Sinisterra Solís Fabio Andrés, Romero Castellanos Francisco Rubén, Cortés Mancera Emilly Alejandra, Calderón Ávila Ana L, González Rueda Sofía Denisse, Rosales García Juan Salvador, Kerik Rotenberg Nora Estela, Tristán Samaniego Dioselina Panamá, Bonilla Navarrete Andrés Mauricio
PET/CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City 14269, Mexico.
Nuclear Medicine Department, National Cancer Institute, Mexico City 14080, Mexico.
Brain Sci. 2024 Sep 18;14(9):930. doi: 10.3390/brainsci14090930.
Parkinsonian syndromes are considered clinicopathological conditions that are challenging to diagnose. Molecular imaging with [18F]-FDOPA and [18F]-FDG contributes to a more accurate clinical diagnosis by evaluating presynaptic dopaminergic pathways and glucose metabolism, respectively. The aim of this study was to correlate diagnoses made from dual PET/CT with the initial clinical diagnoses, as well as during follow-ups in patients with Parkinsonian syndromes. A secondary objective was to describe the imaging findings. A total of 150 patients with a clinical diagnosis of neurodegenerative Parkinsonism were evaluated using dual PET/CT. Clinically, 82% were diagnosed with PD, while the remaining 18% had an atypical Parkinsonism. Using dual PET/CT, the most frequent diagnosis was PD in 67% of the patients, with the rest being diagnosed with an atypical Parkinsonism. In an agreement analysis between the initial clinical diagnosis and the imaging diagnosis by dual PET/CT, a concordance of 94.1% (n = 95) was observed for PD. In the remaining patients, the clinical diagnosis differed from that suggested by dual PET/CT, with atypical Parkinsonian syndromes being diagnosed as DLB in 40% (n = 4), PSP in 46.7% (n = 7), MSA-C in 75% (n = 6), MSA-P in 70% (n = 7), and CBD in 66.7% (n = 4). A total of 38.66% (n = 58) of patients were followed up (median follow-up of 27 months), with a Kappa coefficient of 0.591 ( < 0.001), suggesting substantial agreement. Dual FDOPA-FDG PET/CT demonstrated moderate agreement with the initial clinical diagnosis of Parkinsonism and moderate to substantial agreement during follow-up. This dual technique, therefore, stands out in differentiating between types of Parkinsonisms.
帕金森综合征被认为是具有诊断挑战性的临床病理状况。使用[18F]-FDOPA和[18F]-FDG进行分子成像，分别通过评估突触前多巴胺能通路和葡萄糖代谢，有助于更准确的临床诊断。本研究的目的是将双PET/CT做出的诊断与初始临床诊断以及帕金森综合征患者随访期间的诊断进行关联。第二个目标是描述影像学表现。共有150例临床诊断为神经退行性帕金森病的患者接受了双PET/CT评估。临床上，82%被诊断为帕金森病，其余18%患有非典型帕金森病。使用双PET/CT，最常见的诊断是67%的患者为帕金森病，其余患者被诊断为非典型帕金森病。在初始临床诊断与双PET/CT影像学诊断的一致性分析中，帕金森病的一致性为94.1%（n = 95）。在其余患者中，临床诊断与双PET/CT提示的诊断不同，40%（n = 4）的非典型帕金森综合征被诊断为路易体痴呆，46.7%（n = 7）为进行性核上性麻痹，75%（n = 6）为小脑型多系统萎缩，70%（n = 7）为纹状体黑质变性，66.7%（n = 4）为皮质基底节变性。共有38.66%（n = 58）的患者接受了随访（中位随访时间为27个月），kappa系数为0.591（<0.001），提示有实质性一致性。双FDOPA-FDG PET/CT与帕金森病的初始临床诊断显示出中度一致性，随访期间显示出中度至实质性一致性。因此，这种双重技术在区分帕金森病类型方面表现突出。
