Diagnostic reliability of clinical symptoms in patients with incomplete manifestation of the triad of parkinsonism compared to 18F-DOPA PET-CT MRI imaging

PERALTA C; SOTO DEPETRIS T; PEREZ A; BIAFORE F; GILI JA; VALDA A; MENNA D; AGUILAR M; CORRADINI H; BASTIANELLO M

Berlin

Congreso; 20th International Congress of Parkinson's Disease and Movement; 2016

International Parkinson and Movement Disorder Society

Objective: To describe the diagnostic reliability of the triad of clinical symptoms compared to the uptake of 18 F-DOPA PET-CT fusion MRI scan. To compare the match between the visual and quantitative interpretation of the 18 F-DOPA uptake in putamen and caudate.Background: The differential diagnosis of Parkinson?s disease in cases of incomplete manifestation of the triad of bradykinesia (B), rigidity (R) and tremor (T) includes essential/dystonic tremor and parkinsonism unrelated to striatal dopaminergic deficiency.Methods: Patients who presented incomplete/atypical presentation of the clinical triad (2/2 or 3/3 and/or unresponsive to dopaminergic therapy) underwent 18F -DOPA PET-CT fusion MRI scan. Neurologists examined the patients and ranked the clinical suspicion, masked to the 18F-DOPA PET-CT results.Results: There were 14 patients, mean age= 62 ys old (41?79); male/female=9/5; mean symptoms duration=3.6 y (1?10), clinical triad: TR=3, TBR=9, BR=1, TB=1. Out of 14 patients with clinical suspicion of parkinsonism, 6 had dopaminergic deficit in 18F-DOPA PET-CT (42.86%). 2/2 clinical symptons were not associated with low putaminal uptake, as opposed to 3/3 symptoms in which 6/9 patients presented reduced putaminal uptake (67%). The correlation between low 18F-DOPA putaminal uptake and higher UPDRS scores was stronger than in caudate (p=0.05). Higher UPDRS scores were associated with reduced putaminal uptake in correlation coefficients (-0.63 (right), -0.73 (left)). There was no association in caudate (-0.27 (right) -0.50 (left)). In the visual analysis, 8 patients had low putaminal uptake and 7 were confirmed by the quantitative analysis, while 6 had normal uptake confirmed by quantitative analysis (13/14 correctly diagnosed).Conclusions: This exploratory analysis showed that 2/2 symptoms were not associated with a decrease in putaminal uptake, while 3/3 symptoms showed low putaminal uptake in 67% of cases. Higher UPDRS scores were more frequently associated with a decrease in putaminal uptake. Accuracy for detection of 18F-DOPA uptake was similar for visual and quantitative analysis.