The value of 18F-FDG PET in the diagnosis and differential diagnosis of Parkinson's disease and multiple system atrophy with parkinsonism-predominant
DU Xiao-xiao
DONG Wan-hui
LI Yi
SUN Zhi-hui
FAN Kang-li
ZHANG Ying
Abstract：Objective To investigate the value of 18F-FDG PET in the diagnosis and differential diagnosis of Parkinson's disease(PD)and multiple system atrophy with parkinsonism-predominant(MSA-P).Methods Total 96 patients with PD and 52 patients with MSA-P from The First Hospital of Jilin University from May 2019 to December 2022 were included,and 18F-FDG PET data were collected from all patients and 18F-FDG PET data was analyzed using CortexID Suite software.The diagnostic and differential diagnostic efficacy of PD and MSA-P of 18F-FDG PET was evaluated using the receiver operating characteristic(ROC)curve and area under the curve(AUC).The Z-scores of 26 brain regions were obtained,and the brain glucose metabolism patterns of patients with PD and MSA-P were finally obtained by comparing with the normal control database.The consistency between 18F-FDG PET and"gold standard"diagnosis was evaluated using the Kappa test.Results 1)Metabolic pattern:compared with the normal control database,the PD group showed significantly hypermetabolism in pons(t=2.851,P=0.005),cerebellum(t=2.295,P=0.024)and mesial temporal(t=5.850,P=0.000),and significantly hypometabolism in lateral occipital(t=-7.116,P=0.000),superior parietal(t=-13.466,P=0.000),inferior parietal(t=-21.838,P=0.000),precuneus(t=-7.121,P=0.000),sensorimotor(t=-6.931,P=0.000)and lateral prefrontal(t=-6.778,P=0.000);while the MSA-P group showed significant hypometabolism in pons(t=-8.364,P=0.000),cerebellum(t=-9.900,P=0.000),superior parietal(t=-4.830,P=0.000)and inferior parietal(t=-11.287,P=0.000),and hypermetabolism in the primary visual(t=5.579,P=0.000).2)Diagnosis and differential diagnosis:compared with the MSA-P group,the PD group had lower Z-score in sensorimotor(t=-0.646,P=0.008),precuneus(t=-4.516,P=0.000),superior parietal(t=-4.611,P=0.000),inferior parietal(t=-5.903,P=0.000),lateral occipital(t=-5.088,P=0.000)and primary visual(t=-3.218,P=0.002),while the Z-scores in mesial temporal(t=3.718,P=0.002),cerebellum(t=9.880,P=0.000)and pons(t=9.520,P=0.000)were higher.The ROC curve was drew for the differential diagnostic efficacy of 18F-FDG PET through the six brain regions with statistical difference and P=0.000 between the 2 groups,the result showed that the AUC of cerebellum(Z=3.595,P=0.000;Z=2.942,P=0.003;Z=2.942,P=0.003;Z=3.519,P=0.000),pons(Z=3.363,P=0.001;Z=3.237,P=0.000;Z=2.376,P=0.018;Z=3.012,P=0.003)and the combination of the six brain regions(Z=4.354,P=0.000;Z=4.242,P=0.000;Z=3.711,P=0.000;Z=4.233,P=0.000)were bigger than the AUC of precuneus,superior parietal,inferior parietal and lateral occipital;the AUC of the combination of the six brain regions was bigger than pons(Z=1.986,P=0.047).Kappa test indicated that the diagnosis of the 18F-FDG PET had good agreement with the diagnosis of the"gold standard"in the two diseases(κ=0.678,P=0.000,for all).Conclusions The characteristic brain glucose metabolism patterns of PD and MSA-P can be obtained by 18F-FDG PET.18F-FDG PET has good diagnostic and differential diagnostic efficacy for PD and MSA-P.
Keywords：Parkinson diseaseMultiple system atrophyPositron emission tomography computed tomographyDiagnosisdifferential
Publication Date：2024-12-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：9( 1047-1055 )