Neurology, Vol 45, Issue 11 1995-2004, Copyright © 1995 by American Academy of Neurology

ARTICLES

Early differential diagnosis of Parkinson's disease with 18F- fluorodeoxyglucose and positron emission tomography

D Eidelberg, JR Moeller, T Ishikawa, V Dhawan, P Spetsieris, T Chaly, A Belakhlef, F Mandel, S Przedborski and S Fahn
Department of Neurology, North Shore University Hospital/Cornell University Medical College, Manhasset, NY 11030, USA.

Early-stage Parkinson's disease (EPD) is often clinically asymmetric. We used 18F-fluorodeoxyglucose (FDG) and PET to assess whether EPD can be detected by a characteristic pattern of regional metabolic asymmetry. To identify this pattern, we studied 10 EPD (Hoehn and Yahr stage I) patients (mean age 61.1 +/- 11.1 years) using 18F-FDG and PET to calculate regional metabolic rates for glucose. The scaled subprofile model (SSM) was applied to metabolic asymmetry measurements for the combined group of EPD patients and normal subjects to identify a specific covariation pattern that discriminated EPD patients from normal subjects. To determine whether this pattern could be used diagnostically, we studied a subsequent group of five presumptive EPD patients (mean age 50.9 +/- 18.3), five normal subjects (mean age 44.6 +/- 15.3), and nine patients with atypical drug-resistant early-stage parkinsonism (APD) (mean age 44.6 +/- 14.0). In each member of this prospective cohort, we calculated the expression of the EPD-related covariation pattern (subject scores) on a case-by-case basis. We also studied 11 of the EPD patients, five patients with APD, and 10 normal subjects with 18F-fluorodopa (FDOPA) and PET to measure presynaptic nigrostriatal dopaminergic function, and we assessed the accuracy of differential diagnosis with both PET methods using discrimination analysis. SSM analysis disclosed a significant topographic contrast profile characterized by covariate basal ganglia and thalamic asymmetries. Subject scores for this profile accurately discriminated EPD patients from normal subjects and APD patients (p < 0.0001). Group assignments into the normal or parkinsonian categories with FDG/PET were comparable to those achieved with FDOPA/PET, although APD and EPD patients were not differentiable by the latter method. Metabolic brain imaging with FDG/PET may be useful in the differential diagnosis of EPD.

This article has been cited by other articles:

				K. Van Laere, C. Casteels, L. De Ceuninck, B. Vanbilloen, A. Maes, L. Mortelmans, W. Vandenberghe, A. Verbruggen, and R. Dom Dual-Tracer Dopamine Transporter and Perfusion SPECT in Differential Diagnosis of Parkinsonism Using Template-Based Discriminant Analysis J. Nucl. Med., March 1, 2006; 47(3): 384 - 392. [Abstract] [Full Text] [PDF]

				Y. Stern, C. Habeck, J. Moeller, N. Scarmeas, K. E. Anderson, H. J. Hilton, J. Flynn, H. Sackeim, and R. van Heertum Brain Networks Associated with Cognitive Reserve in Healthy Young and Old Adults Cereb Cortex, April 1, 2005; 15(4): 394 - 402. [Abstract] [Full Text] [PDF]

				M. D. Boska, T. B. Lewis, C. J. Destache, E. J. Benner, J. A. Nelson, M. Uberti, R. L. Mosley, and H. E. Gendelman Quantitative 1H Magnetic Resonance Spectroscopic Imaging Determines Therapeutic Immunization Efficacy in an Animal Model of Parkinson's Disease J. Neurosci., February 16, 2005; 25(7): 1691 - 1700. [Abstract] [Full Text] [PDF]

				B. Ravina, D. Eidelberg, J. E. Ahlskog, R. L. Albin, D. J. Brooks, M. Carbon, V. Dhawan, A. Feigin, S. Fahn, M. Guttman, et al. The role of radiotracer imaging in Parkinson disease Neurology, January 25, 2005; 64(2): 208 - 215. [Abstract] [Full Text] [PDF]

				S. Colloby and J. O'Brien Functional Imaging in Parkinson's Disease and Dementia with Lewy Bodies J Geriatr Psychiatry Neurol, September 1, 2004; 17(3): 158 - 163. [Abstract] [PDF]

				S. T. DeKosky and K. Marek Looking Backward to Move Forward: Early Detection of Neurodegenerative Disorders Science, October 31, 2003; 302(5646): 830 - 834. [Abstract] [Full Text] [PDF]

				K. Marek, D. Jennings, and J. Seibyl Imaging the dopamine system to assess disease-modifying drugs: Studies comparing dopamine agonists and levodopa Neurology, September 23, 2003; 61(90063): S43 - 48. [Full Text]

				W.-S. Huang, Y.-H. Chiang, J.-C. Lin, Y.-H. Chou, C.-Y. Cheng, and R.-S. Liu Crossover Study of 99mTc-TRODAT-1 SPECT and 18F-FDOPA PET in Parkinson's Disease Patients J. Nucl. Med., July 1, 2003; 44(7): 999 - 1005. [Abstract] [Full Text] [PDF]

				Parkinson Study Group Dopamine Transporter Brain Imaging to Assess the Effects of Pramipexole vs Levodopa on Parkinson Disease Progression JAMA, April 3, 2002; 287(13): 1653 - 1661. [Abstract] [Full Text] [PDF]

				W.-S. Huang, S.-Z. Lin, J.-C. Lin, S.-P. Wey, G. Ting, and R.-S. Liu Evaluation of Early-Stage Parkinson's Disease with 99mTc-TRODAT-1 Imaging J. Nucl. Med., September 1, 2001; 42(9): 1303 - 1308. [Abstract] [Full Text] [PDF]

				R. Kruger, W. Kuhn, K.L. Leenders, R. Sprengelmeyer, T. Muller, D. Woitalla, A.T. Portman, R.P. Maguire, L. Veenma, U. Schroder, et al. Familial parkinsonism with synuclein pathology: Clinical and PET studies of A30P mutation carriers Neurology, May 22, 2001; 56(10): 1355 - 1362. [Abstract] [Full Text] [PDF]

				A multicenter assessment of dopamine transporter imaging with DOPASCAN/SPECT in parkinsonism Neurology, November 28, 2000; 55(10): 1540 - 1547. [Abstract] [Full Text] [PDF]

				K. Marek Dopaminergic Dysfunction in Parkinsonism: New Lessons from Imaging Neuroscientist, September 1, 1999; 5(5): 333 - 340. [Abstract] [PDF]

				V. S. Kostic, M. Svetel, N. Sternic, N. Dragasevic, and S. Przedborski Theophylline increases ""on"" time in advanced parkinsonian patients Neurology, June 1, 1999; 52(9): 1916 - 1916. [Full Text] [PDF]

				A. E. Lang and A. M. Lozano Parkinson's Disease- First of Two Parts N. Engl. J. Med., October 8, 1998; 339(15): 1044 - 1053. [Full Text] [PDF]