title: Dual-tracer dopamine transporter and perfusion SPECT in differential diagnosis of parkinsonism using template-based discriminant analysis.
abstract: Clinical differential diagnosis in parkinsonism can be difficult especially at early stages. We investigated whether combined perfusion and dopamine transporter (DAT) imaging can aid in the differential diagnosis of parkinsonian disorders: idiopathic Parkinson's disease (IPD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), dementia with Lewy bodies (LBD), and essential tremor (ET).
  
  
  METHODS
  One hundred twenty-nine patients were studied, retrospectively (69 males; 24 MSA, 12 PSP, 8 LBD, 27 ET, and 58 IPD; mean disease duration, 3.5 +/- 3.7 y). Diagnosis was based on established clinical criteria after follow-up of 5.5 +/- 3.8 y in a university specialist movement disorders clinic. Group characterization was done using a categoric voxel-based design and, second, a predefined volume-of-interest approach along Brodmann areas (BA) and subcortical structures, including striatal asymmetry and anteroposterior indices. Stepwise forward discriminant analysis was performed with cross-validation (CV) using the leave-one-out technique.
  
  
  RESULTS
  Characteristic patterns for perfusion and DAT were found for all pathologies. In the parkinson-plus group, MSA, PSP, and LBD could be discriminated in 100% (+CV) of the cases. When including IPD, discrimination accuracy was 82.4% (99% without CV). 2beta-Carbomethoxy-3beta-(4-iodophenyl)nortropane imaging as a single technique was able to discriminate between ET and neurodegenerative forms with an accuracy of 93.0% (+CV); inclusion of perfusion information augmented this slightly to 97.4% (+CV).
  
  
  CONCLUSIONS
  Dual-tracer DAT and perfusion SPECT in combination with discrimination analysis allows an automated, accurate differentiation between the most common forms of parkinsonism in a clinically relevant setting.
authors.affiliation: Division of Nuclear Medicine, University Hospital Gasthuisberg and K.U. Leuven, Leuven, Belgium. koen.vanlaere@uz.kuleuven.ac.be
authors.forename: Koenraad
authors.initials: K
authors.lastname: Van Laere
authors.forename: Cindy
authors.initials: C
authors.lastname: Casteels
authors.forename: Liesbet
authors.initials: L
authors.lastname: De Ceuninck
authors.forename: Bert
authors.initials: B
authors.lastname: Vanbilloen
authors.forename: Alex
authors.initials: A
authors.lastname: Maes
authors.forename: Luc
authors.initials: L
authors.lastname: Mortelmans
authors.forename: Wim
authors.initials: W
authors.lastname: Vandenberghe
authors.forename: Alfons
authors.initials: A
authors.lastname: Verbruggen
authors.forename: René
authors.initials: R
authors.lastname: Dom
mesh_terms: D000465:Algorithms; D001921:Brain / Q000000981:diagnostic imaging* / Q000378:metabolism; D003545:Cysteine / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D003937:Diagnosis, Differential; D016002:Discriminant Analysis; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D015609:Organotechnetium Compounds / Q000493:pharmacokinetics; D010300:Parkinson Disease / Q000145:classification / Q000000981:diagnostic imaging* / Q000378:metabolism; D010363:Pattern Recognition, Automated / Q000379:methods; D010477:Perfusion; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014326:Tropanes / Q000493:pharmacokinetics
chemical_list: D050483:Dopamine Plasma Membrane Transport Proteins; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane; C059659:technetium Tc 99m bicisate; D003545:Cysteine