Differential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy

Abstract [18F]fluorodeoxyglucose (FDG) PET and [123I]metaiodobenzylguanidine (MIBG) scintigraphy may contribute to the differential diagnosis of neurodegenerative parkinsonism. To identify the superior method, we retrospectively evaluated 54 patients with suspected neurodegenerative parkinsonism, wh...

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Autores principales:	Joachim Brumberg, Nils Schröter, Ganna Blazhenets, Lars Frings, Jens Volkmann, Constantin Lapa, Wolfgang H. Jost, Ioannis U. Isaias, Philipp T. Meyer
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2020
Materias:	Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/76f2b64fc9244ade9b5595d1f9784421
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spelling	oai:doaj.org-article:76f2b64fc9244ade9b5595d1f97844212021-12-02T12:33:17ZDifferential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy10.1038/s41531-020-00141-y2373-8057https://doaj.org/article/76f2b64fc9244ade9b5595d1f97844212020-12-01T00:00:00Zhttps://doi.org/10.1038/s41531-020-00141-yhttps://doaj.org/toc/2373-8057Abstract [18F]fluorodeoxyglucose (FDG) PET and [123I]metaiodobenzylguanidine (MIBG) scintigraphy may contribute to the differential diagnosis of neurodegenerative parkinsonism. To identify the superior method, we retrospectively evaluated 54 patients with suspected neurodegenerative parkinsonism, who were referred for FDG PET and MIBG scintigraphy. Two investigators visually assessed FDG PET scans using an ordinal 6-step score for disease-specific patterns of Lewy body diseases (LBD) or atypical parkinsonism (APS) and assigned the latter to the subgroups multiple system atrophy (MSA), progressive supranuclear palsy (PSP), or corticobasal syndrome. Regions-of-interest analysis on anterior planar MIBG images served to calculate the heart-to-mediastinum ratio. Movement disorder specialists blinded to imaging results established clinical follow-up diagnosis by means of guideline-derived case vignettes. Clinical follow-up (1.7 ± 2.3 years) revealed the following diagnoses: n = 19 LBD (n = 17 Parkinson’s disease [PD], n = 1 PD dementia, and n = 1 dementia with Lewy bodies), n = 31 APS (n = 28 MSA, n = 3 PSP), n = 3 non-neurodegenerative parkinsonism; n = 1 patient could not be diagnosed and was excluded. Receiver operating characteristic analyses for discriminating LBD vs. non-LBD revealed a larger area under the curve for FDG PET than for MIBG scintigraphy at statistical trend level for consensus rating (0.82 vs. 0.69, p = 0.06; significant for investigator #1: 0.83 vs. 0.69, p = 0.04). The analysis of PD vs. MSA showed a similar difference (0.82 vs. 0.69, p = 0.11; rater #1: 0.83 vs. 0.69, p = 0.07). Albeit the notable differences in diagnostic performance did not attain statistical significance, the authors consider this finding clinically relevant and suggest that FDG PET, which also allows for subgrouping of APS, should be preferred.Joachim BrumbergNils SchröterGanna BlazhenetsLars FringsJens VolkmannConstantin LapaWolfgang H. JostIoannis U. IsaiasPhilipp T. MeyerNature PortfolioarticleNeurology. Diseases of the nervous systemRC346-429ENnpj Parkinson's Disease, Vol 6, Iss 1, Pp 1-7 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurology. Diseases of the nervous system RC346-429 Joachim Brumberg Nils Schröter Ganna Blazhenets Lars Frings Jens Volkmann Constantin Lapa Wolfgang H. Jost Ioannis U. Isaias Philipp T. Meyer Differential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy
description	Abstract [18F]fluorodeoxyglucose (FDG) PET and [123I]metaiodobenzylguanidine (MIBG) scintigraphy may contribute to the differential diagnosis of neurodegenerative parkinsonism. To identify the superior method, we retrospectively evaluated 54 patients with suspected neurodegenerative parkinsonism, who were referred for FDG PET and MIBG scintigraphy. Two investigators visually assessed FDG PET scans using an ordinal 6-step score for disease-specific patterns of Lewy body diseases (LBD) or atypical parkinsonism (APS) and assigned the latter to the subgroups multiple system atrophy (MSA), progressive supranuclear palsy (PSP), or corticobasal syndrome. Regions-of-interest analysis on anterior planar MIBG images served to calculate the heart-to-mediastinum ratio. Movement disorder specialists blinded to imaging results established clinical follow-up diagnosis by means of guideline-derived case vignettes. Clinical follow-up (1.7 ± 2.3 years) revealed the following diagnoses: n = 19 LBD (n = 17 Parkinson’s disease [PD], n = 1 PD dementia, and n = 1 dementia with Lewy bodies), n = 31 APS (n = 28 MSA, n = 3 PSP), n = 3 non-neurodegenerative parkinsonism; n = 1 patient could not be diagnosed and was excluded. Receiver operating characteristic analyses for discriminating LBD vs. non-LBD revealed a larger area under the curve for FDG PET than for MIBG scintigraphy at statistical trend level for consensus rating (0.82 vs. 0.69, p = 0.06; significant for investigator #1: 0.83 vs. 0.69, p = 0.04). The analysis of PD vs. MSA showed a similar difference (0.82 vs. 0.69, p = 0.11; rater #1: 0.83 vs. 0.69, p = 0.07). Albeit the notable differences in diagnostic performance did not attain statistical significance, the authors consider this finding clinically relevant and suggest that FDG PET, which also allows for subgrouping of APS, should be preferred.
format	article
author	Joachim Brumberg Nils Schröter Ganna Blazhenets Lars Frings Jens Volkmann Constantin Lapa Wolfgang H. Jost Ioannis U. Isaias Philipp T. Meyer
author_facet	Joachim Brumberg Nils Schröter Ganna Blazhenets Lars Frings Jens Volkmann Constantin Lapa Wolfgang H. Jost Ioannis U. Isaias Philipp T. Meyer
author_sort	Joachim Brumberg
title	Differential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy
title_short	Differential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy
title_full	Differential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy
title_fullStr	Differential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy
title_full_unstemmed	Differential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy
title_sort	differential diagnosis of parkinsonism: a head-to-head comparison of fdg pet and mibg scintigraphy
publisher	Nature Portfolio
publishDate	2020
url	https://doaj.org/article/76f2b64fc9244ade9b5595d1f9784421
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Differential diagnosis of parkinsonism: a head-to-head comparison of FDG PET and MIBG scintigraphy

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