Abstract
Dopamine transporter (DAT) and glucose metabolism imaging have been applied in the diagnosis of Parkinson’s disease (PD). We explored the possibility of evaluating for PD with NeuroQ software by analyzing 11C-2β-carbomethoxy-3β-(4-fluorophenyl) tropane (11C-CFT) and 18F-FDG PET/CT. We retrospectively analyzed brain 11C-CFT and 18F-FDG PET/CT of 38 patients with parkinsonism, including 20 with PD, 10 with multiple system atrophy (MSA) and 8 with essential tremor (ET), and compared them with the PET/CT of 11 normal healthy controls (NC). PD patients were divided into mild and moderate-severe grade according to the Hoehn-Yahr (H&Y) scale. The 11C-CFT uptake in the caudate nuclei (CN) and putamen (Pu) normalized with cerebellum (CN/Cb and Pu/Cb) were obtained with a manual method and NeuroQ software, and their diagnostic performance was compared.18F-FDG uptake of specific regions was also obtained with NeuroQ, and the enhancement effect for the differential diagnosis was evaluated. There was significant agreement between the manual method and the NeuroQ method for 11C-CFT uptake by CN (r2= 0.680) and Pu (r2= 0.770). 11C-CFT uptake by CN and Pu in PD and MSA patients was significantly lower compared to NC and ET patients. The cutoffs of CN/Cb and Pu/Cb for the distinction between PD and NC were 1.71 and 2.20, respectively. No difference in uptake ratios occurred between PD and MSA. 18F-FDG uptake by the pons and cerebellum in the MSA group was markedly decreased. It was highly accurate in distinguishing between PD and MSA when combined with analysis of 11C-CFT uptake. Pu/Cb decreased significantly in mild grade PD compared to NC group (1.92 ± 0.33 vs. 2.82 ± 0.43); however no statistically significant decrease in CN/Cb was observed until moderate-severe grade PD (1.43 ± 0.11 vs. 2.23 ± 0.36). In early asymmetric PD, a statistically significant difference could be seen with Pu/Cb between the symptomatic and asymptomatic side (2.17 ± 0.30 vs. 1.95 ± 0.22). 11C-CFT and 18F-FDG PET/CT can be analyzed quantitatively with NeuroQ software, which provides an accurate method for the diagnosis and severity evaluation of PD.
Highlights
Parkinson’s disease (PD) is one of the most common neurodegenerative diseases, affecting approximately 1% of the population over the age of 60 years (Abbas et al, 2017)
One-way ANOVA was performed to analyze the difference of 11C-CFT uptake among groups (PD, normal healthy controls (NC), multiple system atrophy (MSA), and essential tremor (ET))
caudate nuclei (CN)/Cb and putamen to cerebellum (Pu/Cb) were markedly decreased in the PD compared with those of NC (CN/Cb: 1.67 ± 0.36 vs. 2.23 ± 0.36, P < 0.01; Pu/Cb: 1.74 ± 0.31 vs. 2.82 ± 0.43, P < 0.01) and ET (CN/Cb: 1.67 ± 0.36 vs. 2.50 ± 0.47, P < 0.01; Pu/Cb: 1.74 ± 0.31 vs. 3.16 ± 0.49, P < 0.01)
Summary
Parkinson’s disease (PD) is one of the most common neurodegenerative diseases, affecting approximately 1% of the population over the age of 60 years (Abbas et al, 2017). Many markers in this pathway have been exploited in targeted imaging approaches, such as the synthesis and presynaptic storage of dopamine (DA), the reuptake of DA with dopamine transporter (DAT), and the expression of the dopamine D2-type receptor (D2R) on the post-synaptic striatal neurons (Frey, 2017). The degeneration and loss of dopamine neurons in the substantia nigra and striatum of PD patients are accompanied by a decrease in the number and function of DAT in the presynaptic membrane (Piccini, 2003). According to the International Parkinson and Movement Disorder Society Clinical Diagnostic Criteria for Parkinson’s Disease (MDS-PD Criteria), the presence of normal presynaptic DAT on imaging is one way to rule out PD (Postuma et al, 2015). The quantitative analysis of DAT function is important for the diagnosis and evaluation of PD
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