The value of putaminal diffusion imaging versus 18-fluorodeoxyglucose positron emission tomography for the differential diagnosis of the Parkinson variant of multiple system atrophy

Authors

  • Simon Baudrexel MD,

    Corresponding author
    1. Department of Neurology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
    2. Brain Imaging Center, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
    • Correspondence to: Dr. Simon Baudrexel, Department of Neurology and Brain Imaging Center, Goethe University Frankfurt am Main, Schleusenweg 2–16, D-60528 Frankfurt am Main, Germany; Simon.Baudrexel@kgu.de

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  • Carola Seifried MD,

    1. Department of Neurology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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  • Bianca Penndorf,

    1. Department of Neurology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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  • Johannes C. Klein MD,

    1. Department of Neurology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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  • Marcus Middendorp MD,

    1. Department of Nuclear Medicine, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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  • Helmuth Steinmetz MD,

    1. Department of Neurology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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  • Frank Grünwald MD,

    1. Department of Nuclear Medicine, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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  • Rüdiger Hilker MD

    1. Department of Neurology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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  • Relevant conflicts of interest/financial disclosures: S.B. has been supported by grants from the Bundesministerium for Bildung und Forschung. C.S. has received research funding from the Hugelschaffner-Stiftung. R.H. has received research funding from the Deutsche Parkinson Vereinigung (dPV), the Bundesministerium für Bildung und Forschung, and from the Goethe-University of Frankfurt. All other authors report no disclosures related to this article.

  • Full financial disclosures and author roles may be found in the online version of this article.

ABSTRACT

Differentiating the Parkinson variant of multiple system atrophy (MSA-P) from idiopathic Parkinson's disease (PD) and other forms of atypical parkinsonism can be difficult because symptoms overlap considerably. 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) is a powerful imaging technique that can assist in the diagnosis of MSA-P via detection of putaminal and cerebellar hypometabolism. Recent studies suggest that diffusion-weighted imaging (DWI) might be of similar diagnostic value, as it can detect microstructural damage in the putamen by means of an increased mean diffusivity (MD). The aim of this study was a direct comparison of DWI and FDG-PET by using both methods on the same subject cohort. To this end, combined DWI and FDG-PET were employed in patients with MSA-P (n = 11), PD (n = 13), progressive supranuclear palsy (n = 8), and in 6 control subjects. MD values and FDG uptake ratios were derived from volumetric parcellations of the putamen and subjected to further analysis of covariance (ANCOVA) and receiver operating characteristics analyses. MSA-P was found to be associated with an increased posterior putaminal MD (P < 0.001 in all subgroup comparisons) that correlated strongly with local reductions in FDG uptake (r = −0.85, P = 0.002). DWI discriminated patients with MSA-P from other subgroups nearly as accurately as FDG-PET (area under the curve = 0.89 vs 0.95, P = 0.27 [pooled data]). Our data suggest a close association between the amount of putaminal microstructural damage and a reduced energy metabolism in patients with MSA-P. The clinical use of DWI for the differential diagnosis of MSA-P is encouraged. © 2013 International Parkinson and Movement Disorder Society

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