Diagnostic accuracy of 18F-FP-CIT PET for clinically uncertain Parkinsonian syndrome
Abstract 18F-FP-CIT is a high-resolution imaging marker of nigrostriatal neuronal integrity, differentiating Parkinsonism with loss of dopaminergic terminals (presynaptic Parkinsonian syndrome [PS]) from Parkinsonism without nigrostriatal degeneration (non-PS). We assessed the diagnostic accuracy of...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2023-09-01
|
| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-42135-9 |
| _version_ | 1797452629708636160 |
|---|---|
| author | Minyoung Oh Seung Jun Oh Sang Ju Lee Jungsu S. Oh Sun Ju Chung Jae Seung Kim |
| author_facet | Minyoung Oh Seung Jun Oh Sang Ju Lee Jungsu S. Oh Sun Ju Chung Jae Seung Kim |
| author_sort | Minyoung Oh |
| collection | DOAJ |
| description | Abstract 18F-FP-CIT is a high-resolution imaging marker of nigrostriatal neuronal integrity, differentiating Parkinsonism with loss of dopaminergic terminals (presynaptic Parkinsonian syndrome [PS]) from Parkinsonism without nigrostriatal degeneration (non-PS). We assessed the diagnostic accuracy of 18F-FP-CIT PET in patients with clinically uncertain PS (CUPS) at the first visit. Among the 272 patients who underwent 18F-FP-CIT PET imaging at the first visit between September 2008 and July 2012, 111 had CUPS (age, 62.6 ± 10.5 y; male:female, 45:66; symptom duration, 13.1 ± 8.8 months). Uncertainty criteria included only one of the three cardinal signs of Parkinsonism, two signs without bradykinesia, or atypical signs. The baseline clinical and 18F-FP-CIT PET imaging diagnostic accuracy was compared with the accuracy of clinical diagnosis after > 2-year follow-up. Nuclear medicine physicians assessed the 18F-FP-CIT PET images visually. Focal dopamine transporter binding deficit in the posterior putamen was considered PS. Bilateral symmetric striatum without focal deficit, suggesting normal 18F-FP-CIT PET, and focal deficits elsewhere in the striatum suggesting vascular Parkinsonism were considered non-PS. Seventy-nine patients had PS, and 32 did not. Baseline clinical diagnosis included PS in 45 patients, non-PS in 24, and inconclusive in 42. Among patients in whom initial clinical diagnosis (PS or non-PS) was possible, the sensitivity, specificity, and accuracy of the baseline clinical and 18F-FP-CIT PET imaging diagnoses were 54.4, 50.0, and 53.2%, and 98.7, 100, and 99.1%, respectively. The respective positive and negative predictive values were 95.6 and 66.7%, and 100 and 97.0%. Among those with initially inconclusive diagnosis, 64.2% were eventually diagnosed with PS while 35.7% were diagnosed with non-PS. The final clinical diagnosis of these patients all matched those made by 18F-FP-CIT PET imaging, except in one patient with scan without evidence of dopaminergic deficit (SWEDD). 18F-FP-CIT PET diagnosis was more accurate than clinical diagnosis, reducing the false-negative and inconclusive clinical diagnosis rates at baseline in patients with CUPS. |
| first_indexed | 2024-03-09T15:11:25Z |
| format | Article |
| id | doaj.art-13fbcc4f1aa04a3ca05a9cee3ee4dded |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-09T15:11:25Z |
| publishDate | 2023-09-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-13fbcc4f1aa04a3ca05a9cee3ee4dded2023-11-26T13:21:18ZengNature PortfolioScientific Reports2045-23222023-09-011311710.1038/s41598-023-42135-9Diagnostic accuracy of 18F-FP-CIT PET for clinically uncertain Parkinsonian syndromeMinyoung Oh0Seung Jun Oh1Sang Ju Lee2Jungsu S. Oh3Sun Ju Chung4Jae Seung Kim5Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Nuclear Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Nuclear Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Nuclear Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Neurology, Asan Medical Center, University of Ulsan College of MedicineDepartment of Nuclear Medicine, Asan Medical Center, University of Ulsan College of MedicineAbstract 18F-FP-CIT is a high-resolution imaging marker of nigrostriatal neuronal integrity, differentiating Parkinsonism with loss of dopaminergic terminals (presynaptic Parkinsonian syndrome [PS]) from Parkinsonism without nigrostriatal degeneration (non-PS). We assessed the diagnostic accuracy of 18F-FP-CIT PET in patients with clinically uncertain PS (CUPS) at the first visit. Among the 272 patients who underwent 18F-FP-CIT PET imaging at the first visit between September 2008 and July 2012, 111 had CUPS (age, 62.6 ± 10.5 y; male:female, 45:66; symptom duration, 13.1 ± 8.8 months). Uncertainty criteria included only one of the three cardinal signs of Parkinsonism, two signs without bradykinesia, or atypical signs. The baseline clinical and 18F-FP-CIT PET imaging diagnostic accuracy was compared with the accuracy of clinical diagnosis after > 2-year follow-up. Nuclear medicine physicians assessed the 18F-FP-CIT PET images visually. Focal dopamine transporter binding deficit in the posterior putamen was considered PS. Bilateral symmetric striatum without focal deficit, suggesting normal 18F-FP-CIT PET, and focal deficits elsewhere in the striatum suggesting vascular Parkinsonism were considered non-PS. Seventy-nine patients had PS, and 32 did not. Baseline clinical diagnosis included PS in 45 patients, non-PS in 24, and inconclusive in 42. Among patients in whom initial clinical diagnosis (PS or non-PS) was possible, the sensitivity, specificity, and accuracy of the baseline clinical and 18F-FP-CIT PET imaging diagnoses were 54.4, 50.0, and 53.2%, and 98.7, 100, and 99.1%, respectively. The respective positive and negative predictive values were 95.6 and 66.7%, and 100 and 97.0%. Among those with initially inconclusive diagnosis, 64.2% were eventually diagnosed with PS while 35.7% were diagnosed with non-PS. The final clinical diagnosis of these patients all matched those made by 18F-FP-CIT PET imaging, except in one patient with scan without evidence of dopaminergic deficit (SWEDD). 18F-FP-CIT PET diagnosis was more accurate than clinical diagnosis, reducing the false-negative and inconclusive clinical diagnosis rates at baseline in patients with CUPS.https://doi.org/10.1038/s41598-023-42135-9 |
| spellingShingle | Minyoung Oh Seung Jun Oh Sang Ju Lee Jungsu S. Oh Sun Ju Chung Jae Seung Kim Diagnostic accuracy of 18F-FP-CIT PET for clinically uncertain Parkinsonian syndrome Scientific Reports |
| title | Diagnostic accuracy of 18F-FP-CIT PET for clinically uncertain Parkinsonian syndrome |
| title_full | Diagnostic accuracy of 18F-FP-CIT PET for clinically uncertain Parkinsonian syndrome |
| title_fullStr | Diagnostic accuracy of 18F-FP-CIT PET for clinically uncertain Parkinsonian syndrome |
| title_full_unstemmed | Diagnostic accuracy of 18F-FP-CIT PET for clinically uncertain Parkinsonian syndrome |
| title_short | Diagnostic accuracy of 18F-FP-CIT PET for clinically uncertain Parkinsonian syndrome |
| title_sort | diagnostic accuracy of 18f fp cit pet for clinically uncertain parkinsonian syndrome |
| url | https://doi.org/10.1038/s41598-023-42135-9 |
| work_keys_str_mv | AT minyoungoh diagnosticaccuracyof18ffpcitpetforclinicallyuncertainparkinsoniansyndrome AT seungjunoh diagnosticaccuracyof18ffpcitpetforclinicallyuncertainparkinsoniansyndrome AT sangjulee diagnosticaccuracyof18ffpcitpetforclinicallyuncertainparkinsoniansyndrome AT jungsusoh diagnosticaccuracyof18ffpcitpetforclinicallyuncertainparkinsoniansyndrome AT sunjuchung diagnosticaccuracyof18ffpcitpetforclinicallyuncertainparkinsoniansyndrome AT jaeseungkim diagnosticaccuracyof18ffpcitpetforclinicallyuncertainparkinsoniansyndrome |