN, 55905, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1st Street S.W., Rochester, MN, 55905, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1st Street S.W., Rochester, MN, 55905, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Hoon-Ki Min
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1st Street S.W., Rochester, MN, 55905, USA.
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Bayram E, Dickson DW, Reich SG, Litvan I. Pathology-Proven Corticobasal Degeneration Presenting as Richardson's Syndrome. Mov Disord Clin Pract 2020; 7:267-272. [PMID: 32258223 DOI: 10.1002/mdc3.12900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/23/2019] [Accepted: 01/14/2020] [Indexed: 11/11/2022] Open
Abstract
Background Corticobasal degeneration (CBD) can present with various clinical phenotypes including Richardson's syndrome (RS). Although neuropathological examination can differentiate CBD and progressive supranuclear palsy (PSP) pathologies, no clinical or imaging findings can differentiate CBD from other pathologies when a patient presents with a variant type of CBD. As these various phenotypes are associated with non-CBD pathologies, clinical diagnostic accuracy can be low for such patients. Objectives To present clinical features of two cases with symptom progression in line with PSP-RS, who were diagnosed with CBD based on neuropathological examination. Methods Baseline, follow up examinations, and detailed neuropathological examinations of two CBD cases presenting and progressing in line with probable PSP-RS are demonstrated. Results The two cases clinically diagnosed as probable PSP-RS were shown to have CBD upon neuropathological examination, which is the gold standard for diagnosis of both PSP and CBD. Conclusions These cases emphasize the importance of neuropathology for the definite diagnosis, and stress the need for distinctive markers to increase the reliability of clinical diagnosis before death.
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Affiliation(s)
- Ece Bayram
- Department of Neurosciences, Parkinson and Other Movement Disorders Center University of California San Diego La Jolla California USA
| | | | - Stephen G Reich
- Department of Neurology University of Maryland Baltimore Maryland USA
| | - Irene Litvan
- Department of Neurosciences, Parkinson and Other Movement Disorders Center University of California San Diego La Jolla California USA
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25
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Carré G, Dietemann JL, Gebus O, Montaut S, Lagha-Boukbiza O, Wirth T, Kremer S, Namer IJ, Anheim M, Tranchant C. Brain MRI of multiple system atrophy of cerebellar type: a prospective study with implications for diagnosis criteria. J Neurol 2020; 267:1269-1277. [PMID: 31938861 DOI: 10.1007/s00415-020-09702-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/27/2022]
Abstract
AIM The second consensus statement for the diagnosis of multiple system atrophy type cerebellar (MSA-C) includes pons and middle cerebellar peduncle (MCP) atrophy as MRI features. However, other MRI abnormalities such as MCP hyperintensity, hot cross bun sign (HCB), putaminal hypointensity and hyperintense putaminal rim have been described. OBJECTIVES To evaluate, in patients with sporadic late-onset cerebellar ataxia (SLOCA), the discriminative value of several MRI features for the diagnosis of MSA-C, to follow their evolution during the course of MSA-C, and to search for correlations between these MRI features and clinical signs. METHODS Consecutive patients referred for SLOCA underwent comprehensive clinical evaluation and laboratory investigations, brain MRI, DaTscan and a 1-year follow-up. RESULTS Among 80 patients, 26 had MSA-C, 22 another diagnosis, and 32 no diagnosis at the end of the follow-up. At baseline, MCP hyperintensity and HCB were more frequent in patients finally diagnosed with MSA-C than in other patients with SLOCA (p < 0.0001), and had the highest specificity (98.5%) and positive predictive value (91.7%) for the diagnosis of MSA-C, compared to all other MRI signs. The most relevant MRI sequence regarding HCB sign was the T2-proton density (DP) weighted. All MRI features were more frequent with disease duration. No correlation was found between any MRI feature and neither clinical data, nor dopaminergic neuronal loss (p = 0.5008), except between vermis atrophy and UPDRSIII score. CONCLUSION MCP hyperintensity and HCB sign should be added into the list of additional features of possible MSA-C. MRI signal abnormalities suggestive of MSA-C should be searched for in suitable sequence.
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Affiliation(s)
- G Carré
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
- Service de Neurologie, Hôpitaux Civils de Colmar, Hôpital Louis Pasteur, 39 avenue de la Liberté, 68024, Colmar, France
| | - J L Dietemann
- Service d'imagerie 2, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg Cedex, France
| | - O Gebus
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
| | - S Montaut
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
| | - O Lagha-Boukbiza
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
| | - T Wirth
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
| | - S Kremer
- Service d'imagerie 2, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg Cedex, France
| | - I J Namer
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
| | - M Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
| | - C Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France.
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France.
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Zupan G, Šuput D, Pirtošek Z, Vovk A. Semi-Automatic Signature-Based Segmentation Method for Quantification of Neuromelanin in Substantia Nigra. Brain Sci 2019; 9:brainsci9120335. [PMID: 31766668 PMCID: PMC6956028 DOI: 10.3390/brainsci9120335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/16/2022] Open
Abstract
In Parkinson's disease (PD), there is a reduction of neuromelanin (NM) in the substantia nigra (SN). Manual quantification of the NM volume in the SN is unpractical and time-consuming; therefore, we aimed to quantify NM in the SN with a novel semi-automatic segmentation method. Twenty patients with PD and twelve healthy subjects (HC) were included in this study. T1-weighted spectral pre-saturation with inversion recovery (SPIR) images were acquired on a 3T scanner. Manual and semi-automatic atlas-free local statistics signature-based segmentations measured the surface and volume of SN, respectively. Midbrain volume (MV) was calculated to normalize the data. Receiver operating characteristic (ROC) analysis was performed to determine the sensitivity and specificity of both methods. PD patients had significantly lower SN mean surface (37.7 ± 8.0 vs. 56.9 ± 6.6 mm2) and volume (235.1 ± 45.4 vs. 382.9 ± 100.5 mm3) than HC. After normalization with MV, the difference remained significant. For surface, sensitivity and specificity were 91.7 and 95 percent, respectively. For volume, sensitivity and specificity were 91.7 and 90 percent, respectively. Manual and semi-automatic segmentation methods of the SN reliably distinguished between PD patients and HC. ROC analysis shows the high sensitivity and specificity of both methods.
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Affiliation(s)
- Gašper Zupan
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (G.Z.); (Z.P.); (A.V.)
| | - Dušan Šuput
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (G.Z.); (Z.P.); (A.V.)
- Correspondence: ; Tel.: +386-1-543-7821
| | - Zvezdan Pirtošek
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (G.Z.); (Z.P.); (A.V.)
- Department of Neurology, University Medical Center, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Andrej Vovk
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (G.Z.); (Z.P.); (A.V.)
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Pasquini J, Durcan R, Wiblin L, Gersel Stokholm M, Rochester L, Brooks DJ, Burn D, Pavese N. Clinical implications of early caudate dysfunction in Parkinson's disease. J Neurol Neurosurg Psychiatry 2019; 90:1098-1104. [PMID: 31079063 PMCID: PMC6817982 DOI: 10.1136/jnnp-2018-320157] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/26/2019] [Accepted: 04/15/2019] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Although not typical of Parkinson's disease (PD), caudate dopaminergic dysfunction can occur in early stages of the disease. However, its frequency and longitudinal implications in large cohorts of recently diagnosed patients remain to be established. We investigated the occurrence of caudate dopaminergic dysfunction in the very early phases of PD (<2 years from diagnosis) using 123I-FP-CIT single photon emission CT and determined whether it was associated with the presence or subsequent development of cognitive impairment, depression, sleep and gait problems. METHODS Patients with PD and healthy controls were identified from the Parkinson's Progression Markers Initiative (PPMI) database. We defined a clinically significant caudate dysfunction as 123I-FP-CIT binding <-2 SDs compared with the controls' mean and categorised three groups accordingly (no reduction, unilateral reduction, bilateral reduction). All statistical analyses were adjusted for mean putamen binding. RESULTS At baseline, 51.6% of 397 patients had normal caudate dopamine transporter binding, 26.0% had unilateral caudate involvement, 22.4% had bilaterally impaired caudate.Compared with those with a baseline normal caudate function, at the4-year follow-up patients with a baseline bilateral caudate involvement showed a higher frequency of cognitive impairment (p<0.001) and depression (p<0.001), and worse cognitive (p<0.001), depression (<0.05) and gait (<0.001) ratings. Significant caudate involvement was observed in 83.9% of the population after 4 years (unilateral 22.5%, bilateral 61.4%). CONCLUSIONS Early significant caudate dopaminergic denervation was found in half of the cases in the PPMI series. Baseline bilateral caudate involvement was associated with increased risk of developing cognitive impairment, depression and gait problems over the next 4 years.
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Affiliation(s)
- Jacopo Pasquini
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, University of Milan, Milan, Italy.,Department of Neurology - Stroke Unit and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Rory Durcan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Wiblin
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Morten Gersel Stokholm
- Department of Nuclear Medicine and PET Centre, Aarhus Universitetshospital, Aarhus, Denmark
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David James Brooks
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Department of Nuclear Medicine and PET Centre, Aarhus Universitetshospital, Aarhus, Denmark
| | - David Burn
- Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Pavese
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK .,Department of Nuclear Medicine and PET Centre, Aarhus Universitetshospital, Aarhus, Denmark
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Classification of degenerative parkinsonism subtypes by support-vector-machine analysis and striatal 123I-FP-CIT indices. J Neurol 2019; 266:1771-1781. [PMID: 31037416 PMCID: PMC6586917 DOI: 10.1007/s00415-019-09330-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/10/2019] [Accepted: 04/21/2019] [Indexed: 12/30/2022]
Abstract
Objectives To provide an automated classification method for degenerative parkinsonian syndromes (PS) based on semiquantitative 123I-FP-CIT SPECT striatal indices and support-vector-machine (SVM) analysis. Methods 123I-FP-CIT SPECT was performed at a single-center level on 370 individuals with PS, including 280 patients with Parkinson’s disease (PD), 21 with multiple system atrophy-parkinsonian type (MSA-P), 41 with progressive supranuclear palsy (PSP) and 28 with corticobasal syndrome (CBS) (mean age 70.3 years, 47% female, mean disease duration at scan 1.4 year), as well as 208 age- and gender-matched control subjects. Striatal volumes-of-interest (VOIs) uptake, VOIs asymmetry indices (AIs) and caudate/putamen (C/P) ratio were used as input for SVM individual classification using fivefold cross-validation. Results Univariate analyses showed significantly lower VOIs uptake, higher striatal AI and C/P ratio for each PS in comparison to controls (all p < 0.001). Among PS, higher degree of striatal impairment was observed in MSA-P and PSP, while CBS showed moderate uptake reduction and higher AI. Binary SVM classification showed 92.9% accuracy in distinguishing PS from controls. Classification based on each binary combination of PS ranged 62.9–83.7% accuracy with the most satisfactory results when separating CBS from the other PS. Sensitivity and specificity values were high and balanced ranging from 60 to 80% for all analyses with > 70% accuracy. Overall, striatal AI and C/P ratio on the more affected side had the highest weighting factors. Conclusion Semiquantitative 123I-FP-CIT SPECT striatal evaluation combined with SVM represents a promising approach to disentangle PD from non-degenerative conditions and from atypical PS at the early stage.
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Kaasinen V, Kankare T, Joutsa J, Vahlberg T. Presynaptic Striatal Dopaminergic Function in Atypical Parkinsonism: A Metaanalysis of Imaging Studies. J Nucl Med 2019; 60:1757-1763. [PMID: 30979821 DOI: 10.2967/jnumed.119.227140] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/04/2019] [Indexed: 12/29/2022] Open
Abstract
Multiple-system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS) have signs and symptoms overlapping those of Parkinson disease (PD), complicating their clinical diagnosis. Although presynaptic dopaminergic brain imaging with PET and SPECT is clinically widely used for patients with suspected PD, the benefit of functional imaging in atypical parkinsonism syndromes remains unclear. We compared striatal presynaptic dopaminergic function in MSA parkinsonism variant (MSA-P), MSA cerebellar variant (MSA-C), PSP, CBS, and PD using combined quantitative data from all published studies. Methods: The PubMed database was searched from inception to August 2018 for the terms "dopamine" OR "dopaminergic" AND "PET" OR "SPECT" OR "SPET" and keywords related to PD, MSA, PSP, and CBS. In total, 1,711 publications were identified. PET or SPECT studies comparing patients with atypical parkinsonism to another diagnostic group (PD, MSA, PSP, or CBS) were included. Tracers for dopamine transporter (DAT), aromatic amino acid decarboxylase (AADC), or vesicular monoamine type 2 were investigated. Tracer binding data were extracted from the original articles. Heterogeneity of the data was examined using I 2 statistics, and a random-effects model was used to summarize data. Hedges g was used as an estimator of effect size in group comparisons. Results are reported according to PRISMA guidelines. Results: Thirty-five studies (29 DAT, 6 AADC, no vesicular monoamine type 2 studies) with 356 MSA-P patients, 204 PSP patients, 79 CBS patients, and 62 MSA-C patients were included in the metaanalysis. Caudate nucleus and putamen DAT function was clearly lower in PSP than in PD (caudate: 34.1% difference, g = -1.08, 95% confidence interval [CI] = -1.52 to -0.64; putamen: 18.2%, g = -0.86, 95% CI = -1.50 to -0.21) and MSA-P (striatum: 31.4%, g = -0.70, 95% CI = -1.21 to -0.19) and was clearly lower in MSA-P than in MSA-C (striatum: 46.0%, g = 1.46, 95% CI = 0.23 to 2.68). Although not significant because of limited data, aromatic l-AADC results paralleled the DAT findings. Conclusion: Striatal presynaptic DAT function is clearly lower in PSP patients than in PD and MSA-P patients and is clearly lower in MSA-P patients than in MSA-C patients.
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Affiliation(s)
- Valtteri Kaasinen
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland .,Department of Neurology, University of Turku, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland; and
| | - Tuomas Kankare
- Department of Neurology, University of Turku, Turku, Finland
| | - Juho Joutsa
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
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Iwabuchi Y, Nakahara T, Kameyama M, Yamada Y, Hashimoto M, Matsusaka Y, Osada T, Ito D, Tabuchi H, Jinzaki M. Impact of a combination of quantitative indices representing uptake intensity, shape, and asymmetry in DAT SPECT using machine learning: comparison of different volume of interest settings. EJNMMI Res 2019; 9:7. [PMID: 30689072 PMCID: PMC6890908 DOI: 10.1186/s13550-019-0477-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We sought to assess the machine learning-based combined diagnostic accuracy of three types of quantitative indices obtained using dopamine transporter single-photon emission computed tomography (DAT SPECT)-specific binding ratio (SBR), putamen-to-caudate ratio (PCR)/fractal dimension (FD), and asymmetry index (AI)-for parkinsonian syndrome (PS). We also aimed to compare the effect of two different types of volume of interest (VOI) settings from commercially available software packages DaTQUANT (Q) and DaTView (V) on diagnostic accuracy. METHODS Seventy-one patients with PS and 40 without PS (NPS) were enrolled. Using SPECT images obtained from these patients, three quantitative indices were calculated at two different VOI settings each. SBR-Q, PCR-Q, and AI-Q were derived using the VOI settings from DaTQUANT, whereas SBR-V, FD-V, and AI-V were derived using those from DaTView. We compared the diagnostic value of these six indices for PS. We incorporated a support vector machine (SVM) classifier for assessing the combined accuracy of the three indices (SVM-Q: combination of SBR-Q, PCR-Q, and AI-Q; SVM-V: combination of SBR-V, FD-V, and AI-V). A Mann-Whitney U test and receiver-operating characteristics (ROC) analysis were used for statistical analyses. RESULTS ROC analyses demonstrated that the areas under the curve (AUC) for SBR-Q, PCR-Q, AI-Q, SBR-V, FD-V, and AI-V were 0.978, 0.837, 0.802, 0.906, 0.972, and 0.829, respectively. On comparing the corresponding quantitative indices between the two types of VOI settings, SBR-Q performed better than SBR-V (p = 0.006), whereas FD-V performed better than PCR-Q (p = 0.0003). No significant difference was observed between AI-Q and AI-V (p = 0.56). The AUCs for SVM-Q and SVM-V were 0.988 and 0.994, respectively; the two different VOI settings displayed no significant differences in terms of diagnostic accuracy (p = 0.48). CONCLUSION The combination of the three indices obtained using the SVM classifier improved the diagnostic performance for PS; this performance did not differ based on the VOI settings and software used.
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Affiliation(s)
- Yu Iwabuchi
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
| | - Masashi Kameyama
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.,Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Hashimoto
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Yohji Matsusaka
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Takashi Osada
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Daisuke Ito
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Hajime Tabuchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
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Abstract
Corticobasal syndrome is the most common phenotype of corticobasal degeneration (CBD). F-FP-CIT PET and MRI are not helpful in distinguishing CBD from idiopathic Parkinson disease. Dual-phase F-FP-CIT PET is a recently developed imaging that shows regional cerebral perfusion in the early phase and dopamine transporter density in the late phase. We investigated the usefulness of dual-phase F-FP-CIT PET imaging in 3 patients with corticobasal syndrome. This image highlights that the early phases of F-FP-CIT PET may reflect regional cerebral perfusion with a pattern very similar to that of regional glucose metabolism in CBD.
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Rahman MGM, Islam MM, Tsujikawa T, Kiyono Y, Okazawa H. Count-based method for specific binding ratio calculation in [I-123]FP-CIT SPECT analysis. Ann Nucl Med 2018; 33:14-21. [PMID: 30276622 PMCID: PMC6314989 DOI: 10.1007/s12149-018-1297-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To calculate the specific binding ratio (SBR) appropriately in dopamine transporter (DAT) imaging, a method for extracting the striatal volume of interest (VOI) was developed. METHODS This study included 200 patients (72 ± 10 years) who were suspected of parkinsonian syndromes (PS) or dementia with Lewy body (DLB). The patients were divided into three groups of PS with dopaminergic degeneration, DLB and non-PS after [123I]ioflupane (FP-CIT) SPECT and clinical follow-up. The image data were reconstructed with CT attenuation correction and scatter correction, and with only CT attenuation correction (CTAC). The new method extracted striatal VOI according to the high-level counts and the average striatum volume, and calculated SBR using the reference occipital counts. The SBR values for each patient were obtained using the Tossici-Bolt method (SBRBolt) and our method. Reproducibility of SBR calculation using our method was compared by two operators. RESULTS The mean SBR values for the PS and DLB groups were significantly different from that of the non-PS group with both methods. The coefficients of variation of the SBR were significantly smaller with the proposed method compared with those of SBRBolt (p < 0.001), except for the CTAC images. There were no differences in SBR between the two operators using our method. The diagnostic accuracies with our method for the PS and DLB groups were 98.4 and 96.0%, respectively. CONCLUSION Our new method for SBR calculation in the FP-CIT SPECT showed less coefficients of variation with high reproducibility, which would be useful for clinical diagnosis and in assessing the severity of diseases in follow-up studies.
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Affiliation(s)
- Mahmudur G M Rahman
- Biomedical Imaging Research Center, University of Fukui, 23-3, Matsuoka-Shimaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Muhammad M Islam
- Biomedical Imaging Research Center, University of Fukui, 23-3, Matsuoka-Shimaizuki, Eiheiji, Fukui, 910-1193, Japan.,Department of Biomedical Engineering, Khulna University of Engineering and Technology, Khulna, Bangladesh
| | - Tetsuya Tsujikawa
- Biomedical Imaging Research Center, University of Fukui, 23-3, Matsuoka-Shimaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Yasushi Kiyono
- Biomedical Imaging Research Center, University of Fukui, 23-3, Matsuoka-Shimaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center, University of Fukui, 23-3, Matsuoka-Shimaizuki, Eiheiji, Fukui, 910-1193, Japan.
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Thobois S, Prange S, Scheiber C, Broussolle E. What a neurologist should know about PET and SPECT functional imaging for parkinsonism: A practical perspective. Parkinsonism Relat Disord 2018; 59:93-100. [PMID: 30181086 DOI: 10.1016/j.parkreldis.2018.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 12/16/2022]
Abstract
The diagnosis of a parkinsonian syndrome based on clinical criteria remains sometimes difficult, especially at disease onset. Brain or heart molecular imaging techniques (SPECT or PET) can provide a major help to improve and speed up diagnosis, influencing treatment strategies. Presynaptic dopaminergic imaging using either [18F]-Dopa PET or 123I -2β-Carbomethoxy-3β-(4-Iodophenyl)- N-(3-Fluoropropyl) Nortropane ([123I]-Ioflupane)SPECT demonstrates or rules out the presence of a dopaminergic degenerative process. This allows to distinguish Parkinson's disease, Parkinson "plus" syndromes and dementia with Lewy bodies (reduced radiotracers binding) from essential tremor, psychogenic, post-neuroleptic or vascular parkinsonisms, dopa-responsive dystonia and Alzheimer's disease (normal radiotracers binding). For differential diagnosis between Parkinson's disease and Parkinson "plus" syndromes, brain molecular imaging with [18F]-Fluorodeoxyglucose ([18F]-FDG) PET or 99mTc-HMPAO SPECT can provide useful information, whereas [18F]-Dopa PET or [123I]-Ioflupane does not separate these entities. Finally, sympathetic cardiac [123I]-Metaiodobenzylguanidine ([123I]-MIBG) scintigraphy or SPECT can help distinguishing Parkinson's disease and dementia with Lew bodies (decreased binding) from multiple system atrophy and progressive supranuclear palsy (normal binding). New radiotracers notably those targeting the pathological process itself such as Tau aggregates are under development and may provide interesting informations to delineate the different Parkinson "plus" syndromes.
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Affiliation(s)
- Stéphane Thobois
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, F-69675, Bron, France; Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Lyon, France; Univ Lyon, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, F-69921, Oullins, France.
| | - Stéphane Prange
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, F-69675, Bron, France; Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Lyon, France
| | - Christian Scheiber
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Médecine Nucléaire, Lyon, France
| | - Emmanuel Broussolle
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, F-69675, Bron, France; Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Lyon, France; Univ Lyon, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, F-69921, Oullins, France
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Bu LL, Liu FT, Jiang CF, Guo SS, Yu H, Zuo CT, Wu P, Wang J. Patterns of dopamine transporter imaging in subtypes of multiple system atrophy. Acta Neurol Scand 2018; 138:170-176. [PMID: 29573392 DOI: 10.1111/ane.12932] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To investigate the differences in the pattern of striatal (caudate and putamen) dopamine transporter (DAT) loss in a multiple system atrophy (MSA) cohort, based on the clinical variants parkinsonian subtype (MSA-P) and cerebellar subtype (MSA-C) via (11)C-N-2-carbomethoxy-3-(4-fluorophenyl)-tropane (11 C-CFT) positron emission tomography (PET) imaging. MATERIALS AND METHODS One hundred and six subjects (forty-one patients with probable MSA-P; forty patients with probable MSA-C; twenty-five healthy controls) underwent 11 C-CFT PET. Subregional 11 C-CFT uptake of bilateral caudate, anterior putamen, and posterior putamen was calculated respectively to measure the striatal dopaminergic function. RESULTS Significant decrease in DAT binding in striatum was revealed in patients with MSA-C and MSA-P compared to normal controls (all regions, MSA-C vs controls, P < .0001; MSA-P vs controls, P < .0001). DAT reduction was more pronounced in MSA-P patients than that in MSA-C patients (all regions, P < .0001). Eleven of forty MSA-C patients displayed no DAT loss, whereas striatal DAT loss was evident in all MSA-P patients. MSA-P subtype showed a more obvious anteroposterior gradient of DAT loss and more asymmetric dopaminergic dysfunction compared to MSA-C patients. CONCLUSION The subtypes of MSA studied here show significantly different spatial/anatomic patterns of striatonigral degeneration which may provide insights into their disease pathophysiology. Specifically, MSA-P patients exhibit an uneven and much greater pronounced loss of dopamine innervation, while a relatively uniform pattern is revealed in patients with the MSA-C. Furthermore, the typical reduction in DAT 11 C-CFT binding in striatum is not present in all MSA-C patients, with a minority of cases showing normal DAT binding.
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Affiliation(s)
- L.-L. Bu
- Department of Neurology & National Clinical Research Center for Aging and Medicine; Huashan Hospital; Fudan University; Shanghai China
| | - F.-T. Liu
- Department of Neurology & National Clinical Research Center for Aging and Medicine; Huashan Hospital; Fudan University; Shanghai China
| | - C.-F. Jiang
- Department of Nuclear Medicine; Affiliated Kunshan Hospital; Jiangsu University; Kunshan China
| | - S.-S. Guo
- Department of Neurology & National Clinical Research Center for Aging and Medicine; Huashan Hospital; Fudan University; Shanghai China
| | - H. Yu
- Department of Neurology & National Clinical Research Center for Aging and Medicine; Huashan Hospital; Fudan University; Shanghai China
| | - C.-T. Zuo
- PET Center; Huashan Hospital; Fudan University; Shanghai China
- Institute of Functional and Molecular Medical Imaging; Fudan University; Shanghai China
| | - P. Wu
- PET Center; Huashan Hospital; Fudan University; Shanghai China
| | - J. Wang
- Department of Neurology & National Clinical Research Center for Aging and Medicine; Huashan Hospital; Fudan University; Shanghai China
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123I-FP-CIT SPECT Accurately Distinguishes Parkinsonian From Cerebellar Variant of Multiple System Atrophy. Clin Nucl Med 2018; 43:e33-e36. [DOI: 10.1097/rlu.0000000000001899] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brumberg J, Isaias IU. SPECT Molecular Imaging in Atypical Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 142:37-65. [DOI: 10.1016/bs.irn.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Matsusue E, Fujihara Y, Tanaka K, Aozasa Y, Shimoda M, Nakayasu H, Nakamura K, Ogawa T. The Utility of the Combined Use of 123I-FP-CIT and 123I-MIBG Myocardial Scintigraphy in Differentiating Parkinson’s Disease from Other Parkinsonian Syndromes. Yonago Acta Med 2018. [DOI: 10.33160/yam.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Eiji Matsusue
- *Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Yoshio Fujihara
- *Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Kenichiro Tanaka
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Yuki Aozasa
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Manabu Shimoda
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Hiroyuki Nakayasu
- †Department of Neurology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Kazuhiko Nakamura
- *Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Toshihide Ogawa
- ‡Division of Radiology, Department of Pathophysiological Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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The utility of the combination of a SPECT study with [123I]-FP-CIT of dopamine transporters and [123I]-MIBG myocardial scintigraphy in differentiating Parkinson disease from other degenerative parkinsonian syndromes. Nucl Med Commun 2017; 38:487-492. [PMID: 28410288 PMCID: PMC5433627 DOI: 10.1097/mnm.0000000000000674] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective Molecular imaging of nigrostriatal dopamine transporters (DAT) and sympathetic cardiac innervation with single-photon emission computed tomography (SPECT) are useful tools for differentiating idiopathic Parkinson disease (PD) from other degenerative parkinsonian syndromes (non-PD). Nevertheless, these modalities are often insufficient for achieving a definite diagnosis. The aims of this study were to evaluate the diagnostic accuracy of the combination of these tools. Materials and methods The SPECT radiotracers [123I]-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)-nortropane (FP-CIT) and meta-[123I]-iodobenzylguanidine (MIBG) were used to research presynaptic dopaminergic projections (DAT SPECT) and myocardial adrenergic innervation (MIBG scintigraphy), respectively. PD patients (n=15; age: 61.5±13.6 years) and non-PD patients (n=19; age: 62.6±14.2 years) who underwent both tests were enrolled in this study. Receiver-operating characteristic analyses were used to set the cutoff values of the specific binding ratio in DAT SPECT and the heart to mediastinum ratio in delayed scan in MIBG scintigraphy for differentiating PD from non-PD. We calculated the sensitivity, specificity, and test accuracy of the individual methods and also the combination of these two modalities. Results When DAT SPECT and MIBG scintigraphy were used individually, they showed mild accuracy in differentiating PD from non-PD (DAT, 67.6%; MIBG, 67.6%). The combination of the two approaches using cutoff values of less than 3.24 for the specific binding ratio and less than 2.745 for the delayed heart to mediastinum ratio enabled more accurate differentiation between PD and non-PD. The accuracy of these indices in distinguishing PD from non-PD was 79.4%. Conclusion These results suggested that the combination of DAT SPECT and MIBG scintigraphy may improve the diagnostic accuracy in differentiating PD from non-PD.
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Whitwell JL, Höglinger GU, Antonini A, Bordelon Y, Boxer AL, Colosimo C, van Eimeren T, Golbe LI, Kassubek J, Kurz C, Litvan I, Pantelyat A, Rabinovici G, Respondek G, Rominger A, Rowe JB, Stamelou M, Josephs KA. Radiological biomarkers for diagnosis in PSP: Where are we and where do we need to be? Mov Disord 2017; 32:955-971. [PMID: 28500751 PMCID: PMC5511762 DOI: 10.1002/mds.27038] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/11/2022] Open
Abstract
PSP is a pathologically defined neurodegenerative tauopathy with a variety of clinical presentations including typical Richardson's syndrome and other variant PSP syndromes. A large body of neuroimaging research has been conducted over the past two decades, with many studies proposing different structural MRI and molecular PET/SPECT biomarkers for PSP. These include measures of brainstem, cortical and striatal atrophy, diffusion weighted and diffusion tensor imaging abnormalities, [18F] fluorodeoxyglucose PET hypometabolism, reductions in striatal dopamine imaging and, most recently, PET imaging with ligands that bind to tau. Our aim was to critically evaluate the degree to which structural and molecular neuroimaging metrics fulfill criteria for diagnostic biomarkers of PSP. We queried the PubMed, Cochrane, Medline, and PSYCInfo databases for original research articles published in English over the past 20 years using postmortem diagnosis or the NINDS-SPSP criteria as the diagnostic standard from 1996 to 2016. We define a five-level theoretical construct for the utility of neuroimaging biomarkers in PSP, with level 1 representing group-level findings, level 2 representing biomarkers with demonstrable individual-level diagnostic utility, level 3 representing biomarkers for early disease, level 4 representing surrogate biomarkers of PSP pathology, and level 5 representing definitive PSP biomarkers of PSP pathology. We discuss the degree to which each of the currently available biomarkers fit into this theoretical construct, consider the role of biomarkers in the diagnosis of Richardson's syndrome, variant PSP syndromes and autopsy confirmed PSP, and emphasize current shortfalls in the field. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Günter U. Höglinger
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, IRCCS Hospital San Camillo, Venice and Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
| | - Thilo van Eimeren
- German Center for Neurodegenerative Diseases (DZNE), Germany
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Lawrence I. Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Carolin Kurz
- Psychiatrische Klinik, Ludwigs-Maximilians-Universität, München, Germany
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, CA, USA
| | | | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Gesine Respondek
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Axel Rominger
- Deptartment of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - James B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Maria Stamelou
- Second Department of Neurology, Attikon University Hospital, University of Athens, Greece; Philipps University, Marburg, Germany; Movement Disorders Dept., HYGEIA Hospital, Athens, Greece
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Additional Value of Early-Phase 18F-FP-CIT PET Image for Differential Diagnosis of Atypical Parkinsonism. Clin Nucl Med 2017; 42:e80-e87. [PMID: 27922865 DOI: 10.1097/rlu.0000000000001474] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Regional cerebral perfusion is coupled to metabolism in general. Early perfusion dominant imaging using F-FP-CIT PET (pCIT) may provide complementary information to delayed dopamine transporter dominant images. We investigated the ability of pCIT to differentiate atypical Parkinson disorder from Parkinson disease (PD) compared to FDG and the image quality for optimizing the acquisition time. METHODS Sixty-seven subjects [PD, 23 subjects; multiple system atrophy-cerebellar type (MSA-C), 27 subjects; MSA-Parkinson type (MSA-P), 12 subjects; and progressive supranuclear palsy (PSP), 5 subjects] underwent F-FP-CIT and FDG PET. Using dynamic PET data acquired during the first 10 minutes after F-FP-CIT administration, we generated potential perfusion images of 0 to 5 (pCIT-5m), 0 to 7 (pCIT-7m), and 0 to 10 (pCIT-10m) minutes. We compared regional uptake between groups in pCIT and FDG images and image quality among pCIT images using visual, quantitative, or statistical parametric mapping analyses. RESULTS Regional cerebral uptake of pCITs correlated well to that of the FDG images (R > 0.5, all). Multiple system atrophy-cerebellar type and MSA-P groups show different regional uptake patterns compared with PD group on pCITs in quantitative and statistical parametric mapping analyses, analogous to FDG images, but not in the PSP group. In visual analysis, concordance rates between each pCIT and FDG image were high (92.3%-96.0%, regional; 86.2%-93.1%, diagnostic), and there was no significant difference among pCITs. However, pCIT-10m discriminated PSP better than others and showed higher signal-to-noise ratio (P = 0.001). CONCLUSION F-FP-CIT PETs with the first 10 minutes could be useful for the differential diagnosis of atypical Parkinson disorder by providing complementary FDG-like information to the dopamine transporter binding on late-phase FP-CIT images.
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Mallik AK, Drzezga A, Minoshima S. Molecular Imaging and Precision Medicine in Dementia and Movement Disorders. PET Clin 2017; 12:119-136. [DOI: 10.1016/j.cpet.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Isaacson SH, Fisher S, Gupta F, Hermanowicz N, Kremens DE, Lew MF, Marek K, Pahwa R, Russell DS, Seibyl J. Clinical utility of DaTscan™ imaging in the evaluation of patients with parkinsonism: a US perspective. Expert Rev Neurother 2016; 17:219-225. [DOI: 10.1080/14737175.2017.1256205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, FL, USA
| | - Stanley Fisher
- Saint Luke’s Marion Bloch Neuroscience Institute, Kansas City, MO, USA
| | - Fiona Gupta
- Hackensack University Medical Center, Movement Disorders Center, Hackensack, NJ, USA
| | - Neal Hermanowicz
- Irvine Health Movement Disorders Program, University of California, Irvine, CA, USA
| | - Daniel E. Kremens
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Mark F. Lew
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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Nocker M, Seppi K, Boesch S, Donnemiller E, Virgolini I, Wenning GK, Poewe W, Scherfler C. Topography of Dopamine Transporter Availability in the Cerebellar Variant of Multiple System Atrophy. Mov Disord Clin Pract 2016; 4:389-396. [PMID: 30363469 DOI: 10.1002/mdc3.12446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/09/2016] [Accepted: 08/16/2016] [Indexed: 11/06/2022] Open
Abstract
Background Voxel-wise comparison of [123I]-2β-carbomethoxy-3beta-(4-iodophenyl)tropane ([123I]β-CIT) radioligand distribution measured by single-photon emission computed tomography (SPECT) revealed distinct patterns of reduced dopamine transporter (DAT) availability in the Parkinson's variant of MSA (MSA-P). The aim of this study was to identify the monoamine transporter distribution pattern in patients with the cerebellar variant of MSA (MSA-C). Additionally, monoamine transporter availability was investigated in a small cohort of patients with sporadic adult-onset ataxia (SAOA). Methods [123I]β-CIT SPECT was performed in patients with MSA-C (n = 12), MSA-P (n = 14), SAOA (n = 5), and controls (n = 15) matched for age. Parametric images of [123I]β-CIT binding potential (BPND) were generated and analyzed by statistical parametric mapping (SPM) and region of interest (ROI) analysis. Results SPM localized significant reductions of [123I]β-CIT BPND in the striatum, midbrain, and pons in MSA-C compared to controls. When compared with MSA-P, the striatal DAT decline was significantly less affected in MSA-C. ROI analysis revealed reductions of striatal and midbrain [123I]β-CIT binding in MSA-C compared to SAOA, whereas no significant difference was apparent between the SAOA and control groups. Conclusions Midbrain and pontine monoaminergic transporter binding was severely impaired in MSA-C, matching the underlying pathological features. Striatal DAT availability was relatively less affected in MSA-C compared to MSA-P, reflecting measureable, but less-profound, degeneration of the nigrostriatal dopaminergic projections. Preliminary results of reduced striatal and midbrain [123I]β-CIT binding in MSA-C, compared to SAOA, suggest that the potential of DAT-SPECT as a surrogate marker in the diagnostic workup of patients with adult-onset cerebellar ataxia should be further investigated.
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Affiliation(s)
- Michael Nocker
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Klaus Seppi
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Sylvia Boesch
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Eveline Donnemiller
- Department of Nuclear Medicine Medical University of Innsbruck Innsbruck Austria
| | - Irene Virgolini
- Department of Nuclear Medicine Medical University of Innsbruck Innsbruck Austria
| | - Gregor K Wenning
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Werner Poewe
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
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Pirker S, Perju-Dumbrava L, Kovacs GG, Traub-Weidinger T, Pirker W. Progressive Dopamine Transporter Binding Loss in Autopsy-Confirmed Corticobasal Degeneration. JOURNAL OF PARKINSONS DISEASE 2016; 5:907-12. [PMID: 26485425 DOI: 10.3233/jpd-150625] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Corticobasal degeneration (CBD) is characterized by neuronal and glial deposition of 4-repeat tau in the frontal and parietal cerebral cortex, white matter and striatum. There is neuronal loss in affected cortical regions and in the substantia nigra (SN). Recent single photon emission tomography (SPECT) studies have reported normal striatal dopamine transporter (DAT) binding in individual patients with CBD. OBJECTIVE To study the pattern and course of DAT binding loss in CBD. METHODS We retrospectively analyzed DAT SPECT studies in two patients presenting with a corticobasal syndrome in whom a diagnosis of CBD was later confirmed pathologically. RESULTS Baseline scans at 1.5 years after symptom onset revealed only mild abnormalities (reduced uptake in one putamen). Follow up scans at 4.5 years (Case 1) and 5 years (Case 2) after symptom onset showed a marked decline of striatal DAT binding. In both cases, there was a 37% binding reduction from the age-expected striatal binding value. Asymmetry of striatal DAT binding had increased from mild in the first SPECT studies to moderate at the time of their final imaging. CONCLUSION CBD patients can have delayed neuronal loss in the SN. Follow up DAT imaging may be of value in patients with possible CBD and a normal baseline scan.
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Affiliation(s)
- Susanne Pirker
- 2nd Neurological Department, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | | | - Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna, Austria
| | - Tatiana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Walter Pirker
- Department of Neurology, Wilhelminenspital, Vienna, Austria
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45
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Brooks DJ. Molecular imaging of dopamine transporters. Ageing Res Rev 2016; 30:114-21. [PMID: 26802555 DOI: 10.1016/j.arr.2015.12.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/26/2015] [Accepted: 12/29/2015] [Indexed: 12/31/2022]
Abstract
The dopamine transporter (DAT) is responsible for clearance of dopamine from the synaptic cleft after its release. Imaging DAT availability provides a measure of dopamine terminal function and a method for detecting the striatal dopamine terminal dysfunction present in idiopathic Parkinson's disease (PD) and atypical neurodegenerative parkinsonian disorders such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). DAT imaging with positron emission tomography (PET) or single photon emission computed tomography (SPECT) can be used to support or refute a diagnosis of dopamine deficient parkinsonism in cases where this is unclear and rationalise a trial of dopamine replacement agents as therapy. It can also detect subclinical dopaminergic dysfunction when present in subjects at risk for PD such as relatives of patients, susceptibility gene mutation carriers, and subjects with late onset hyposmia or sleep disorders. The presence of normal DAT availability on imaging can help categorise "subjects without evidence of dopamine deficiency" (SWEDDs) who on occasion mimic PD and include dystonic tremors, drug-induced and psychogenic parkinsonism in their ranks. Reduced levels of baseline striatal DAT availability on PET or SPECT scanning, however, should be regarded as supportive rather than diagnostic of dopamine deficient parkinsonism.
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Badoud S, Van De Ville D, Nicastro N, Garibotto V, Burkhard PR, Haller S. Discriminating among degenerative parkinsonisms using advanced (123)I-ioflupane SPECT analyses. Neuroimage Clin 2016; 12:234-40. [PMID: 27489771 PMCID: PMC4950578 DOI: 10.1016/j.nicl.2016.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/23/2016] [Accepted: 07/04/2016] [Indexed: 11/26/2022]
Abstract
(123)I-ioflupane single photon emission computed tomography (SPECT) is a sensitive and well established imaging tool in Parkinson's disease (PD) and atypical parkinsonian syndromes (APS), yet a discrimination between PD and APS has been considered inconsistent at least based on visual inspection or simple region of interest analyses. We here reappraise this issue by applying advanced image analysis techniques to separate PD from the various APS. This study included 392 consecutive patients with degenerative parkinsonism undergoing (123)I-ioflupane SPECT at our institution over the last decade: 306 PD, 24 multiple system atrophy (MSA), 32 progressive supranuclear palsy (PSP) and 30 corticobasal degeneration (CBD) patients. Data analysis included voxel-wise univariate statistical parametric mapping and multivariate pattern recognition using linear discriminant classifiers. MSA and PSP showed less ioflupane uptake in the head of caudate nucleus relative to PD and CBD, yet there was no difference between MSA and PSP. CBD had higher uptake in both putamen relative to PD, MSA and PSP. Classification was significant for PD versus APS (AUC 0.69, p < 0.05) and between APS subtypes (MSA vs CBD AUC 0.80, p < 0.05; MSA vs PSP AUC 0.69 p < 0.05; CBD vs PSP AUC 0.69 p < 0.05). Both striatal and extra-striatal regions contain classification information, yet the combination of both regions does not significantly improve classification accuracy. PD, MSA, PSP and CBD have distinct patterns of dopaminergic depletion on (123)I-ioflupane SPECT. The high specificity of 84-90% for PD versus APS indicates that the classifier is particularly useful for confirming APS cases.
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Affiliation(s)
- Simon Badoud
- Neurology Division, Department of Clinical Neurosciences (NEUCLI), Geneva University Hospitals, Switzerland
- Neurophysiology Unit, Department of Medicine, University of Fribourg (CH), Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
| | - Dimitri Van De Ville
- Department of Imaging and Medical Informatics, University Hospitals of Geneva, Faculty of Medicine, University of Geneva, Switzerland
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Switzerland
| | - Nicolas Nicastro
- Neurology Division, Department of Clinical Neurosciences (NEUCLI), Geneva University Hospitals, Switzerland
| | - Valentina Garibotto
- Faculty of Medicine, University of Geneva, Switzerland
- Nuclear Medicine and Molecular Imaging Division, Department of Imaging and Medical Informatics, University Hospitals of Geneva, Switzerland
| | - Pierre R. Burkhard
- Neurology Division, Department of Clinical Neurosciences (NEUCLI), Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
| | - Sven Haller
- Faculty of Medicine, University of Geneva, Switzerland
- Affidea Centre de Diagnostic Radiologique de Carouge CDRC, Geneva, Switzerland
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Department of Neuroradiology, University Hospital Freiburg, Germany
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Kwon GH, Jang J, Choi HS, Hwang EJ, Jung SL, Ahn KJ, Kim BS, Yoo IR, Kim SH, Haacke EM. The phase value of putamen measured by susceptibility weighted images in Parkinson's disease and in other forms of Parkinsonism: a correlation study with F18 FP-CIT PET. Acta Radiol 2016; 57:852-60. [PMID: 26377263 DOI: 10.1177/0284185115604515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/10/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Iron deposition of basal ganglia in Parkinson's disease (PD) can be measured using susceptibility weighted images (SWI) on magnetic resonance imaging (MRI). Fluoropropyl carbomethoxy-3b-4-iodophenyltropane (F18 FP-CIT) positron emission tomography (PET) has been used to differentiate Parkinsonism. PURPOSE To compare SWI phase values in Parkinsonian syndrome and age-matched control and to correlate them with F18 FP-CIT PET. MATERIAL AND METHODS Retrospectively, patients with Parkinsonian movement disorder (n = 62) and age-matched control (n = 16) were enrolled. Mean phase values on SWI were measured by region of interest (ROI) in putamens and caudate heads. Mean standardized uptake value (SUV) on F18 FP-CIT were measured in the same ROIs of PD (n = 40) and other forms of Parkinsonism (n = 22). A statistical analysis was performed to compare the phase values and SUVs and to correlate them between groups. RESULTS The putaminal mean phase values were higher in Parkinsonism than in the control (P ≤ 0.001). There was no difference of phase value in caudate head among the groups. Also, the mean phase value of putamen between PD and other forms of Parkinsonism was not different. Mean SUV of F18 FP-CIT in the putamen was lower in PD than other forms of Parkinsonism (P ≤ 0.014). However, there was no significant correlation between phase values and mean SUV (P > 0.05). CONCLUSION The putaminal phase value was higher than in Parkinsonian syndrome than in the age-matched controls. F18 FP-CIT PET/CT showed different tracer activity between PD and other forms of Parkinsonism. However, no correlation between phase and SUV values was discovered.
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Affiliation(s)
- Gene Hyuk Kwon
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jinhee Jang
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Seok Choi
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eo-Jin Hwang
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Lyung Jung
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kook-Jin Ahn
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bum-soo Kim
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ie Ryung Yoo
- Department of Nuclear Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Hoon Kim
- Department of Nuclear Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - E Mark Haacke
- Department of Biomedical Engineering and Radiology, Harper University Hospital, Wayne State University, Detroit, MI, USA
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48
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Brooks DJ, Tambasco N. Imaging synucleinopathies. Mov Disord 2016; 31:814-29. [PMID: 26879635 DOI: 10.1002/mds.26547] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/18/2015] [Accepted: 12/20/2015] [Indexed: 01/05/2023] Open
Abstract
In this review the structural and functional imaging changes associated with the synucleinopathies PD, MSA, and dementias associated with Lewy bodies are reviewed. The role of imaging for supporting differential diagnosis, detecting subclinical disease, and following disease progression is discussed and its potential use for monitoring disease progression is debated. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- David J Brooks
- Dept of Nuclear Medicine, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Dept of Medicine, Imperial College London, London, United Kingdom.,Division of Neurology, Newcastle University, Newcastle, United Kingdom
| | - Nicola Tambasco
- Dept of Neurology, Azienda Ospedaliera e Universitaria di Perugia, Perugia, Italy
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Intensity normalization of DaTSCAN SPECT imaging using a model-based clustering approach. Appl Soft Comput 2015. [DOI: 10.1016/j.asoc.2015.08.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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50
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Broski SM, Hunt CH, Johnson GB, Morreale RF, Lowe VJ, Peller PJ. Structural and functional imaging in parkinsonian syndromes. Radiographics 2015; 34:1273-92. [PMID: 25208280 DOI: 10.1148/rg.345140009] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Movement disorders with parkinsonian features are common, and in recent years imaging has assumed a greater role in diagnosis and management. Thus, it is important that radiologists become familiar with the most common imaging patterns of parkinsonism, especially given the significant clinical overlap and diagnostic difficulty associated with these disorders. The authors review the most common magnetic resonance (MR) and molecular imaging patterns of idiopathic Parkinson disease and atypical parkinsonian syndromes. They also discuss the interpretation of clinically available molecular imaging studies, including assessment of cerebral metabolism with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET), cortical amyloid deposition with carbon 11 ((11)C) Pittsburgh compound B and fluorine 18 ((18)F) florbetapir PET, and dopaminergic activity with iodine 123 ((123)I) ioflupane single photon emission computed tomography (SPECT). Although no single imaging test is diagnostic, a combination of tests may help narrow the differential diagnosis. Findings at (123)I ioflupane SPECT can confirm the loss of dopaminergic neurons in patients with parkinsonism and help distinguish these syndromes from treatable conditions, including essential tremor and drug-induced parkinsonism. FDG PET uptake can demonstrate patterns of neuronal dysfunction that are specific to a particular parkinsonian syndrome. Although MR imaging findings are typically nonspecific in parkinsonian syndromes, classic patterns of T2 signal change can be seen in multiple system atrophy and progressive supranuclear palsy. Finally, positive amyloid-binding PET findings can support the diagnosis of dementia with Lewy bodies. Combined with a thorough clinical evaluation, multimodality imaging information can afford accurate diagnosis, allow selection of appropriate therapy, and provide important prognostic information.
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Affiliation(s)
- Stephen M Broski
- From the Departments of Radiology (S.M.B., C.H.H., G.B.J., V.J.L., P.J.P.), Immunology (G.B.J.), and Medical Illustration (R.F.M.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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