Optimizing Parkinson’s disease diagnosis: the role of a dual nuclear imaging algorithm

Abstract The diagnosis of Parkinson’s disease (PD) currently relies almost exclusively on the clinical judgment of an experienced neurologist, ideally a specialist in movement disorders. However, such clinical diagnosis is often incorrect in a large percentage of patients, particularly in the early...

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Autores principales:	J. William Langston, Jesse C. Wiley, Michele Tagliati
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2018
Materias:	Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/1b8e167263ed4d5483547bc741ca5407
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spelling	oai:doaj.org-article:1b8e167263ed4d5483547bc741ca54072021-12-02T15:10:33ZOptimizing Parkinson’s disease diagnosis: the role of a dual nuclear imaging algorithm10.1038/s41531-018-0041-92373-8057https://doaj.org/article/1b8e167263ed4d5483547bc741ca54072018-02-01T00:00:00Zhttps://doi.org/10.1038/s41531-018-0041-9https://doaj.org/toc/2373-8057Abstract The diagnosis of Parkinson’s disease (PD) currently relies almost exclusively on the clinical judgment of an experienced neurologist, ideally a specialist in movement disorders. However, such clinical diagnosis is often incorrect in a large percentage of patients, particularly in the early stages of the disease. A commercially available, objective and quantitative marker of nigrostriatal neurodegeneration was recently provided by 123-iodine 123I-ioflupane SPECT imaging, which is however unable to differentiate PD from a variety of other parkinsonian syndromes associated with striatal dopamine deficiency. There is evidence to support an algorithm utilizing a dual neuroimaging strategy combining 123I-ioflupane SPECT and the noradrenergic receptor ligand 123I-metaiodobenzylguanidine (MIBG), which assesses the post-ganglion peripheral autonomic nervous system. Evolving concepts regarding the synucleinopathy affecting the central and peripheral autonomic nervous systems as part of a multisystem disease are reviewed to sustain such strategy. Data are presented to show how MIBG deficits are a common feature of multisystem Lewy body disease and can be used as a unique feature to distinguish PD from atypical parkinsonisms. We propose that the combination of cardiac (MIBG) and cerebral 123I-ioflupane SPECT could satisfy one of the most significant unmet needs of current PD diagnosis and management, namely the early and accurate diagnosis of patients with typical Lewy body PD. Exemplary case scenarios will be described, highlighting how dual neuroimaging strategy can maximize diagnostic accuracy for patient care, clinical trials, pre-symptomatic PD screening, and special cases provided by specific genetic mutations associated with PD.J. William LangstonJesse C. WileyMichele TagliatiNature PortfolioarticleNeurology. Diseases of the nervous systemRC346-429ENnpj Parkinson's Disease, Vol 4, Iss 1, Pp 1-7 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurology. Diseases of the nervous system RC346-429 J. William Langston Jesse C. Wiley Michele Tagliati Optimizing Parkinson’s disease diagnosis: the role of a dual nuclear imaging algorithm
description	Abstract The diagnosis of Parkinson’s disease (PD) currently relies almost exclusively on the clinical judgment of an experienced neurologist, ideally a specialist in movement disorders. However, such clinical diagnosis is often incorrect in a large percentage of patients, particularly in the early stages of the disease. A commercially available, objective and quantitative marker of nigrostriatal neurodegeneration was recently provided by 123-iodine 123I-ioflupane SPECT imaging, which is however unable to differentiate PD from a variety of other parkinsonian syndromes associated with striatal dopamine deficiency. There is evidence to support an algorithm utilizing a dual neuroimaging strategy combining 123I-ioflupane SPECT and the noradrenergic receptor ligand 123I-metaiodobenzylguanidine (MIBG), which assesses the post-ganglion peripheral autonomic nervous system. Evolving concepts regarding the synucleinopathy affecting the central and peripheral autonomic nervous systems as part of a multisystem disease are reviewed to sustain such strategy. Data are presented to show how MIBG deficits are a common feature of multisystem Lewy body disease and can be used as a unique feature to distinguish PD from atypical parkinsonisms. We propose that the combination of cardiac (MIBG) and cerebral 123I-ioflupane SPECT could satisfy one of the most significant unmet needs of current PD diagnosis and management, namely the early and accurate diagnosis of patients with typical Lewy body PD. Exemplary case scenarios will be described, highlighting how dual neuroimaging strategy can maximize diagnostic accuracy for patient care, clinical trials, pre-symptomatic PD screening, and special cases provided by specific genetic mutations associated with PD.
format	article
author	J. William Langston Jesse C. Wiley Michele Tagliati
author_facet	J. William Langston Jesse C. Wiley Michele Tagliati
author_sort	J. William Langston
title	Optimizing Parkinson’s disease diagnosis: the role of a dual nuclear imaging algorithm
title_short	Optimizing Parkinson’s disease diagnosis: the role of a dual nuclear imaging algorithm
title_full	Optimizing Parkinson’s disease diagnosis: the role of a dual nuclear imaging algorithm
title_fullStr	Optimizing Parkinson’s disease diagnosis: the role of a dual nuclear imaging algorithm
title_full_unstemmed	Optimizing Parkinson’s disease diagnosis: the role of a dual nuclear imaging algorithm
title_sort	optimizing parkinson’s disease diagnosis: the role of a dual nuclear imaging algorithm
publisher	Nature Portfolio
publishDate	2018
url	https://doaj.org/article/1b8e167263ed4d5483547bc741ca5407
work_keys_str_mv	AT jwilliamlangston optimizingparkinsonsdiseasediagnosistheroleofadualnuclearimagingalgorithm AT jessecwiley optimizingparkinsonsdiseasediagnosistheroleofadualnuclearimagingalgorithm AT micheletagliati optimizingparkinsonsdiseasediagnosistheroleofadualnuclearimagingalgorithm
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Optimizing Parkinson’s disease diagnosis: the role of a dual nuclear imaging algorithm

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