J Nucl Med. 2008; 49 (Supplement 1):5P
Neurosciences: NeurologyMovement Disorders |
Differential diagnosis of parkinsonism with [F-18]DMFP PET
Klaus Tatsch1,
Björn Wängler1,
Kai Bötzel2,
Gabriele Pöpperl1,
Johannes Levin2 and
Peter Bartenstein1
1 Nuclear Medicine;
2 Neurology, Univ. of Munich, Munich, Germany
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Objectives: Postsynaptic D2 receptor imaging is a valuable tool for the differential diagnosis of parkinsonism. Widely used PET and SPECT ligands such as [C-11]raclopride and [I-123]IBZM, however, have several disadvantages. [F-18]desmethoxyfallypride (DMFP) is a promising alternative. Aim of this study was to assess the diagnostic performance of DMFP PET to distinguish between idiopathic (IPS) and atypical parkinsonism (non-IPS).
Methods: DMFP PET was performed in 45 pts with proven presynaptic deficit and clinically established diagnoses of IPS (n=18) and non-IPS (n=27). BRASS software (Hermes Medical Solutions) was used to automatically assess specific DMFP binding in striatal regions (S=striatum; C=caudate; Pa=anterior putamen; Pp=posterior putamen) using 3D VOI maps after stereotactic normalization. In addition, Pp/C and Pp/Pa ratios were calculated. ROC analyses were performed to evaluate the discrimination capacity of all parameters.
Results: Mean values of all parameters were significantly lower in non-IPS compared to IPS pts (p<0.0001). Results of the ROC analyses are summarized in the table below. The best performance was delivered by the posterior putamen.
Conclusions: DMFP PET allowed to distinguish between IPS and non-IPS with best sensitivity/specificity pairs of 89%/82% and 78%/96%, respectively. Thus, diagnostic performance was at least equal or even superior to the one known for the mostly used [C-11]- and [I-123]-labelled D2 ligands. Due to the advantages of [F-18]-labelling, DMFP PET may be considered an accurate or even preferable alternative for the differential diagnosis of parkinsonism.
