18F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

被引:164
作者
Meyer, Philipp T. [1 ]
Frings, Lars [1 ,2 ]
Ruecker, Gerta [3 ]
Hellwig, Sabine [4 ]
机构
[1] Univ Freiburg, Fac Med, Med Ctr, Dept Nucl Med, Freiburg, Germany
[2] Univ Freiburg, Fac Med, Med Ctr, Ctr Geriatr & Gerontol, Freiburg, Germany
[3] Univ Freiburg, Fac Med, Med Ctr, Inst Med Biometry & Stat, Freiburg, Germany
[4] Univ Freiburg, Fac Med, Med Ctr, Dept Psychiat, Freiburg, Germany
关键词
FDG PET; Parkinson disease; multiple-system atrophy; progressive supranuclear palsy; corticobasal degeneration; mild cognitive impairment; CEREBRAL GLUCOSE-METABOLISM; MULTIPLE SYSTEM ATROPHY; PROGRESSIVE SUPRANUCLEAR PALSY; DEEP BRAIN-STIMULATION; FDG-PET; NETWORK ACTIVITY; CORTICOBASAL DEGENERATION; CLINICAL-DIAGNOSIS; ALZHEIMERS-DISEASE; LEWY BODIES;
D O I
10.2967/jnumed.116.186403
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Accurate differential diagnosis of parkinsonism is of paramount therapeutic and prognostic importance. In addition, with the development of invasive therapies and novel disease-specific therapies, strategies for patient enrichment in trial populations are of growing importance. Imaging disease-specific patterns of regional glucose metabolism with PET and F-18-FDG allows for a highly accurate distinction between Parkinson disease (PD) and atypical parkinsonian syndromes, including multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration. On the basis of a preliminary metaanalysis of currently available studies with inclusion of multiple disease groups, we estimated that the diagnostic sensitivity and specificity for visual PET readings supported by voxel-based statistical analyses for diagnosis of atypical parkinsonian syndromes are 91.4% and 90.6%, respectively. The diagnostic specificity of F-18-FDG PET for diagnosing multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration was consistently shown to be high (> 90%), whereas sensitivity was more variable (> 75%). It is increasingly acknowledged that cognitive impairment represents a major challenge in PD, with mild cognitive impairment being a prodromal stage of PD with dementia (PDD). In line with clinical and neuropsychologic studies, recent PET studies demonstrated that posterior cortical dysfunction in nondemented PD patients precedes cognitive decline and the development of PDD by several years. Taken together, the current literature underscores the utility of F-18-FDG PET for diagnostic evaluation of parkinsonism and the promising role of F-18-FDG PET for assessment and risk stratification of cognitive impairment in PD.
引用
收藏
页码:1888 / 1898
页数:11
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