4.7 Article

Transcranial sonography and [18F] fluorodeoxyglucose positron emission tomography for the differential diagnosis of parkinsonism: a head-to-head comparison

期刊

EUROPEAN JOURNAL OF NEUROLOGY
卷 21, 期 6, 页码 860-866

出版社

WILEY-BLACKWELL
DOI: 10.1111/ene.12394

关键词

atypical parkinsonian syndrome; parkinsonism; positron emission tomography; transcranial sonography

资金

  1. GE Healthcare Buchler GmbH Co.
  2. Merz Pharmaceuticals GmbH
  3. UCB Pharma and Medtronic GmbH
  4. Ipsen Pharma and Actelion Pharmaceuticals
  5. University of Marburg
  6. AAN
  7. Fresenius Medical Care
  8. Medical Faculty, University of Freiburg

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Background and purposeBrain imaging with positron emission tomography using [F-18]fluorodeoxyglucose (FDG-PET) and transcranial B-mode sonography (TCS) improves the differential diagnosis of parkinsonism. The diagnostic merits of these approaches in identifying and differentiating atypical parkinsonian syndromes (APS) are compared. MethodsData were included from 36 patients with clinically suspected APS who underwent PET and TCS. FDG-PET scans were analyzed by visual assessment (including voxel-based statistical maps) of a priori defined disease-specific metabolic patterns. Sonographers achieved diagnoses according to pre-defined criteria for echogenicities of the substantia nigra and lenticular nucleus, and third ventricle diameter. Patients with APS were identified and allocated to the subgroups multiple system atrophy (MSA), progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD). ResultsAfter a median follow-up period of 9months, the final clinical diagnoses (reference standard) were Parkinson's disease, n=15; MSA, n=9; PSP, n=7; and CBD, n=5 (n=21 APS in total). Six patients (4 APS) showed an insufficient bone window for TCS. In the remaining 30 patients, sensitivity/specificity for diagnosing APS were 82%/100% and 82%/85% for FDG-PET and TCS, respectively. Diagnostic accuracies did not differ between FDG-PET (90%) and TCS (83%; P=0.69). Likewise, overall accuracy of subgroup classification (non-APS, MSA, PSP and CBD) did not differ between modalities (FDG-PET 87% and TCS 83%; P=1.00). ConclusionsFDG-PET and TCS show comparable accuracies for differential diagnosis of neurodegenerative parkinsonism. This preliminary study supports the use of TCS and warrants further prospective validation.

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