A1 Refereed original research article in a scientific journal
Simple Ratio Analysis of F-18-Fluorodopa Uptake in Striatal Subregions Separates Patients with Early Parkinson Disease from Healthy Controls
Authors: Jokinen P, Helenius H, Rauhala E, Bruck A, Eskola O, Rinne JO
Publisher: SOC NUCLEAR MEDICINE INC
Publication year: 2009
Journal: Journal of Nuclear Medicine
Journal name in source: JOURNAL OF NUCLEAR MEDICINE
Journal acronym: J NUCL MED
Volume: 50
Issue: 6
First page : 893
Last page: 899
Number of pages: 7
ISSN: 0161-5505
DOI: https://doi.org/10.2967/jnumed.108.061572
Abstract
6-F-18-fluoro-L-dopa (F-18-FDOPA) is widely used to investigate dopaminergic hypofunction, for instance, in Parkinson disease PD). Conventionally, a 90-min scan with either a graphical or a metabolite-purified plasma input approach has been used for quantification. In the clinical setting, to increase compliance, especially in patients with more advanced disease, and to increase the efficacy of tracer and scanner time use, a shorter acquisition and a simple quantitative analysis are desirable. Taking into account the asymmetry of clinical symptoms and the uneven distribution of striatal dopaminergic hypofunction may also improve the use of F-18-FDOPA PET in early disease detection. Therefore, we compared subregional striatal F-18-FDOPA PET data from a large group of nonmedicated patients with early PD and a set of healthy elderly volunteers to find out whether a simple ratio approach would reliably separate PD patients from healthy controls. Methods: A total of 89 nonmedicated patients with early PD and 21 healthy volunteers were studied with F-18-FDOPA PET, and both a region-to-reference striatal-to-occipital) ratio SOR) calculated from 75 to 90 min after injection and a graphical analysis of data calculated from 15 to 90 min after F-18-FDOPA injection yielding the influx constant [K-i(ref)]) were used. Results: Both SOR and K-i(ref) values in the PD patients were lowest, relative to those in the healthy controls, in the posterior putamen contralateral to the side with predominant clinical symptoms. The contralateral posterior putamen showed the largest areas under the receiver operating characteristic ROC) curve-0.994 for SOR and 0.998 for K-i(ref)-indicating excellent separation of the PD and control groups. The caudate nucleus and the ventral striatum were less impressive in this respect. Conclusion: A single 15-min scan 75 min after tracer injection seems to be sufficient for separating patients with PD from healthy controls in a clinical research environment. This method represents a powerful and economical alternative for research on the disease mechanism and differential diagnosis.
6-F-18-fluoro-L-dopa (F-18-FDOPA) is widely used to investigate dopaminergic hypofunction, for instance, in Parkinson disease PD). Conventionally, a 90-min scan with either a graphical or a metabolite-purified plasma input approach has been used for quantification. In the clinical setting, to increase compliance, especially in patients with more advanced disease, and to increase the efficacy of tracer and scanner time use, a shorter acquisition and a simple quantitative analysis are desirable. Taking into account the asymmetry of clinical symptoms and the uneven distribution of striatal dopaminergic hypofunction may also improve the use of F-18-FDOPA PET in early disease detection. Therefore, we compared subregional striatal F-18-FDOPA PET data from a large group of nonmedicated patients with early PD and a set of healthy elderly volunteers to find out whether a simple ratio approach would reliably separate PD patients from healthy controls. Methods: A total of 89 nonmedicated patients with early PD and 21 healthy volunteers were studied with F-18-FDOPA PET, and both a region-to-reference striatal-to-occipital) ratio SOR) calculated from 75 to 90 min after injection and a graphical analysis of data calculated from 15 to 90 min after F-18-FDOPA injection yielding the influx constant [K-i(ref)]) were used. Results: Both SOR and K-i(ref) values in the PD patients were lowest, relative to those in the healthy controls, in the posterior putamen contralateral to the side with predominant clinical symptoms. The contralateral posterior putamen showed the largest areas under the receiver operating characteristic ROC) curve-0.994 for SOR and 0.998 for K-i(ref)-indicating excellent separation of the PD and control groups. The caudate nucleus and the ventral striatum were less impressive in this respect. Conclusion: A single 15-min scan 75 min after tracer injection seems to be sufficient for separating patients with PD from healthy controls in a clinical research environment. This method represents a powerful and economical alternative for research on the disease mechanism and differential diagnosis.
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