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Keir G, Mashriqi F, Caravella C, Clouston SAP, Rini JN, Franceschi AM. Optimization of [ 18F]-FDOPA Brain PET Acquisition Times for Assessment of Parkinsonism in the Clinical Setting. AJNR Am J Neuroradiol 2024; 45:781-787. [PMID: 38663986 DOI: 10.3174/ajnr.a8207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE Fluorine 18-fluoro-L-dopa ([18F]-FDOPA) was approved by the FDA in 2019 and reimbursed by the Centers for Medicare & Medicaid Services in 2022 for use with PET to visualize dopaminergic nerve terminals in the striatum for evaluation of parkinsonism. We sought to determine the optimal image acquisition time for [18F]-FDOPA PET by evaluating rater-estimated FDOPA positivity and image quality across 4 time points. MATERIALS AND METHODS Brain PET/CT was acquired 90 minutes following injection of 185 megabecquerel (5 mCi) of [18F]-FDOPA. PET was acquired in list mode for 20 minutes, and data were replayed to represent 15-, 10-, and 5-minute acquisitions. By means of MIMneuro, PET/MR imaging or PET/CT was independently graded for FDOPA positivity and image quality by 2 readers, blinded to the clinical report and diagnosis. Expert neuroradiologist clinical reads were used as the criterion standard. RESULTS Twenty patients were included, average age 65.6 years, 55% women. Image-quality ratings decreased with shorter acquisition times for both readers (reader 1, ρ = 0.23, P = .044; reader 2, ρ = 0.24, P = .036), but there was no association between abnormality confidence scores and acquisition time (reader 1, ρ = -0.13, P = .250; reader 2, ρ = -0.19, P = .100). There was a high degree of consistency in intra- and interrater agreement and agreement with the expert reads when using acquisition times of ≥10 minutes (maximal confidence score consistency [ρ = 0.92] and interrater agreement [κ = 0.90] were observed at 15 minutes), while image quality was consistently rated as low and FDOPA positivity ratings were inconsistent when using a 5-minute acquisition time. CONCLUSIONS Our study suggests that image-quality ratings were stable after 15 minutes and that between-subject abnormality detection rates were highly consistent between the 2 readers when acquired for at least 10 and up to 20 minutes but were inconsistent at 5 minutes. Shorter [18F]-FDOPA PET acquisition times may help maximize patient comfort while increasing throughput in the clinical setting.
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Affiliation(s)
- Graham Keir
- From the Neuroradiology Division (G.K., F.M., A.M.F.), Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
| | - Faizullah Mashriqi
- From the Neuroradiology Division (G.K., F.M., A.M.F.), Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
| | - Christopher Caravella
- Nuclear Medicine Division (C.C., J.N.R.), Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Sean A P Clouston
- Department of Family, Population and Preventive Medicine (S.A.P.C.), Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Josephine N Rini
- Nuclear Medicine Division (C.C., J.N.R.), Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Ana M Franceschi
- From the Neuroradiology Division (G.K., F.M., A.M.F.), Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
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Slingerland S, van der Zee S, Carli G, Slomp AC, Boertien JM, d’Angremont E, Bohnen NI, Albin RL, van Laar T. Cholinergic innervation topography in GBA-associated de novo Parkinson's disease patients. Brain 2024; 147:900-910. [PMID: 37748026 PMCID: PMC10907081 DOI: 10.1093/brain/awad323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/23/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
The most common genetic risk factors for Parkinson's disease are GBA1 mutations, encoding the lysosomal enzyme glucocerebrosidase. Patients with GBA1 mutations (GBA-PD) exhibit earlier age of onset and faster disease progression with more severe cognitive impairments, postural instability and gait problems. These GBA-PD features suggest more severe cholinergic system pathologies. PET imaging with the vesicular acetylcholine transporter ligand 18F-F-fluoroethoxybenzovesamicol (18F-FEOBV PET) provides the opportunity to investigate cholinergic changes and their relationship to clinical features in GBA-PD. The study investigated 123 newly diagnosed, treatment-naïve Parkinson's disease subjects-with confirmed presynaptic dopaminergic deficits on PET imaging. Whole-gene GBA1 sequencing of saliva samples was performed to evaluate GBA1 variants. Patients underwent extensive neuropsychological assessment of all cognitive domains, motor evaluation with the Unified Parkinson's Disease Rating Scale, brain MRI, dopaminergic PET to measure striatal-to-occipital ratios of the putamen and 18F-FEOBV PET. We investigated differences in regional cholinergic innervation between GBA-PD carriers and non-GBA1 mutation carriers (non-GBA-PD), using voxel-wise and volume of interest-based approaches. The degree of overlap between t-maps from two-sample t-test models was quantified using the Dice similarity coefficient. Seventeen (13.8%) subjects had a GBA1 mutation. No significant differences were found in clinical features and dopaminergic ratios between GBA-PD and non-GBA-PD at diagnosis. Lower 18F-FEOBV binding was found in both the GBA-PD and non-GBA-PD groups compared to controls. Dice (P < 0.05, cluster size 100) showed good overlap (0.7326) between the GBA-PD and non-GBA-PD maps. GBA-PD patients showed more widespread reduction in 18F-FEOBV binding than non-GBA-PD when compared to controls in occipital, parietal, temporal and frontal cortices (P < 0.05, FDR-corrected). In volume of interest analyses (Bonferroni corrected), the left parahippocampal gyrus was more affected in GBA-PD. De novo GBA-PD show a distinct topography of regional cholinergic terminal ligand binding. Although the Parkinson's disease groups were not distinguishable clinically, in comparison to healthy controls, GBA-PD showed more extensive cholinergic denervation compared to non-GBA-PD. A larger group is needed to validate these findings. Our results suggest that de novo GBA-PD and non-GBA-PD show differential patterns of cholinergic system changes before clinical phenotypic differences between carriers versus non-carrier groups are observable.
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Affiliation(s)
- Sofie Slingerland
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Sygrid van der Zee
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
- Department of Neurology, Division of Clinical Neuropsychology, University of Groningen, University Medical Center, 9713 GZ Groningen, The Netherlands
| | - Giulia Carli
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Anne C Slomp
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
- Department of Neurology, Division of Clinical Neuropsychology, University of Groningen, University Medical Center, 9713 GZ Groningen, The Netherlands
| | - Jeffrey M Boertien
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Emile d’Angremont
- Department of Biomedical Sciences of Cells and Systems, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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Beauchamp LC, Dore V, Villemagne VL, Xu S, Finkelstein D, Barnham KJ, Rowe C. Using 18F-AV-133 VMAT2 PET Imaging to Monitor Progressive Nigrostriatal Degeneration in Parkinson Disease. Neurology 2023; 101:e2314-e2324. [PMID: 37816639 PMCID: PMC10727223 DOI: 10.1212/wnl.0000000000207748] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are limited validated biomarkers in Parkinson disease (PD) which substantially hinders the ability to monitor disease progression and consequently measure the efficacy of disease-modifying treatments. Imaging biomarkers, such as vesicular monoamine transporter type 2 (VMAT2) PET, enable enhanced diagnostic accuracy and detect early neurodegenerative changes associated with prodromal PD. This study sought to assess whether 18F-AV-133 VMAT2 PET is sensitive enough to monitor and quantify disease progression over a 2-year window. METHODS 18F-AV-133 PET scans were performed on participants with PD and REM sleep behavior disorder (RBD) and neurologic controls (NC). All participants were scanned twice ∼26 months apart. Regional tracer retention was calculated with a primary visual cortex reference region and expressed as the standard uptake volume ratio. Regions of interest included caudate, anterior, and posterior putamen. At the time of scanning, participants underwent clinical evaluation including UPDRSMOTOR test, Sniffin' Sticks, and Hospital Anxiety and Depression Score. RESULTS Over the 26-month interval, a significant decline in PET signal was observed in all 3 regions in participants with PD (N = 26) compared with NC (N = 12), consistent with a decrease in VMAT2 level and ongoing neurodegeneration. Imaging trajectory calculations suggest that the neurodegeneration in PD occurs over ∼33 years [CI: 27.2-39.5], with ∼10.5 years [CI: 9.1-11.3] of degeneration in the posterior putamen before it becomes detectable on a VMAT2 PET scan, a further ∼6.5 years [CI: 1.6-12.7] until symptom onset, and a further ∼3 years [CI: 0.3-8.7] until clinical diagnosis. DISCUSSION Over a 2-year period, 18F-AV-133 VMAT2 PET was able to detect progression of nigrostriatal degeneration in participants with PD, and it represents a sensitive tool to identify individuals at risk of progression to PD, which are currently lacking using clinical readouts. Trajectory models propose that there is nigrostriatal degeneration occurring for 20 years before clinical diagnosis. These data demonstrate that VMAT2 PET provides a sensitive measure to monitor neurodegenerative progression of PD which has implications for PD diagnostics and subsequently clinical trial patient stratification and monitoring. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that VMAT2 PET can detect patients with Parkinson disease and quantify progression over a 2-year window.
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Affiliation(s)
- Leah C Beauchamp
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - Vincent Dore
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - Victor L Villemagne
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - SanSan Xu
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - David Finkelstein
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - Kevin J Barnham
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia.
| | - Christopher Rowe
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
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Hazut Krauthammer S, Cohen D, Even-Sapir E, Lerman H. Beyond Visual Assessment of Basal Ganglia Uptake: Can Automated Method and Pineal Body Uptake Assessment Improve Identification of Nigrostriatal Dysfunction on 18F-DOPA PET/CT? Int J Mol Sci 2023; 24:ijms24065683. [PMID: 36982756 PMCID: PMC10056028 DOI: 10.3390/ijms24065683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
The interpretation of 18F-DOPA PET/CT performed for assessing nigrostriatal dysfunction (NSD) is usually based on visual assessment of the uptake in the basal ganglia (VA-BG). In the present study, we evaluate the diagnostic performance of an automated method that assesses BG uptake (AM-BG) and of methods that assess pineal body uptake, and examine whether these methods can enhance the diagnostic performance of VA-BG alone. We retrospectively included 112 scans performed in patients with clinically suspected NSD who also had a subsequent final clinical diagnosis provided by a movement disorder specialist (69 NSD and 43 non-NSD patients). All scans were categorized as positive or negative based on (1) VA-BG, (2) AM-BG, and (3) qualitative and semiquantitative assessment of pineal body uptake. VA-BG, AM-BG, assessment of pineal body 18F-DOPA uptake by VA (uptake > background), by SUVmax (≥0.72), and by pineal to occipital ratio (POR ≥ 1.57) could all significantly differentiate NSD from non-NSD patients (Pv < 0.01 for all five methods). Of these methods, VA-BG provided the highest sensitivity (88.4%) and accuracy (90.2%). Combining VA-BG with AM-BG did not improve diagnostic accuracy. An interpretation algorithm that combines VA-BG with pineal body uptake assessment by POR calculation increased sensitivity to 98.5%, at the expense of decreased specificity. In conclusion, an automated method that assesses 18F-DOPA uptake in the BG and assessment of pineal body 18F-DOPA uptake can significantly separate NSD from non-NSD patients, with apparent inferior diagnostic performance when applied alone compared with VA-BG. When VA-BG categorizes a scan as negative or equivocal, assessment of the 18F-DOPA uptake in the pineal body has the potential to minimize the rate of false negative reports. Further research is essential to validate this approach and to study the pathophysiologic relationship between 18F-DOPA uptake in the pineal body and nigrostriatal dysfunction.
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Affiliation(s)
- Shir Hazut Krauthammer
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
- Correspondence:
| | - Dan Cohen
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hedva Lerman
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Head-to-Head Comparison Between Rabbit Sign and EANM/SNMMI Criteria for the 18F-DOPA Visual Assessment of Parkinsonian Syndromes in PET/MRI: A Multiple Expert-Based and Blinded Controlled Study. Clin Nucl Med 2023; 48:112-118. [PMID: 36607361 DOI: 10.1097/rlu.0000000000004481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study was to compare the diagnostic performance of the rabbit visual pattern versus the one endorsed by the EANM/SNMMI for the diagnosis of parkinsonian syndromes in PET/MRI. PATIENTS AND METHODS The 18F-DOPA PET images of 129 consecutive patients (65 Park+ and 64 controls) with 1 year of clinical follow-up were reviewed independently by 5 experienced readers on the same imaging workstation, blinded to the final clinical diagnosis. Two visual methods were assessed independently, with several days to months of interval: the criteria endorsed by EANM/SNMMI and the "rabbit" shape of the striate assessed on 3D MIP images. The sensitivities, specificities, likelihood ratios, and predictive values of the 2 diagnostic tests were estimated simultaneously by using the "comparison of 2 binary diagnostic tests to a paired design" method. RESULTS The estimated 95% confidence interval (CI) of sensitivities and specificities ranged from 49.4% to 76.5% and from 83.2% to 97.7%, respectively. The 95% CI estimates of positive and negative likelihood ratios ranged from 3.8 to 26.7 and from 0.26 to 0.56, respectively. The 95% CI estimates of the positive and negative predictive values ranged from 78.1% to 96.7% and from 60.3% to 81.4%, respectively. For all the parameters, no statistical difference was observed between the 2 methods (P > 0.05). The rabbit sign reduced the readers' discrepancies by 25%, while maintaining the same performance. CONCLUSIONS The rabbit visual pattern appears at least comparable to the current EANM/SNMMI reference procedure for the assessment of parkinsonian syndromes in daily clinical practice, without the need of any image postprocessing. Further multicenter prospective studies would be of relevance to validate these findings.
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Wallert E, Letort E, van der Zant F, Winogrodzka A, Berendse H, Beudel M, de Bie R, Booij J, Raijmakers P, van de Giessen E. Comparison of [ 18F]-FDOPA PET and [ 123I]-FP-CIT SPECT acquired in clinical practice for assessing nigrostriatal degeneration in patients with a clinically uncertain parkinsonian syndrome. EJNMMI Res 2022; 12:68. [PMID: 36273088 PMCID: PMC9588108 DOI: 10.1186/s13550-022-00943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/15/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Two commonly used imaging techniques to aid in the diagnosis of neurodegenerative parkinsonian syndromes are dopamine transporter (DAT) imaging with [123I]-FP-CIT single-photon emission computed tomography (DAT-SPECT) and positron emission tomography with [18F]-FDOPA (FDOPA-PET). This paper provides a unique series of parkinsonian patients who received both FDOPA-PET and DAT-SPECT in routine clinical practice and compares the reported results to assess potential differences between these two imaging techniques. Methods We present 11 patients with a clinically uncertain parkinsonian syndrome (CUPS), who received both FDOPA-PET and DAT-SPECT. All patients received an FDOPA-PET scan and DAT-SPECT as part of routine clinical care. Results The median time between the F-DOPA-PET scan and DAT-SPECT scan was 6 months (range 0–15 months). There was a discrepancy in the reported results of the FDOPA-PET and DAT-SPECT scans in nine patients, including 7 patients whose FDOPA-PET scan was reportedly normal, whereas their DAT-SPECT scan was abnormal. Conclusions In this case series of CUPS patients, DAT-SPECT was more often rated as abnormal than FDOPA-PET. The striatal loss of FDOPA uptake can be less pronounced than that of DAT binding in CUPS patients in early disease stages. Consequently, the interpretation of FDOPA-PET scans in CUPS can sometimes be challenging in routine practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-022-00943-6.
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Affiliation(s)
- Elon Wallert
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Erwann Letort
- Department of Nuclear Medicine, Northwest Clinics, Location Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands.,Department of Radiology & Nuclear Medicine, Spaarne Gasthuis, Location Haarlem, Boerhaavelaan 22, Haarlem, The Netherlands
| | - Friso van der Zant
- Department of Nuclear Medicine, Northwest Clinics, Location Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands
| | - Ania Winogrodzka
- Department of Neurology, Northwest Clinics, Location Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands
| | - Henk Berendse
- Department of Neurology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rob de Bie
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Pieter Raijmakers
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Elsmarieke van de Giessen
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
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Wallert ED, van de Giessen E, Knol RJJ, Beudel M, de Bie RMA, Booij J. Imaging Dopaminergic Neurotransmission in Neurodegenerative Disorders. J Nucl Med 2022; 63:27S-32S. [PMID: 35649651 PMCID: PMC9165729 DOI: 10.2967/jnumed.121.263197] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/25/2022] [Indexed: 12/14/2022] Open
Abstract
Imaging of dopaminergic transmission in neurodegenerative disorders such as Parkinson disease (PD) or dementia with Lewy bodies plays a major role in clinical practice and in clinical research. We here review the role of imaging of the nigrostriatal pathway, as well as of striatal receptors and dopamine release, in common neurodegenerative disorders in clinical practice and research. Imaging of the nigrostriatal pathway has a high diagnostic accuracy to detect nigrostriatal degeneration in disorders characterized by nigrostriatal degeneration, such as PD and dementia with Lewy bodies, and disorders of more clinical importance, namely in patients with clinically uncertain parkinsonism. Imaging of striatal dopamine D2/3 receptors is not recommended for the differential diagnosis of parkinsonian disorders in clinical practice anymore. Regarding research, recently the European Medicines Agency has qualified dopamine transporter imaging as an enrichment biomarker for clinical trials in early PD, which underlines the high diagnostic accuracy of this imaging tool and will be implemented in future trials. Also, imaging of the presynaptic dopaminergic system plays a major role in, for example, examining the extent of nigrostriatal degeneration in preclinical and premotor phases of neurodegenerative disorders and to examine subtypes of PD. Also, imaging of postsynaptic dopamine D2/3 receptors plays a role in studying, for example, the neuronal substrate of impulse control disorders in PD, as well as in measuring endogenous dopamine release to examine, for example, motor complications in the treatment of PD. Finally, novel MRI sequences as neuromelanin-sensitive MRI are promising new tools to study nigrostriatal degeneration in vivo.
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Affiliation(s)
- Elon D Wallert
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Remco J J Knol
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands; and
| | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;
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Dhawan V, Niethammer MH, Lesser ML, Pappas KN, Hellman M, Fitzpatrick TM, Bjelke D, Singh J, Quatarolo LM, Choi YY, Oh A, Eidelberg D, Chaly T. Prospective F-18 FDOPA PET Imaging Study in Human PD. Nucl Med Mol Imaging 2022; 56:147-157. [DOI: 10.1007/s13139-022-00748-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022] Open
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Pineda-Pardo JA, Sánchez-Ferro Á, Monje MHG, Pavese N, Obeso JA. Onset pattern of nigrostriatal denervation in early Parkinson's disease. Brain 2022; 145:1018-1028. [PMID: 35349639 DOI: 10.1093/brain/awab378] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022] Open
Abstract
The striatal dopaminergic deficit in Parkinson's disease exhibits a typical pattern, extending from the caudal and dorsal putamen at onset to its more rostral region as the disease progresses. Clinically, upper-limb onset of cardinal motor features is the rule. Thus, according to current understanding of striatal somatotopy (i.e. the lower limb is dorsal to the upper limb) the assumed pattern of early dorsal striatal dopaminergic denervation in Parkinson's disease does not fit with an upper-limb onset. We have examined the topography of putaminal denervation in a cohort of 23 recently diagnosed de novo Parkinson's disease patients and 19 age-/gender-matched healthy subjects assessed clinically and by 18F-DOPA PET; 15 patients were re-assessed after 2 years. There was a net upper-limb predominance of motor features at onset. Caudal denervation of the putamen was confirmed in both the more- and less-affected hemispheres and corresponding hemibodies. Spatial covariance analysis of the most affected hemisphere revealed a pattern of 18F-DOPA uptake rate deficit that suggested focal dopamine loss starting in the posterolateral and intermediate putamen. Functional MRI group-activation maps during a self-paced motor task were used to represent the somatotopy of the putamen and were then used to characterize the decline in 18F-DOPA uptake rate in the upper- and lower-limb territories. This showed a predominant decrement in both hemispheres, which correlated significantly with severity of bradykinesia. A more detailed spatial analysis revealed a dorsoventral linear gradient of 18F-DOPA uptake rate in Parkinson's disease patients, with the highest putamen denervation in the caudal intermediate subregion (dorsoventral plane) compared to healthy subjects. The latter area coincides with the functional representation of the upper limb. Clinical motor assessment at 2-year follow-up showed modest worsening of parkinsonism in the primarily affected side and more noticeable increases in the upper limb in the less-affected side. Concomitantly, 18F-DOPA uptake rate in the less-affected putamen mimicked that recognized on the most-affected side. Our findings suggest that early dopaminergic denervation in Parkinson's disease follows a somatotopically related pattern, starting with the upper-limb representation in the putamen and progressing over a 2-year period in the less-affected hemisphere. These changes correlate well with the clinical presentation and evolution of motor features. Recognition of a precise somatotopic onset of nigrostriatal denervation may help to better understand the onset and progression of dopaminergic neurodegeneration in Parkinson's disease and eventually monitor the impact of putative therapies.
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Affiliation(s)
- José A Pineda-Pardo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Universidad San Pablo-CEU, Madrid, Spain.,CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
| | - Álvaro Sánchez-Ferro
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mariana H G Monje
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Universidad San Pablo-CEU, Madrid, Spain.,CIBERNED, Instituto de Salud Carlos III, Madrid, Spain.,Ken and Ruth Davee Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Nicola Pavese
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - José A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Universidad San Pablo-CEU, Madrid, Spain.,CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
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10
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Stormezand GN, Schreuder RSBH, Brouwers AH, Slart RHJA, Elsinga PH, Walenkamp AME, Dierckx RAJO, Glaudemans AWJM, Luurtsema G. The effects of molar activity on [ 18F]FDOPA uptake in patients with neuroendocrine tumors. EJNMMI Res 2021; 11:88. [PMID: 34495420 PMCID: PMC8426426 DOI: 10.1186/s13550-021-00829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background 6-[18F]fluoro-l-3,4-dihydroxyphenyl alanine ([18F]FDOPA) is a commonly used PET tracer for the detection and staging of neuroendocrine tumors. In neuroendocrine tumors, [18F]FDOPA is decarboxylated to [18F]dopamine via the enzyme amino acid decarboxylase (AADC), leading to increased uptake when there is increased AADC activity. Recently, in our hospital, a new GMP compliant multi-dose production of [18F]FDOPA has been developed, [18F]FDOPA-H, resulting in a higher activity yield, improved molar activity and a lower administered mass than the conventional method ([18F]FDOPA-L). Aims This study aimed to investigate whether the difference in molar activity affects the [18F]FDOPA uptake at physiological sites and in tumor lesions, in patients with NET. It was anticipated that the specific uptake of [18F]FDOPA-H would be equal to or higher than [18F]FDOPA-L. Methods We retrospectively analyzed 49 patients with pathologically confirmed NETs and stable disease who underwent PET scanning using both [18F]FDOPA-H and [18F]FDOPA-L within a time span of 5 years. A total of 98 [18F]FDOPA scans (49 [18F]FDOPA-L and 49 [18F]FDOPA-H with average molar activities of 8 and 107 GBq/mmol) were analyzed. The SUVmean was calculated for physiological organ uptake and SUVmax for tumor lesions in both groups for comparison, and separately in subjects with low tumor load (1–2 lesions) and higher tumor load (3–10 lesions). Results Comparable or slightly higher uptake was demonstrated in various physiological uptake sites in subjects scanned with [18F]FDOPA-H compared to [18F]FDOPA-L, with large overlap being present in the interquartile ranges. Tumor uptake was slightly higher in the [18F]FDOPA-H group with 3–10 lesion (SUVmax 6.83 vs. 5.19, p < 0.001). In the other groups, no significant differences were seen between H and L. Conclusion [18F]FDOPA-H provides a higher activity yield, offering the possibility to scan more patients with one single production. Minor differences were observed in SUV’s, with slight increases in uptake of [18F]FDOPA-H in comparison to [18F]FDOPA-L. This finding is not a concern for clinical practice, but could be of importance when quantifying follow-up scans while introducing new production methods with a higher molar activity of [18F]FDOPA.
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Affiliation(s)
- Gilles N Stormezand
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Medical Imaging Center, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Romano S B H Schreuder
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Medical Imaging Center, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Medical Imaging Center, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Medical Imaging Center, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Philip H Elsinga
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Medical Imaging Center, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Annemiek M E Walenkamp
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Medical Imaging Center, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Medical Imaging Center, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Gert Luurtsema
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Medical Imaging Center, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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11
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Arena JE, Urrutia L, Falasco G, de Leon MP, Vazquez S, Rossi M, Merello M. Correlation between 99mTc-TRODAT-1 SPECT and 18F-FDOPA PET in patients with Parkinson's disease: a pilot study. Radiol Bras 2021; 54:232-237. [PMID: 34393289 PMCID: PMC8354188 DOI: 10.1590/0100-3984.2020.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To determine whether technetium-99m-labeled tropane derivative single-photon emission computed tomography (99mTc-TRODAT-1 SPECT) provides results comparable to those of the less widely available, less accessible tool fluorine-18-labeled fluorodopa positron-emission tomography (18F-FDOPA PET) in the setting of a movement disorders clinic. Materials and Methods In this prospective pilot study, eight subjects with a clinical diagnosis of Parkinson’s disease were randomly selected from among patients under treatment at a movement disorders clinic and submitted to 99mTc-TRODAT-1 SPECT and 18F-FDOPA PET. The results were read by two experienced observers, and a semiquantitative analysis was performed. Results The visual and semiquantitative analyses were concordant for all studies, showing that radiotracer uptake in the contralateral striatum on the most affected side was lower when 99mTc-TRODAT-1 SPECT was employed. The semiquantitative analysis demonstrated a significant correlation between 18F-FDOPA PET and 99mTc-TRODAT-1 SPECT (r = 0.73; p < 0.01). Conclusion It appears that 99mTc-TRODAT-1 SPECT is a valid option for the study of dopaminergic function in a clinical setting.
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Affiliation(s)
| | | | | | | | | | | | - Marcelo Merello
- Fleni, Buenos Aires, Argentina.,Pontificia Universidad Catolica Argentina, Buenos Aires, Argentina
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12
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Akdemir ÜÖ, Bora Tokçaer A, Atay LÖ. Dopamine transporter SPECT imaging in Parkinson’s disease and parkinsonian disorders. Turk J Med Sci 2021; 51:400-410. [PMID: 33237660 PMCID: PMC8203173 DOI: 10.3906/sag-2008-253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/24/2020] [Indexed: 12/29/2022] Open
Abstract
The dopamine transporter (DAT) imaging provides an objective tool for the assessment of dopaminergic function of presynaptic terminals which is valuable for the differential diagnosis of parkinsonian disorders related to a striatal dopaminergic deficiency from movement disorders not related a striatal dopaminergic deficiency. DAT imaging with single-photon emission computed tomography (SPECT) can be used to confirm or exclude a diagnosis of dopamine deficient parkinsonism in cases where the diagnosis is unclear. It can also detect the dopaminergic dysfunction in presymptomatic subjects at risk for Parkinson’s disease (PD) since the reduced radiotracer binding to DATs in striatum is already present in the prodromal stage of PD. This review covers the rationale of using DAT SPECT imaging in the diagnosis of PD and other parkinsonian disorders, specifically focusing on the practical aspects of imaging and routine clinical indications.
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Affiliation(s)
- Ümit Özgür Akdemir
- Department of Nuclear Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayşe Bora Tokçaer
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Lütfiye Özlem Atay
- Department of Nuclear Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
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13
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Olivieri P, Lebouvier T, Hardouin JB, Courtemanche H, Le Dily S, Barbin L, Pallardy A, Derkinderen P, Boutoleau-Bretonnière C. LeSCoD: a new clinical scale for the detection of Lewy body disease in neurocognitive disorders. J Neurol 2021; 268:3886-3896. [PMID: 33830336 DOI: 10.1007/s00415-021-10539-0] [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: 01/31/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dementia with Lewy bodies remains underdiagnosed in clinical practice mainly because of the low sensitivity of existing diagnostic criteria and a strong overlap with Alzheimer's pathology that can mask the Lewy phenotype. OBJECTIVE The objective of this study was therefore to develop and validate a new clinical scale designed to detect signs of Lewy body disease, called LeSCoD for Lewy body Screening scale in Cognitive Disorders. METHODS 128 patients who fulfilled the clinical criteria of dementia with Lewy bodies (DLB; n = 32), Alzheimer's disease (AD; n = 77) or both (n = 19) was prospectively enrolled. 18F-DOPA PET imaging and/or CSF biomarkers were available in some patients. LeSCoD scale was systematically administered and the potential correlation with 18F-DOPA PET imaging was evaluated in a subgroup of patients. RESULTS LeSCoD scale showed robust internal and external validity. We determined a cut-off of 10 above which the sensitivity and specificity for Lewy body disease diagnosis were 86% and 95%, respectively. The LeSCoD scale correlated with striatal dopamine uptake in 18F-DOPA PET. CONCLUSION LeSCoD scale is a simple and reliable tool for the evaluation of Lewy body disease in routine clinical practice, with a higher sensitivity and specificity than the existing criteria. It might be an alternative to the use of dopamine-specific imaging.
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Affiliation(s)
- Pauline Olivieri
- Department of Neurology of Memory and Language, GHU Paris Psychiatry and Neurosciences, Hôpital Sainte Anne, 75014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Thibaud Lebouvier
- University of Lille, Inserm U1172, CHU Lille, DISTALZ, Lille, France
| | - Jean-Benoît Hardouin
- UMR INSERM 1246-SPHERE "Methods in Patient-Centered Outcomes and Health Research", Université de Nantes, Université de Tours, Tours, France.,Unit of Methodology and Biostatistics, Université de Nantes, Nantes, France
| | - Hélène Courtemanche
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France.,INSERM CIC 04, Nantes, France
| | | | | | | | | | - Claire Boutoleau-Bretonnière
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France. .,INSERM CIC 04, Nantes, France. .,Claire Boutoleau-Bretonnière, Centre Mémoire Ressource et Recherche (CMRR), Centre Hospitalier Universitaire de Nantes Hôpital Laennec, Boulevard Jacques Monod, 44000, Nantes, France.
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14
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The role of the deep convolutional neural network as an aid to interpreting brain [ 18F]DOPA PET/CT in the diagnosis of Parkinson's disease. Eur Radiol 2021; 31:7003-7011. [PMID: 33686474 DOI: 10.1007/s00330-021-07779-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/12/2020] [Accepted: 02/12/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To test the performance of a 3D convolutional neural network (CNN) in analysing brain [18F]DOPA PET/CT in order to identify patients with nigro-striatal neurodegeneration. We evaluated the robustness of the 3D CNN by testing it against a manual regional analysis of the striata by using a striatal-to-occipital ratio (SOR). METHODS We analyzed patients who had undergone [18F]DOPA PET/CT from 2016 to 2018. Two examiners interpreted PET/CT images as positive or negative. Only patients with at least 2 years of follow-up and an ascertained neurological diagnosis were included. A 3D CNN was developed to evaluate [18F]DOPA PET/CT and refine the diagnosis of movement disorder. This system required training and testing, which were carried out on 2/3 and 1/3 of patients, respectively. A regional analysis was also conducted by drawing region of interest on T1-weighted 3D MRI scans, on which the [18F]DOPA PET images were first co-registered. RESULTS Ninety-eight patients were enrolled: 43 presented nigro-striatal degeneration and 55 negative cases used as controls. After training on 69 patients, the diagnostic performance of the 3D CNN was then calculated in 29 patients. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy were 100%, 89%, 100%, 85% and 93%, respectively. When we compared the 3D CNN results with the SOR analysis, we found that the two patients falsely classified as positive by the 3D CNN procedure showed SOR values ≤ 5th percentile of the negative cases' distribution. CONCLUSIONS 3D CNNs are able to interpret [18F]DOPA PET/CT properly, revealing patients affected by Parkinson's disease. KEY POINTS • [18F]DOPA PET/CT is a sensitive diagnostic tool to identify patients with nigro-striatal neurodegeneration. • A semiquantitative evaluation of the images allows a more confident interpretation of the PET findings. • 3D convolutional neural network allows an accurate interpretation of 18F-DOPA PET/CT images, revealing patients affected by Parkinson's disease.
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15
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Ye R, Locascio JJ, Goodheart AE, Quan M, Zhang B, Gomperts SN. Serum NFL levels predict progression of motor impairment and reduction in putamen dopamine transporter binding ratios in de novo Parkinson's disease: An 8-year longitudinal study. Parkinsonism Relat Disord 2021; 85:11-16. [PMID: 33639572 DOI: 10.1016/j.parkreldis.2021.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/24/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
Neurofilament light chain (NFL) level in biofluids is a sensitive measure of axonal damage and a promising biomarker in neurodegenerative diseases. In Parkinson's disease (PD), NFL can distinguish PD from other parkinsonian disorders, and NFL concentration is associated with disease severity, risk of progression, and survival. To determine whether serum NFL at baseline in de novo PD predicts motor decline, differentially impacts specific motor features, predicts cognitive decline, and predicts loss of dopamine terminals, here we evaluated 376 de novo PD patients from the PPMI database and analyzed the effect of baseline serum NFL levels on progression over eight years of motor impairment measured with the UPDRS, cognitive function measured with the MoCA, and putamen dopamine transporter (DAT) binding ratio measured with DaTscan. In longitudinal mixed effects models that controlled for age, gender, disease duration, and levodopa equivalent drug dose, higher levels of serum NFL at baseline were associated with greater increases of UPDRS-III and total UPDRS scores, with greater worsening of postural instability and gait disorder (PIGD) scores but not tremor scores over time. In contrast, baseline serum NFL was not associated with significant progression of MoCA scores in this de novo PD cohort. Higher baseline serum NFL was associated with greater reduction of putamen DAT binding ratio over time. Together, these findings show that baseline serum NFL levels predict the rate of motor decline, the accumulation of PIGD clinical features, and the progression of dopamine transporter loss in the early stage of PD.
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Affiliation(s)
- Rong Ye
- Department of Neurology, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China; Department of Neurology, Massachusetts General Hospital, Boston, USA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Boston, USA
| | - Anna E Goodheart
- Department of Neurology, Massachusetts General Hospital, Boston, USA
| | - Moqing Quan
- Department of Neurology, Massachusetts General Hospital, Boston, USA
| | - Baorong Zhang
- Department of Neurology, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China.
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16
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Sood A, Shukla J, Shree R, Vatsa R, Modi M, Mittal BR. Comparative Performance of 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT Imaging in Patients With Parkinson's Disease, Parkinson-Plus Syndrome, and Essential Tremor. Clin Nucl Med 2021; 46:95-102. [PMID: 33234920 DOI: 10.1097/rlu.0000000000003409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to assess the utility of presynaptic dopaminergic imaging using 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT and compare their performance in Parkinson's disease (PD), Parkinson-plus syndrome (PPS), and essential tremor (ET). PATIENTS AND METHODS A total of 103 patients (PD = 48, PPS = 19, and ET = 36) were enrolled prospectively. Hoehn and Yahr (H&Y) staging and MDS-UPDRS (Movement Disorder Society-Sponsored Revision of Unified Parkinson's Disease Rating Scale) were done for PD and PPS cases. All the patients underwent 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT brain scan. The scans were analyzed visually and semiquantitatively. Average pixel count and SUVmean of the striatum were calculated in SPECT and PET images, respectively, to calculate the specific uptake ratio of striatum (SUR). Comparison of scan findings and SURs among different groups and correlation with clinical characteristics was done. RESULTS Symmetrical comma-shaped uptake was seen in bilateral striatum in ET cases with mean SURs significantly higher than in cases of early PD (H&Y stage I and II, n = 37), PD and PPS both on SPECT and PET images (P ≤ 0.001). The mean SURs between PD and PPS showed no significant difference (SPECT, P = 0.17; PET, P = 0.61). Substantial agreement (weighted κ = 0.659) was found between 99mTc-TRODAT-1 and 18F-FDOPA for the detection of presynaptic dopaminergic dysfunction. Specific uptake ratio of striatum correlation between SPECT and PET was statistically significant (r = 0.67; P < 0.01). A negative but nonsignificant correlation was found between the SURs and H&Y staging/MDS-UPDRS. CONCLUSIONS Both 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT showed substantial agreement and proved to be potential imaging biomarker for the detection of dopaminergic dysfunction, thus assisting in differentiating early PD/PD and PPS from ET cases.
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Affiliation(s)
| | | | - Ritu Shree
- Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Manish Modi
- Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Emsen B, Villafane G, David JP, Evangelista E, Chalaye J, Lerman L, Authier FJ, Gracies JM, Itti E. Clinical impact of dual-tracer FDOPA and FDG PET/CT for the evaluation of patients with parkinsonian syndromes. Medicine (Baltimore) 2020; 99:e23060. [PMID: 33157962 PMCID: PMC7647518 DOI: 10.1097/md.0000000000023060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Parkinsonian syndromes include typical cases of idiopathic Parkinson's disease (PD) and atypical parkinsonian syndromes (APS) associated with cognitive and vegetative disorders, which are more challenging to diagnose. The aim of this study was to assess -the value of dual-tracer imaging 6-fluoro-(18F)-L-DOPA (FDOPA) and fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), performed in routine patients demonstrating extrapyramidal signs and cognitive complains, for the diagnosis and management of parkinsonian syndromes.We retrospectively included 143 consecutive patients who underwent both FDOPA PET/CT (for the evaluation of parkinsonism) and FDG PET/CT (for the evaluation of cognitive complaints) in the same institution. The suspected clinical diagnosis before imaging and the final post-imaging diagnosis were collected by a dedicated questionnaire.FDOPA was pathological in 90.2% of cases, including 74.1% of PD, 3.5% of parkinsonian dementia and 7% of APS. FDG was normal or near normal in 58.7% of patients. A pattern of diffuse cortical hypometabolism was observed in the remaining patients, more frequently in APS than in PD patients (P = .001). Importantly, in 7.7% of cases dual-tracer PET/CT allowed to decide between several diagnostic hypotheses and led to a new diagnosis in 14.0%. Therefore, the management of these patients was modified, with clinical re-evaluation in a specialized unit and a control of neuropsychological tests and imaging.Dual-tracer PET/CT imaging may be a precious help in the diagnosis and management of parkinsonian syndromes.
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Affiliation(s)
- Berivan Emsen
- Nuclear Medicine, Henri Mondor University Hospitals, AP-HP/U-PEC, Créteil
| | | | | | - Eva Evangelista
- Nuclear Medicine, Henri Mondor University Hospitals, AP-HP/U-PEC, Créteil
| | - Julia Chalaye
- Nuclear Medicine, Henri Mondor University Hospitals, AP-HP/U-PEC, Créteil
| | - Lionel Lerman
- Nuclear Medicine, Henri Mondor University Hospitals, AP-HP/U-PEC, Créteil
| | | | - Jean-Michel Gracies
- Neurorehabilitation, Henri Mondor University Hospitals, AP-HP/U-PEC, Créteil, France
| | - Emmanuel Itti
- Nuclear Medicine, Henri Mondor University Hospitals, AP-HP/U-PEC, Créteil
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18
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Schmitz-Steinkrüger H, Lange C, Apostolova I, Mathies FL, Frings L, Klutmann S, Hellwig S, Meyer PT, Buchert R. Impact of age and sex correction on the diagnostic performance of dopamine transporter SPECT. Eur J Nucl Med Mol Imaging 2020; 48:1445-1459. [PMID: 33130960 PMCID: PMC8113204 DOI: 10.1007/s00259-020-05085-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
Purpose The specific binding ratio (SBR) of 123I-FP-CIT (FP-CIT) in the putamen decreases with age by about 5% per decade and most likely is about 10% higher in females. However, the clinical utility of age and sex correction of the SBR is still a matter of debate. This study tested the impact of age and sex correction on the diagnostic performance of the putamen SBR in three independent patient samples. Methods Research sample: 207 healthy controls (HC) and 438 Parkinson’s disease (PD) patients. Clinical sample A: 183 patients with neurodegenerative parkinsonian syndrome (PS) and 183 patients with non-neurodegenerative PS from one site. Clinical sample B: 84 patients with neurodegenerative PS and 38 patients with non-neurodegenerative PS from another site. Correction for age and sex of the putamen SBR was based on linear regression in the HC or non-neurodegenerative PS, separately in each sample. The area under the ROC curve (AUC) was used as performance measure. Results The putamen SBR was higher in females compared to males (PPMI: 14%, p < 0.0005; clinical sample A: 7%, p < 0.0005; clinical sample B: 6%, p = 0.361). Age-related decline of the putamen SBR ranged between 3.3 and 10.4% (p ≤ 0.019). In subjects ≥ 50 years, age and sex explained < 10% of SBR between-subjects variance. Correction of the putamen SBR for age and sex resulted in slightly decreased AUC in the PPMI sample (0.9955 versus 0.9969, p = 0.025) and in clinical sample A (0.9448 versus 0.9519, p = 0.057). There was a small, non-significant AUC increase in clinical sample B (0.9828 versus 0.9743, p = 0.232). Conclusion These findings do not support age and sex correction of the putaminal FP-CIT SBR in the diagnostic workup of parkinsonian syndromes. This most likely is explained by the fact that the proportion of between-subjects variance caused by age and sex is considerably below the symptom threshold of about 50% reduction in neurodegenerative PS. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-020-05085-2.
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Affiliation(s)
- Helen Schmitz-Steinkrüger
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Catharina Lange
- Department of Nuclear Medicine, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ivayla Apostolova
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Franziska L Mathies
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lars Frings
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Klutmann
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Sabine Hellwig
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Buchert
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Kathuria H, Mehta S, Ahuja CK, Chakravarty K, Ray S, Mittal BR, Singh P, Lal V. Utility of Imaging of Nigrosome-1 on 3T MRI and Its Comparison with 18F-DOPA PET in the Diagnosis of Idiopathic Parkinson Disease and Atypical Parkinsonism. Mov Disord Clin Pract 2020; 8:224-230. [PMID: 33553492 DOI: 10.1002/mdc3.13091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022] Open
Abstract
Background Loss of nigrosome-1 on 3T and 7T magnetic resonance imaging (MRI) is a recently explored imaging biomarker in the diagnosis of neurodegenerative parkinsonism. Objectives This study was undertaken to evaluate the utility of imaging of nigrosome in the diagnosis of neurodegenerative parkinsonism on 3T MRI. Methods An institution-based prospective case-control study was conducted at a tertiary care center in North India. 3T venous blood oxygen level-dependent (VenoBOLD) and high-resolution susceptibility-weighted imaging (SWI) imaging sequences in MRI were performed in 100 patients with parkinsonism (56 with idiopathic Parkinson's disease [IPD], 30 with young onset Parkinson's disease [YOPD], 12 with progressive supranuclear palsy, and 2 patients with multiple system atrophy) and 15 controls. Grading of nigrosome was done in both the sequences. Each patient underwent 18F-DOPA positron emission tomography (PET), detailed neurological examination including Hoen and Yahr (H&Y) staging and Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scoring. Results The diagnostic sensitivity and specificity of the detection of loss of nigrosome-1 on VenoBOLD and SWI sequence at 3T MR imaging were 90% and 66.7% and 94% and 80%, respectively. A weak negative correlation was found between the grading of the nigrosome and clinical parameters (H&Y and UPDRS III). There was no correlation between the side of nigrosome loss and clinical asymmetry. However, nigrosome imaging was not able to differentiate between Parkinson's disease and atypical parkinsonism. Conclusions The loss of nigrosome-1 on 3T MRI on SWI and VenoBOLD sequences may serve as a potential imaging marker in the diagnosis of degenerative parkinsonian syndromes. However, it cannot differentiate between idiopathic Parkinson's disease and atypical parkinsonian syndromes.
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Affiliation(s)
- Heena Kathuria
- Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Sahil Mehta
- Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Chirag K Ahuja
- Department of Radiodiagnosis Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Kamalesh Chakravarty
- Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Sucharita Ray
- Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Paramjeet Singh
- Department of Radiodiagnosis Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Vivek Lal
- Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
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Abstract
The major applications for molecular imaging with PET in clinical practice concern cancer imaging. Undoubtedly, 18F-FDG represents the backbone of nuclear oncology as it remains so far the most widely employed positron emitter compound. The acquired knowledge on cancer features, however, allowed the recognition in the last decades of multiple metabolic or pathogenic pathways within the cancer cells, which stimulated the development of novel radiopharmaceuticals. An endless list of PET tracers, substantially covering all hallmarks of cancer, has entered clinical routine or is being investigated in diagnostic trials. Some of them guard significant clinical applications, whereas others mostly bear a huge potential. This chapter summarizes a selected list of non-FDG PET tracers, described based on their introduction into and impact on clinical practice.
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21
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Kong Y, Zhang C, Liu K, Wagle Shukla A, Sun B, Guan Y. Imaging of dopamine transporters in Parkinson disease: a meta-analysis of 18 F/ 123 I-FP-CIT studies. Ann Clin Transl Neurol 2020; 7:1524-1534. [PMID: 32794655 PMCID: PMC7480930 DOI: 10.1002/acn3.51122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE 18 F-FP-CIT and 123 I-FP-CIT are widely used radiotracers in molecular imaging for Parkinson's disease (PD) diagnosis. Compared with 123 I-FP-CIT, 18 F-FP-CIT has superior tracer kinetics. We aimed to conduct a meta-analysis to assess the efficacy of using 18 F-FP-CIT positron emission tomography (PET) and 123 I-FP-CIT single-photon emission computed tomography (SPECT) of dopamine transporters in patients with PD in order to provide evidence for clinical decision-making. METHODS We searched the PubMed, Embase, Wanfang Data, and China National Knowledge Infrastructure databases to identify the relevant studies from the time of inception of the databases to 30 April 2020. We identified six PET studies, including 779 patients with PD and 124 healthy controls, which met the inclusion criteria. Twenty-seven SPECT studies with 1244 PD patients and 859 controls were also included in this meta-analysis. RESULTS Overall effect-size analysis indicated that patients with PD showed significantly reduced 18 F-FP-CIT uptake in three brain regions [caudate nucleus: standardized mean difference (SMD) = -1.71, Z = -3.31, P = 0.0009; anterior putamen: SMD = -3.71, Z = -6.26, P < 0.0001; and posterior putamen: SMD = -5.49, Z = -5.97, P < 0.0001]. Significant decreases of 123 I-FP-CIT uptake were also observed in the caudate (SMD = -2.31, Z = -11.49, P < 0.0001) and putamen (SMD = -3.25, Z = -14.79, P < 0.0001). INTERPRETATION In conclusion, our findings indicate that both 18 F-FP-CIT PET and 123 I-FP-CIT SPECT imaging of dopamine transporters can provide viable biomarkers for early PD diagnosis.
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Affiliation(s)
- Yanyan Kong
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,PET Center, Huashan Hospital, Fudan University, Shanghai, 200235, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Kawai Liu
- Department of Mathematics, The Shanghai SMIC Private School, Shanghai, 200000, China
| | - Aparna Wagle Shukla
- Department of Neurology and Fixel Center for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32611
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yihui Guan
- PET Center, Huashan Hospital, Fudan University, Shanghai, 200235, China
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22
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Buchert R, Buhmann C, Apostolova I, Meyer PT, Gallinat J. Nuclear Imaging in the Diagnosis of Clinically Uncertain Parkinsonian Syndromes. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:747-754. [PMID: 31774054 DOI: 10.3238/arztebl.2019.0747] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/01/2019] [Accepted: 08/08/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Parkinsonian syndromes are classified by etiology mainly on clinical grounds, that is, on the basis of the clinical manifestations and with the aid of conventional ancillary studies. In most cases, the clinical diagnosis is clear. In up to 30% of cases, however, the etiological classification remains uncertain after completion of the basic clinical diagnostic evaluation, and additional investigation with nuclear imaging may be indicated. In particular, cerebral single-photon emission computed tomography (SPECT) with dopamine transporter (DAT) ligands may be helpful. DAT-SPECT can be used to demonstrate or rule out nigrostriatal degeneration and thereby differentiate neurodegenerative parkinsonian syndromes from symptomatic parkinsonian syndromes and other differential diagnoses. Positron emission tomography (PET) with the glucose analogue [18F]fluorodeoxyglucose (FDG) can be used to identify disease-specific patterns of neuronal dysfunction/degeneration in order to differentiate the various neurodegenerative parkinsonian syndromes from one another. METHODS In this review, we summarize the current state of the evidence on DAT-SPECT and FDG-PET for the indications mentioned above on the basis of a selective review of the literature. RESULTS DAT-SPECT has been adequately validated as an in vivo marker for nigrostriatal degeneration. Studies using the clinical diagnosis of a movement disorders specialist over the course of the disease as a reference have shown that DAT- SPECT is 78-100% sensitive (median, 93%) and 70-100% specific (median, 89%) for the differentiation of neurodegenerative parkinsonian syndromes from symptomatic parkinsonism and other differential diagnoses in clinically unclear cases. DAT- SPECT scanning led to a change of diagnosis in 27-56% of patients (median, 43%) and to a change of treatment in 33-72% (median, 43%). FDG-PET enables the differentiation of atypical neurodegenerative parkinsonian syndromes from the idiopathic parkinsonian syndrome (i.e., Parkinson's disease proper) with high sensitivity and specificity (both approximately 90%), when the clinical diagnosis by a movement disorders specialist over the course of the disease is used as a reference. CONCLUSION DAT-SPECT has been well documented to be highly diagnostically accurate and to have a relevant influence on the diagnosis and treatment of patients with clinically uncertain parkinsonian or tremor syndrome. It has not yet been shown to improve patient-relevant endpoints such as mortality, morbidity, and health-related quality of life; proof of this will probably have to await the introduction of neuroprotective treatments. The current evidence for the high differential diagnostic accuracy of FDG-PET in neurodegenerative parkinsonian syndromes needs to be reinforced by prospective studies with neuropathological verification of the diagnosis.
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Affiliation(s)
- Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf; Department of Neurology, University Medical Center Hamburg-Eppendorf; Department of Nuclear Medicine, Medical Center-University of Freiburg; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf
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23
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Xu J, Jiao F, Huang Y, Luo X, Xu Q, Li L, Liu X, Zuo C, Wu P, Zhuang X. A Fully Automatic Framework for Parkinson's Disease Diagnosis by Multi-Modality Images. Front Neurosci 2019; 13:874. [PMID: 31507358 PMCID: PMC6716425 DOI: 10.3389/fnins.2019.00874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022] Open
Abstract
Background Parkinson’s disease (PD) is a prevalent long-term neurodegenerative disease. Though the criteria of PD diagnosis are relatively well defined, current diagnostic procedures using medical images are labor-intensive and expertise-demanding. Hence, highly integrated automatic diagnostic algorithms are desirable. Methods In this work, we propose an end-to-end multi-modality diagnostic framework, including segmentation, registration, feature extraction and machine learning, to analyze the features of striatum for PD diagnosis. Multi-modality images, including T1-weighted MRI and 11C-CFT PET, are integrated into the proposed framework. The reliability of this method is validated on a dataset with the paired images from 49 PD subjects and 18 Normal (NL) subjects. Results We obtained a promising diagnostic accuracy in the PD/NL classification task. Meanwhile, several comparative experiments were conducted to validate the performance of the proposed framework. Conclusion We demonstrated that (1) the automatic segmentation provides accurate results for the diagnostic framework, (2) the method combining multi-modality images generates a better prediction accuracy than the method with single-modality PET images, and (3) the volume of the striatum is proved to be irrelevant to PD diagnosis.
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Affiliation(s)
- Jiahang Xu
- School of Data Science, Fudan University, Shanghai, China.,Fudan-Xinzailing Joint Research Center for Big Data, Fudan University, Shanghai, China
| | - Fangyang Jiao
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Yechong Huang
- School of Data Science, Fudan University, Shanghai, China
| | - Xinzhe Luo
- School of Data Science, Fudan University, Shanghai, China
| | - Qian Xu
- Department of Nuclear Medicine, North Huashan Hospital, Fudan University, Shanghai, China
| | - Ling Li
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Xueling Liu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chuantao Zuo
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Ping Wu
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, China.,Fudan-Xinzailing Joint Research Center for Big Data, Fudan University, Shanghai, China
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24
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Wearne D, McCarthy M, Orr C. Differentiating Parkinson's disease from drug-induced Parkinsonism. Aust N Z J Psychiatry 2019; 53:923-924. [PMID: 30897918 DOI: 10.1177/0004867419837751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Deborah Wearne
- 1 Division of Psychiatry, UWA Medical School, The University of Western Australia, Perth, WA, Australia
| | | | - Carolyn Orr
- 3 Royal Perth Hospital, Perth, WA, Australia
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25
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Monti DA, Zabrecky G, Kremens D, Liang TW, Wintering NA, Bazzan AJ, Zhong L, Bowens BK, Chervoneva I, Intenzo C, Newberg AB. N-Acetyl Cysteine Is Associated With Dopaminergic Improvement in Parkinson's Disease. Clin Pharmacol Ther 2019; 106:884-890. [PMID: 31206613 DOI: 10.1002/cpt.1548] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/24/2019] [Indexed: 11/06/2022]
Abstract
This study assessed the biological and clinical effects in patients with Parkinson's disease (PD) of N-acetyl-cysteine (NAC), the prodrug to l-cysteine, a precursor to the natural biological antioxidant glutathione. Forty-two patients with PD were randomized to either weekly intravenous infusions of NAC (50 mg/kg) plus oral doses (500 mg twice per day) for 3 months or standard of care only. Participants received prebrain and postbrain imaging with ioflupane (DaTscan) to measure dopamine transporter (DAT) binding. In the NAC group, significantly increased DAT binding was found in the caudate and putamen (mean increase from 3.4% to 8.3%) compared with controls (P < 0.05), along with significantly improved PD symptoms (P < 0.0001). The results suggest NAC may positively affect the dopaminergic system in patients with PD, with corresponding positive clinical effects. Larger scale studies are warranted.
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Affiliation(s)
- Daniel A Monti
- Department of Integrative Medicine and Nutritional Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - George Zabrecky
- Department of Integrative Medicine and Nutritional Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Kremens
- Department of Neurology, Jefferson Comprehensive Parkinson's Disease and Movement Disorders Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tsao-Wei Liang
- Department of Neurology, Jefferson Comprehensive Parkinson's Disease and Movement Disorders Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nancy A Wintering
- Department of Integrative Medicine and Nutritional Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anthony J Bazzan
- Department of Integrative Medicine and Nutritional Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Li Zhong
- Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brendan K Bowens
- Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Inna Chervoneva
- Department of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Charles Intenzo
- Division of Nuclear Medicine, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew B Newberg
- Department of Integrative Medicine and Nutritional Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Division of Nuclear Medicine, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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26
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Real CC, Doorduin J, Kopschina Feltes P, Vállez García D, de Paula Faria D, Britto LR, de Vries EF. Evaluation of exercise-induced modulation of glial activation and dopaminergic damage in a rat model of Parkinson's disease using [ 11C]PBR28 and [ 18F]FDOPA PET. J Cereb Blood Flow Metab 2019; 39:989-1004. [PMID: 29271291 PMCID: PMC6545619 DOI: 10.1177/0271678x17750351] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Evidence suggests that exercise can modulate neuroinflammation and neuronal damage. We evaluated if such effects of exercise can be detected with positron emission tomography (PET) in a rat model of Parkinson's disease (PD). Rats were unilaterally injected in the striatum with 6-hydroxydopamine (PD rats) or saline (controls) and either remained sedentary (SED) or were forced to exercise three times per week for 40 min (EX). Motor and cognitive functions were evaluated by the open field, novel object recognition, and cylinder tests. At baseline, day 10 and 30, glial activation and dopamine synthesis were assessed by [11C]PBR28 and [18F]FDOPA PET, respectively. PET data were confirmed by immunohistochemical analysis of microglial (Iba-1) / astrocyte (GFAP) activation and tyrosine hydroxylase (TH). [11C]PBR28 PET showed increased glial activation in striatum and hippocampus of PD rats at day 10, which had resolved at day 30. Exercise completely suppressed glial activation. Imaging results correlated well with post-mortem Iba-1 staining, but not with GFAP staining. [18F]FDOPA PET, TH staining and behavioral tests indicate that 6-OHDA caused damage to dopaminergic neurons, which was partially prevented by exercise. These results show that exercise can modulate toxin-induced glial activation and neuronal damage, which can be monitored noninvasively by PET.
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Affiliation(s)
- Caroline C Real
- 1 Laboratory of Cellular Neurobiology, Department of Physiology and Biophysics, University of São Paulo, São Paulo, SP, Brazil.,2 Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,3 Laboratory of Nuclear Medicine (LIM 43), University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Janine Doorduin
- 2 Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paula Kopschina Feltes
- 2 Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David Vállez García
- 2 Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daniele de Paula Faria
- 3 Laboratory of Nuclear Medicine (LIM 43), University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Luiz R Britto
- 1 Laboratory of Cellular Neurobiology, Department of Physiology and Biophysics, University of São Paulo, São Paulo, SP, Brazil
| | - Erik Fj de Vries
- 2 Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Sestini S, Alongi P, Berti V, Calcagni ML, Cecchin D, Chiaravalloti A, Chincarini A, Cistaro A, Guerra UP, Pappatà S, Tiraboschi P, Nobili F. The role of molecular imaging in the frame of the revised dementia with Lewy body criteria. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00321-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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28
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Glaab E, Trezzi JP, Greuel A, Jäger C, Hodak Z, Drzezga A, Timmermann L, Tittgemeyer M, Diederich NJ, Eggers C. Integrative analysis of blood metabolomics and PET brain neuroimaging data for Parkinson's disease. Neurobiol Dis 2019; 124:555-562. [DOI: 10.1016/j.nbd.2019.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/19/2018] [Accepted: 01/07/2019] [Indexed: 02/06/2023] Open
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de Natale ER, Wilson H, Pagano G, Politis M. Imaging Transplantation in Movement Disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 143:213-263. [PMID: 30473196 DOI: 10.1016/bs.irn.2018.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cell replacement therapy with graft transplantation has been tested as a disease-modifying treatment in neurodegenerative diseases characterized by the damage of a predominant cell type, such as substantia nigra dopaminergic neurons in Parkinson's disease (PD) or striatal medium spiny projection neurons in Huntington's disease (HD). The results of these trials are mixed with success in preclinical and pilot open-label trials, which were not consistently reproduced in randomized controlled trials. Positron emission tomography (PET) and single photon emission computed tomography (SPECT) molecular imaging and functional magnetic resonance imaging allow the graft survival, and its relationship with the host tissues to be studied in vivo. In PD, PET with [18F]DOPA showed that graft survival does not necessarily correlate with the clinical improvement and PD patients with worse outcome had lower binding in the ventral striatum and a high serotonin ([11C]DASB PET) to dopamine ([18F]DOPA PET) ratio in the grafted neurons. In HD, PET with [11C]PK11195 showed the graft survival and the clinical responses may be related to the reactive activation of the host inflammatory/immune system. Findings from these studies have been used to refine study protocols and patient selection in current clinical trials, which includes identifying suitable candidates for transplantation using imaging markers and employing multiple and/or novel PET tracers to better assess graft functions and inflammatory responses to grafts.
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Affiliation(s)
- Edoardo Rosario de Natale
- Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Heather Wilson
- Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Gennaro Pagano
- Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Marios Politis
- Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
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30
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Lee I, Kim JS, Park JY, Byun BH, Park SY, Choi JH, Moon H, Kim JY, Lee KC, Chi DY, Kim KM, Lim I, Kang JH, Ahn SH, Kim BI, Ha JH, Lim SM. Head-to-head comparison of 18 F-FP-CIT and 123 I-FP-CIT for dopamine transporter imaging in patients with Parkinson's disease: A preliminary study. Synapse 2018; 72:e22032. [PMID: 29486515 DOI: 10.1002/syn.22032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/30/2018] [Accepted: 02/23/2018] [Indexed: 11/09/2022]
Abstract
123 I-FP-CIT and 18 F-FP-CIT are radiotracers which are widely used to diagnose Parkinson's disease (PD). However, to our knowledge, no studies to date have made head-to-head comparisons between 123 I-FP-CIT and 18 F-FP-CIT. Therefore, in this study, 123 I-FP-CIT SPECT/CT was compared with 18 F-FP-CIT PET/CT in the same cohort of subjects. Patients with PD and essential tremor (ET) underwent 123 I-FP-CIT SPECT/CT and 18 F-FP-CIT PET/CT. Visual and semiquantitative analyses were conducted. The specific binding ratio (SBR) and putamen to caudate ratio (PCR) were compared between subjects who underwent 123 I-FP-CIT SPECT/CT and 18 F-FP-CIT PET/CT. Visual analysis showed that the striatal uptake of both radiotracers was decreased in the PD group, whereas striatal uptake was intact in the ET group. The SBR between 123 I-FP-CIT SPECT/CT and 18 F-FP-CIT PET/CT showed a positive correlation (r = .78, p < .01). However, the mean SBRs on 18 F-FP-CIT PET/CT were higher than those on 123 I-FP-CIT SPECT/CT (2.19 ± .87 and 1.22 ± .49, respectively; p < .01). The PCRs in these two modalities were correlated with each other (r = .71, p < .01). The mean PCRs on 18 F-FP-CIT PET/CT were not significantly higher than those on 123 I-FP-CIT SPECT/CT (1.31 ± .19 and 0.98 ± .06, respectively; p = .06). These preliminary results indicate that the uptake of both 123 I-FP-CIT and 18 F-FP-CIT was decreased in the PD group when compared with the ET controls. Visual analyses using both methods did not affect the diagnostic accuracy in this study. However, semiquantitative analysis indicated a better contrast of 18 F-FP-CIT PET/CT relative to 123 I-FP-CIT SPECT/CT.
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Affiliation(s)
- Inki Lee
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Jin Su Kim
- Division of RI convergence research, Research Institute of Radiological and Medical Sciences, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Joon Yeun Park
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Byung Hyun Byun
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Su Yeon Park
- Department of Neurology, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Joon Ho Choi
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Hansol Moon
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Jung Young Kim
- Division of RI convergence research, Research Institute of Radiological and Medical Sciences, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Kyo Chul Lee
- Division of RI convergence research, Research Institute of Radiological and Medical Sciences, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Dae Yoon Chi
- Department of Chemistry, Sogang University, Seoul, Korea
| | - Kyeong Min Kim
- Division of RI convergence research, Research Institute of Radiological and Medical Sciences, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Ilhan Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Joo Hyun Kang
- Division of RI convergence research, Research Institute of Radiological and Medical Sciences, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Soon Hyuk Ahn
- Radiopharmaceutical Production Center, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Byung Il Kim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Jeong Ho Ha
- Department of Neurology, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
| | - Sang Moo Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institutes of Radiological and Medical Sciences, Seoul, Korea
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Langston JW, Wiley JC, Tagliati M. Optimizing Parkinson's disease diagnosis: the role of a dual nuclear imaging algorithm. NPJ PARKINSONS DISEASE 2018; 4:5. [PMID: 29507872 PMCID: PMC5824845 DOI: 10.1038/s41531-018-0041-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/08/2018] [Accepted: 02/01/2018] [Indexed: 12/11/2022]
Abstract
The diagnosis of Parkinson's disease (PD) currently relies almost exclusively on the clinical judgment of an experienced neurologist, ideally a specialist in movement disorders. However, such clinical diagnosis is often incorrect in a large percentage of patients, particularly in the early stages of the disease. A commercially available, objective and quantitative marker of nigrostriatal neurodegeneration was recently provided by 123-iodine 123I-ioflupane SPECT imaging, which is however unable to differentiate PD from a variety of other parkinsonian syndromes associated with striatal dopamine deficiency. There is evidence to support an algorithm utilizing a dual neuroimaging strategy combining 123I-ioflupane SPECT and the noradrenergic receptor ligand 123I-metaiodobenzylguanidine (MIBG), which assesses the post-ganglion peripheral autonomic nervous system. Evolving concepts regarding the synucleinopathy affecting the central and peripheral autonomic nervous systems as part of a multisystem disease are reviewed to sustain such strategy. Data are presented to show how MIBG deficits are a common feature of multisystem Lewy body disease and can be used as a unique feature to distinguish PD from atypical parkinsonisms. We propose that the combination of cardiac (MIBG) and cerebral 123I-ioflupane SPECT could satisfy one of the most significant unmet needs of current PD diagnosis and management, namely the early and accurate diagnosis of patients with typical Lewy body PD. Exemplary case scenarios will be described, highlighting how dual neuroimaging strategy can maximize diagnostic accuracy for patient care, clinical trials, pre-symptomatic PD screening, and special cases provided by specific genetic mutations associated with PD.
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Affiliation(s)
| | - Jesse C Wiley
- 2Department of Comparative Medicine, University of Washington, 1959 NE Pacific Ave Seattle, Seattle, WA USA
| | - Michele Tagliati
- Department of Neurology, Cedar-Sinai Medical Center, 127 S San Vicente Blvd, AHSP 6600, Los Angeles, CA 90272 USA
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de Natale ER, Niccolini F, Wilson H, Politis M. Molecular Imaging of the Dopaminergic System in Idiopathic Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 141:131-172. [DOI: 10.1016/bs.irn.2018.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Mäkinen E, Joutsa J, Vahlberg T, Kaasinen V. Survival in Parkinson's disease in relation to striatal dopamine transporter binding. Parkinsonism Relat Disord 2017; 42:66-72. [DOI: 10.1016/j.parkreldis.2017.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/02/2017] [Accepted: 06/21/2017] [Indexed: 11/29/2022]
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Monti DA, Zabrecky G, Kremens D, Liang TW, Wintering NA, Cai J, Wei X, Bazzan AJ, Zhong L, Bowen B, Intenzo CM, Iacovitti L, Newberg AB. N-Acetyl Cysteine May Support Dopamine Neurons in Parkinson's Disease: Preliminary Clinical and Cell Line Data. PLoS One 2016; 11:e0157602. [PMID: 27309537 PMCID: PMC4911055 DOI: 10.1371/journal.pone.0157602] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/31/2016] [Indexed: 12/23/2022] Open
Abstract
Backgound The purpose of this study was to assess the biological and clinical effects of n-acetyl-cysteine (NAC) in Parkinson’s disease (PD). Methods The overarching goal of this pilot study was to generate additional data about potentially protective properties of NAC in PD, using an in vitro and in vivo approach. In preparation for the clinical study we performed a cell tissue culture study with human embryonic stem cell (hESC)-derived midbrain dopamine (mDA) neurons that were treated with rotenone as a model for PD. The primary outcome in the cell tissue cultures was the number of cells that survived the insult with the neurotoxin rotenone. In the clinical study, patients continued their standard of care and were randomized to receive either daily NAC or were a waitlist control. Patients were evaluated before and after 3 months of receiving the NAC with DaTscan to measure dopamine transporter (DAT) binding and the Unified Parkinson’s Disease Rating Scale (UPDRS) to measure clinical symptoms. Results The cell line study showed that NAC exposure resulted in significantly more mDA neurons surviving after exposure to rotenone compared to no NAC, consistent with the protective effects of NAC previously observed. The clinical study showed significantly increased DAT binding in the caudate and putamen (mean increase ranging from 4.4% to 7.8%; p<0.05 for all values) in the PD group treated with NAC, and no measurable changes in the control group. UPDRS scores were also significantly improved in the NAC group (mean improvement of 12.9%, p = 0.01). Conclusions The results of this preliminary study demonstrate for the first time a potential direct effect of NAC on the dopamine system in PD patients, and this observation may be associated with positive clinical effects. A large-scale clinical trial to test the therapeutic efficacy of NAC in this population and to better elucidate the mechanism of action is warranted. Trial Registration ClinicalTrials.gov NCT02445651
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Affiliation(s)
- Daniel A. Monti
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - George Zabrecky
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Daniel Kremens
- Movement Disorders Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Tsao-Wei Liang
- Movement Disorders Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Nancy A. Wintering
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Jingli Cai
- Department of Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Xiatao Wei
- Department of Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Anthony J. Bazzan
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Li Zhong
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Brendan Bowen
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Charles M. Intenzo
- Division of Nuclear Medicine, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Lorraine Iacovitti
- Department of Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Andrew B. Newberg
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
- Department of Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States of America
- * E-mail:
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Garibotto V, Nicastro N, Burkhard PR. No more SWEDDs. Mov Disord 2016; 31:1426. [PMID: 27297571 DOI: 10.1002/mds.26705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/11/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Nicastro
- Department of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre R Burkhard
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
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Relation of 18-F-Dopa PET with hypokinesia-rigidity, tremor and freezing in Parkinson's disease. NEUROIMAGE-CLINICAL 2016; 11:68-72. [PMID: 26909330 PMCID: PMC4735657 DOI: 10.1016/j.nicl.2016.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In this retrospective study concerning patients with Parkinson's disease (PD) scanned with 18-F-Dopa PET (N = 129), we looked for an association between reduced 18-F-Dopa uptake and the key PD symptoms tremor and hypokinesia-rigidity. We hypothesized to find a stronger correlation between dopaminergic depletion in the striatum and hypokinesia-rigidity compared to tremor. METHODS The onset side of symptoms (documented for 102 patients) as well as the first registered UPDRS (available for 79 patients) was used to correlate with F-Dopa uptake values in the caudate nucleus and putamen in this large retrospective sample. RESULTS Reduced F-Dopa uptake was contralateral to hypokinesia-rigidity symptoms and correlated with its severity (quantified by UPDRS). For tremor severity, no correlation was seen with F-Dopa reduction. Furthermore, freezing of gait correlated with reduced F-Dopa uptake in the putamen of the right hemisphere. CONCLUSION AND DISCUSSION Our results, obtained in a large patient group, provides support for the concept that tremor in PD is not only based on a dopamine related pathway but may rely on a different pathway.
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Orbitofrontal (18) F-DOPA Uptake and Movement Preparation in Parkinson's Disease. PARKINSONS DISEASE 2015; 2015:180940. [PMID: 26171275 PMCID: PMC4480935 DOI: 10.1155/2015/180940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/27/2015] [Accepted: 05/30/2015] [Indexed: 11/29/2022]
Abstract
In Parkinson's disease (PD) degeneration of mesocortical dopaminergic projections may determine cognitive and behavioral symptoms. Choice reaction time task is related to attention, working memory, and goal-directed behavior. Such paradigm involves frontal cortical circuits receiving mesocortical dopamine which are affected early in PD. The aim of this study is to characterize the role of dopamine on the cognitive processes that precede movement in a reaction time paradigm in PD. We enrolled 16 newly diagnosed and untreated patients with PD without cognitive impairment or depression and 10 control subjects with essential tremor. They performed multiple-choice reaction time task with the right upper limb and brain 18F-DOPA PET/CT scan. A significant inverse correlation was highlighted between average reaction time and 18F-DOPA uptake in the left lateral orbitofrontal cortex. No correlations were found between reaction time and PD disease severity or between reaction time and 18F-DOPA uptake in controls. Our study shows that in PD, but not in controls, reaction time is inversely related to the levels of dopamine in the left lateral orbitofrontal cortex. This novel finding underlines the role of dopamine in the lateral orbitofrontal cortex in the early stages of PD, supporting a relation between the compensatory cortical dopamine and movement preparation.
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Brain (18)F-DOPA PET and cognition in de novo Parkinson's disease. Eur J Nucl Med Mol Imaging 2015; 42:1062-70. [PMID: 25820675 DOI: 10.1007/s00259-015-3039-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/05/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE The role of mesocortical dopaminergic pathways in the cognitive function of patients with early Parkinson's disease (PD) needs to be further clarified. METHODS The study groups comprised 15 drug-naive patients with de novo PD and 10 patients with essential tremor (controls) who underwent (18)F-DOPA PET (static acquisition, normalization on mean cerebellar counts) and an extended neuropsychological test battery. Factor analysis with varimax rotation was applied to the neuropsychological test scores, to yield five factors from 16 original scores, which explained 82 % of the total variance. Correlations between cognitive factors and (18)F-DOPA uptake were assessed with SPM8, taking age and gender as nuisance variables. RESULTS (18)F-DOPA uptake was significantly lower in PD patients than in controls in the bilateral striatum, mainly in the more affected (right) hemisphere, and in a small right temporal region. Significant positive correlations were found only in PD patients between the executive factor and (18)F-DOPA uptake in the bilateral anterior cingulate cortex (ACC) and the middle frontal gyrus, between the verbal fluency factor and (18)F-DOPA uptake in left BA 46 and the bilateral striatum, and between the visuospatial factor and (18)F-DOPA uptake in the left ACC and bilateral striatum. No correlations were found between (18)F-DOPA uptake and either the verbal memory factor or the abstraction-working memory factor. CONCLUSION These data clarify the role of the mesocortical dopaminergic pathways in cognitive function in early PD, highlighting the medial frontal lobe, anterior cingulate, and left BA 46 as the main sites of cortical correlation with executive and language functions.
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Ba F, Martin WW. Dopamine transporter imaging as a diagnostic tool for parkinsonism and related disorders in clinical practice. Parkinsonism Relat Disord 2015; 21:87-94. [PMID: 25487733 DOI: 10.1016/j.parkreldis.2014.11.007] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 01/22/2023]
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Pascu S, Dilworth J. Recent developments in PET and SPECT imaging. J Labelled Comp Radiopharm 2014; 57:191-4. [PMID: 24737125 DOI: 10.1002/jlcr.3196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 02/24/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Sofia Pascu
- Chemistry Department, University of Bath, Bath, UK.
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Järvelä JT, Rinne JO, Eskola O, Kaasinen V. Mortality in Parkinson's disease is not associated with the severity of early dopaminergic defect. Parkinsonism Relat Disord 2014; 20:894-7. [DOI: 10.1016/j.parkreldis.2014.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 05/05/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
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O'Brien JT, Oertel WH, McKeith IG, Grosset DG, Walker Z, Tatsch K, Tolosa E, Sherwin PF, Grachev ID. Is ioflupane I123 injection diagnostically effective in patients with movement disorders and dementia? Pooled analysis of four clinical trials. BMJ Open 2014; 4:e005122. [PMID: 24993764 PMCID: PMC4091455 DOI: 10.1136/bmjopen-2014-005122] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To pool clinical trials of similar design to assess overall sensitivity and specificity of ioflupane I123 injection (DaTSCAN or ioflupane ((123)I)) to detect or exclude a striatal dopaminergic deficit disorder (SDDD), such as parkinsonian syndrome and dementia with Lewy bodies. DESIGN Pooled analysis of three phase 3 and one phase 4 clinical trials. These four trials were selected because they were the four studies used for the US new drug application to the Food and Drug Administration (FDA). SETTING Multicentre, open-label, non-randomised. PARTICIPANTS Patients with either a movement disorder or dementia, and healthy volunteers. INTERVENTIONS Ioflupane ((123)I) was administered. OUTCOME MEASURES Images were assessed by panels of 3-5 blinded experts and/or on-site nuclear medicine physicians, classified as normal or abnormal and compared with clinical diagnosis (reference standard) to determine sensitivity and specificity. RESULTS Pooling the four studies, 928 participants were enrolled, 849 were dosed and 764 completed their study. Across all studies, when images were assessed by on-site readers, ioflupane ((123)I) diagnostic effectiveness had an overall (95% CI) sensitivity of 91.9% (88.7% to 94.5%) and specificity of 83.6% (78.7% to 87.9%). When reads were conducted blindly by a panel of independent experts, the overall sensitivity was 88.7% (86.8% to 90.4%) and specificity was 91.2% (89.0% to 93.0%). CONCLUSIONS In this pooled analysis, the visual assessment of ioflupane ((123)I) images provided high levels of sensitivity and specificity in detecting the presence/absence of an SDDD. Ioflupane ((123)I) imaging has the potential to improve diagnostic accuracy in patients with signs and symptoms of a movement disorder and/or dementia. TRIAL REGISTRATION NUMBER NCT00209456.
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Affiliation(s)
- John T O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, and Cambridgeshire and Peterborough Foundation NHS Trust, Cambridge, UK
| | - Wolfgang H Oertel
- Department of Neurology, Philipps-University of Marburg, Marburg, Germany
| | - Ian G McKeith
- Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Donald G Grosset
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, and University of Glasgow, Glasgow, Scotland, UK
| | - Zuzana Walker
- Mental Health Sciences Unit, University College London, London, UK
- North Essex Partnership University NHS Foundation Trust, Essex, UK
| | - Klaus Tatsch
- Department of Nuclear Medicine, Municipal Hospital Karlsruhe, Inc., Karlsruhe, Germany
| | - Eduardo Tolosa
- Neurology Service, Hospital Clínic, University of Barcelona, Institut d'investigacions Biomédiques August Pi i Sunyer (IDIBAPS),Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Catalonia, Spain
| | - Paul F Sherwin
- Clinical Development, Life Sciences, GE Healthcare, Princeton, New Jersey, USA
| | - Igor D Grachev
- Global Head of Neurology/DaTscan, Medical Affairs, Life Sciences, GE Healthcare, Princeton, New Jersey, USA
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Smits EJ, Tolonen AJ, Cluitmans L, van Gils M, Conway BA, Zietsma RC, Leenders KL, Maurits NM. Standardized handwriting to assess bradykinesia, micrographia and tremor in Parkinson's disease. PLoS One 2014; 9:e97614. [PMID: 24854199 PMCID: PMC4031150 DOI: 10.1371/journal.pone.0097614] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/22/2014] [Indexed: 11/23/2022] Open
Abstract
Objective To assess whether standardized handwriting can provide quantitative measures to distinguish patients diagnosed with Parkinson's disease from age- and gender-matched healthy control participants. Design Exploratory study. Pen tip trajectories were recorded during circle, spiral and line drawing and repeated character ‘elelelel’ and sentence writing, performed by Parkinson patients and healthy control participants. Parkinson patients were tested after overnight withdrawal of anti-Parkinsonian medication. Setting University Medical Center Groningen, tertiary care, the Netherlands. Participants Patients with Parkinson's disease (n = 10; mean age 69.0 years; 6 male) and healthy controls (n = 10; mean age 68.1 years; 6 male). Interventions Not applicable. Main Outcome Measures Movement time and velocity to detect bradykinesia and the size of writing to detect micrographia. A rest recording to investigate the presence of a rest-tremor, by frequency analysis. Results Mean disease duration in the Parkinson group was 4.4 years and the patients were in modified Hoehn-Yahr stages 1–2.5. In general, Parkinson patients were slower than healthy control participants. Median time per repetition, median velocity and median acceleration of the sentence task and median velocity of the elel task differed significantly between Parkinson patients and healthy control participants (all p<0.0014). Parkinson patients also wrote smaller than healthy control participants and the width of the ‘e’ in the elel task was significantly smaller in Parkinson patients compared to healthy control participants (p<0.0014). A rest-tremor was detected in the three patients who were clinically assessed as having rest-tremor. Conclusions This study shows that standardized handwriting can provide objective measures for bradykinesia, tremor and micrographia to distinguish Parkinson patients from healthy control participants.
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Affiliation(s)
- Esther J. Smits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | | | - Luc Cluitmans
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Bernard A. Conway
- The Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | | | - Klaus L. Leenders
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Reproducibility of PET measurement for presynaptic dopaminergic functions using L-[β-11C]DOPA and [18F]FE-PE2I in humans. Nucl Med Commun 2014; 35:231-7. [DOI: 10.1097/mnm.0000000000000052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sydoff M, Andersson M, Mattsson S, Leide-Svegborn S. Use of wall-less ¹⁸F-doped gelatin phantoms for improved volume delineation and quantification in PET/CT. Phys Med Biol 2014; 59:1097-107. [PMID: 24556921 DOI: 10.1088/0031-9155/59/5/1097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Positron emission tomography (PET) with (18)F-FDG is a valuable tool for staging, planning treatment, and evaluating the treatment response for many different types of tumours. The correct volume estimation is of utmost importance in these situations. To date, the most common types of phantoms used in volume quantification in PET utilize fillable, hollow spheres placed in a circular or elliptical cylinder made of polymethyl methacrylate. However, the presence of a non-radioactive sphere wall between the hotspot and the background activity in images of this type of phantom could cause inaccuracies. To investigate the influence of the non-active walls, we developed a phantom without non-active sphere walls for volume delineation and quantification in PET. Three sizes of gelatin hotspots were moulded and placed in a Jaszczak phantom together with hollow plastic spheres of the same sizes containing the same activity concentration. (18)F PET measurements were made with zero background activity and with tumour-to-background ratios of 12.5, 10, 7.5, and 5. The background-corrected volume reproducing threshold, Tvol, was calculated for both the gelatin and the plastic spheres. It was experimentally verified that the apparent background dependence of Tvol, i.e., a decreasing Tvol with increasing background fraction, was not present for wall-less spheres; the opposite results were seen in plastic, hollow spheres in commercially-available phantoms. For the types of phantoms commonly used in activity quantification, the estimation of Tvol using fillable, hollow, plastic spheres with non-active walls would lead to an overestimate of the tumour volume, especially for small volumes in a high activity background.
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Affiliation(s)
- Marie Sydoff
- Medical Radiation Physics, Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital Malmö, SE-205 02 Malmö, Sweden
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A simple algorithm for subregional striatal uptake analysis with partial volume correction in dopaminergic PET imaging. Ann Nucl Med 2013; 28:33-41. [PMID: 24135967 DOI: 10.1007/s12149-013-0778-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE In positron emission tomography (PET) of the dopaminergic system, quantitative measurements of nigrostriatal dopamine function are useful for differential diagnosis. A subregional analysis of striatal uptake enables the diagnostic performance to be more powerful. However, the partial volume effect (PVE) induces an underestimation of the true radioactivity concentration in small structures. This work proposes a simple algorithm for subregional analysis of striatal uptake with partial volume correction (PVC) in dopaminergic PET imaging. METHODS The PVC algorithm analyzes the separate striatal subregions and takes into account the PVE based on the recovery coefficient (RC). The RC is defined as the ratio of the PVE-uncorrected to PVE-corrected radioactivity concentration, and is derived from a combination of the traditional volume of interest (VOI) analysis and the large VOI technique. The clinical studies, comprising 11 patients with Parkinson's disease (PD) and 6 healthy subjects, were used to assess the impact of PVC on the quantitative measurements. Simulations on a numerical phantom that mimicked realistic healthy and neurodegenerative situations were used to evaluate the performance of the proposed PVC algorithm. In both the clinical and the simulation studies, the striatal-to-occipital ratio (SOR) values for the entire striatum and its subregions were calculated with and without PVC. RESULTS In the clinical studies, the SOR values in each structure (caudate, anterior putamen, posterior putamen, putamen, and striatum) were significantly higher by using PVC in contrast to those without. Among the PD patients, the SOR values in each structure and quantitative disease severity ratings were shown to be significantly related only when PVC was used. For the simulation studies, the average absolute percentage error of the SOR estimates before and after PVC were 22.74% and 1.54% in the healthy situation, respectively; those in the neurodegenerative situation were 20.69% and 2.51%, respectively. CONCLUSIONS We successfully implemented a simple algorithm for subregional analysis of striatal uptake with PVC in dopaminergic PET imaging. The PVC algorithm provides an accurate measure of the SOR in the entire striatum and its subregions, and improves the correlation between the SOR values and the clinical disease severity of PD patients.
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123I-FP-Cit and 123I-IBZM SPECT uptake in a prospective normal material analysed with two different semiquantitative image evaluation tools. Nucl Med Commun 2013; 34:978-89. [DOI: 10.1097/mnm.0b013e328364aa2e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This article discusses the current use of PET imaging in the evaluation of dopamine function in Parkinson disease (PD). The article reviews the major radioligands targeting dopaminergic systems in patients with parkinsonian disorders. The primary objective is to show the novel clinical applications of molecular imaging in the diagnosis and assessment of motor and nonmotor symptoms in PD.
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Sydoff M, Lizana H, Mattsson S, Stabin MG, Leide-Svegborn S. Determination of the biodistribution and dosimetry of ¹²³I-FP-CIT in male patients with suspected Parkinsonism or Lewy body dementia using planar and combined planar and SPECT/CT imaging. Appl Radiat Isot 2013; 82:300-7. [PMID: 24135637 DOI: 10.1016/j.apradiso.2013.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 08/01/2013] [Accepted: 09/17/2013] [Indexed: 11/29/2022]
Abstract
In this study, (123)I-FP-CIT biodistribution and dosimetry was determined in 10 adult male patients using planar gamma camera imaging alone or in combination with single photon emission computed tomography /X-ray computed tomography (SPECT/CT) imaging. Dosimetric assessment using planar plus SPECT/CT imaging resulted in significantly different estimates of organ-absorbed doses compared to estimates based on planar imaging alone. We conclude that the use of complementary SPECT/CT measurements in biodistribution studies is valuable for determining the organ doses more accurately.
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Affiliation(s)
- Marie Sydoff
- Medical Radiation Physics, Department of Clinical physiology and Nuclear medicine, Malmö, Lund University, Skåne University Hospital Malmö, SE-205 02 Malmö, Sweden.
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Abstract
The major application for PET imaging in clinical practice is represented by cancer imaging and (18)F-FDG is the most widely employed positron emitter compound. However, some diseases cannot be properly evaluated with this tracer and thus there is the necessity to develop more specific compounds. The last decades were a continuous factory for new radiopharmaceuticals leading to an endless list of PET tracers; however, just some of them guard diagnostic relevance in routine medical practice. This chapter describes a selected list of non-FDG PET tracers, basing on their introduction into and impact on clinical practice.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine Unit, Humanitas Cancer Center, Rozzano, MI, Italy
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