Abstract
Parkinson's disease with orthostatic hypotension (PD + OH) can be difficult to distinguish clinically from the parkinsonian form of multiple system atrophy (MSA-P). Previous studies examined cardiac sympathetic neuroimaging to differentiate PD from MSA but without focusing specifically on PD + OH versus MSA-P, which often is the relevant differential diagnostic issue. To investigate the utility of cardiac sympathetic neuroimaging by 18F-dopamine positron emission tomographic (PET) scanning for separating PD + OH from MSA-P. Cardiac 18F-dopamine PET data were analyzed from 50 PD + OH and 68 MSA-P patients evaluated at the NIH Clinical Center from 1990 to 2020. Noradrenergic deficiency was defined by interventricular septal 18F-dopamine-derived radioactivity <6000 nCi-kg/cc-mCi in the 5' frame with mid-point 8' after initiation of 3' tracer injection. 18F-Dopamine PET separated the PD + OH from the MSA-P group with a sensitivity of 92% and specificity of 96%. Cardiac 18F-dopamine PET scanning efficiently distinguishes PD + OH from MSA-P.
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