title: The utility of FDG-PET in the differential diagnosis of Parkinsonism.
abstract: BACKGROUND
  Differential diagnosis of parkinsonian disorders can be difficult on clinical grounds, especially in the early stage. Recent advancements in 18-F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging reveals different patterns of regional glucose metabolism in idiopathic Parkinson's disease (IPD) and atypical parkinsonian syndromes, such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS), which may help differentiating between these conditions.
  
  
  OBJECTIVE
  To assess the utility of FDG-PET imaging in differential diagnosis of Parkinsonism in clinical practice.
  
  
  METHODS
  FDG-PET was performed in 72 patients with parkinsonism (age 34-80 years) referred to our center by movement disorder specialists. FDG-PET diagnosis was obtained by visual assessment of individual scans combined with voxel-based statistical parametric mapping analysis. FDG-PET diagnosis assigned at the time of imaging was compared with the final clinical diagnosis made by the movement disorder specialists after ≥2 years follow-up.
  
  
  RESULTS
  FDG-PET findings were consistent with IPD in 27, MSA in 18, PSP in 19 and CBS in 2 patients. The final clinical diagnosis was IPD in 29, MSA in 20, PSP in 21 and CBS in 2 patients. Concordance between the FDG-PET and clinical diagnoses was 92% in the overall sample (IPD 93%, MSA 90%, PSP 91% and CBS 100%). The diagnostic accuracy of FDG-PET was 93% for IPD and MSA and 97% for PSP.
  
  
  CONCLUSIONS
  FDG-PET may help differentiate between IPD, MSA, PSP and CBS among patients presenting with parkinsonian symptoms, which is important for patient counselling and making early decisions about treatment.
authors.affiliation: a Center for Nuclear Medicine, Clinical Center of Serbia , Belgrade , Serbia.
authors.forename: Leposava
authors.initials: L
authors.lastname: Brajkovic
authors.affiliation: b Clinic for Neurology , Clinical Center of Serbia , Belgrade , Serbia.|c Faculty of Medicine , University of Belgrade , Belgrade , Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kostic
authors.affiliation: a Center for Nuclear Medicine, Clinical Center of Serbia , Belgrade , Serbia.|c Faculty of Medicine , University of Belgrade , Belgrade , Serbia.
authors.forename: Dragana
authors.initials: D
authors.lastname: Sobic-Saranovic
authors.affiliation: b Clinic for Neurology , Clinical Center of Serbia , Belgrade , Serbia.|c Faculty of Medicine , University of Belgrade , Belgrade , Serbia.
authors.forename: Elka
authors.initials: E
authors.lastname: Stefanova
authors.affiliation: b Clinic for Neurology , Clinical Center of Serbia , Belgrade , Serbia.
authors.forename: Milica
authors.initials: M
authors.lastname: Jecmenica-Lukic
authors.affiliation: a Center for Nuclear Medicine, Clinical Center of Serbia , Belgrade , Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Jesic
authors.affiliation: a Center for Nuclear Medicine, Clinical Center of Serbia , Belgrade , Serbia.
authors.forename: Milica
authors.initials: M
authors.lastname: Stojiljkovic
authors.affiliation: a Center for Nuclear Medicine, Clinical Center of Serbia , Belgrade , Serbia.|c Faculty of Medicine , University of Belgrade , Belgrade , Serbia.
authors.forename: Strahinja
authors.initials: S
authors.lastname: Odalovic
authors.affiliation: d Institute of Molecular Bioimaging and Physiology, National Research Council , Milan , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gallivanone
authors.affiliation: d Institute of Molecular Bioimaging and Physiology, National Research Council , Milan , Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Castiglioni
authors.affiliation: a Center for Nuclear Medicine, Clinical Center of Serbia , Belgrade , Serbia.|e Faculty of Medicine , University of Pristina , Kosovska Mitrovica , Serbia.
authors.forename: Branislava
authors.initials: B
authors.lastname: Radovic
authors.affiliation: a Center for Nuclear Medicine, Clinical Center of Serbia , Belgrade , Serbia.|f Faculty of Medicine , Institute for Medical Statistcis and Informatics, University of Belgrade , Belgrade , Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Trajkovic
authors.affiliation: a Center for Nuclear Medicine, Clinical Center of Serbia , Belgrade , Serbia.|c Faculty of Medicine , University of Belgrade , Belgrade , Serbia.
authors.forename: Vera
authors.initials: V
authors.lastname: Artiko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000000981:diagnostic imaging; D010300:Parkinson Disease / Q000000981:diagnostic imaging*; D020734:Parkinsonian Disorders / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D013494:Supranuclear Palsy, Progressive / Q000000981:diagnostic imaging
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG-PET; SPM analysis; differential diagnosis; neurodegenerative parkinsonism