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Differential Diagnosis of Patients with Inconclusive Parkinsonian Features Using [18F]FP-CIT PET/CT

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Abstract

Purpose

It is often difficult to differentiate parkinsonism, especially when patients show uncertain parkinsonian features. We investigated the usefulness of dopamine transporter (DAT) imaging for the differential diagnosis of inconclusive parkinsonism using [18F]FP-CIT PET.

Methods

Twenty-four patients with inconclusive parkinsonian features at initial clinical evaluation and nine healthy controls were studied. Patients consisted of three subgroups: nine patients whose diagnoses were unclear concerning whether they had idiopathic Parkinson’s disease or drug-induced parkinsonism (‘PD/DIP’), nine patients who fulfilled neither the diagnostic criteria of PD nor of essential tremor (‘PD/ET’), and six patients who were alleged to have either PD or atypical parkinsonian syndrome (‘PD/APS’). Brain PET images were obtained 120 min after injection of 185 MBq [18F]FP-CIT. Imaging results were quantified and compared with follow-up clinical diagnoses.

Results

Overall, 11 of 24 patients demonstrated abnormally decreased DAT availability on the PET scans, whereas 13 were normal. PET results could diagnose PD/DIP and PD/ET patients as having PD in six patients, DIP in seven, and ET in five; however, the diagnoses of all six PD/APS patients remained inconclusive. Among 15 patients who obtained a final follow-up diagnosis, the image-based diagnosis was congruent with the follow-up diagnosis in 11 patients. Four unsolved cases had normal DAT availability, but clinically progressed to PD during the follow-up period.

Conclusion

[18F]FP-CIT PET imaging is useful in the differential diagnosis of patients with inconclusive parkinsonian features, except in patients who show atypical features or who eventually progress to PD.

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Acknowledgments

We thank Prof. Jae Sung Lee for providing FMItool; Hyerina Kim for assistance; Mi-Ok Kim, Jae-Hoon Baek, Ji-Han Kim, and the rest of the staff at the Korea University Anam Hospital PET Center for excellent technical assistance.

This study was supported by Korea University Grants (K0931131 and K0932081).

Financial Support

Korea University Grants (K0931131 and K0932081)

Conflict of Interest

Eunkyung Park, Yu Mi Hwang, Chan-Nyoung Lee, Sujin Kim, Sun Young Oh, Young Chul Kim, Jae Gol Choe, and Kun Woo Park declare that they have no conflict of interest.

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Correspondence to Kun Woo Park.

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Park, E., Hwang, Y.M., Lee, CN. et al. Differential Diagnosis of Patients with Inconclusive Parkinsonian Features Using [18F]FP-CIT PET/CT. Nucl Med Mol Imaging 48, 106–113 (2014). https://doi.org/10.1007/s13139-013-0253-1

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  • DOI: https://doi.org/10.1007/s13139-013-0253-1

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