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Transcranial sonography and [ 18 F]fluorodeoxyglucose positron emission tomography for the differential diagnosis of parkinsonism: a head‐to‐head comparison
Author(s) -
Hellwig S.,
Reinhard M.,
Amtage F.,
Guschlbauer B.,
Buchert R.,
Tüscher O.,
Weiller C.,
Niesen W. D.,
Meyer P. T.
Publication year - 2014
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12394
Subject(s) - progressive supranuclear palsy , medicine , corticobasal degeneration , parkinsonism , positron emission tomography , nuclear medicine , differential diagnosis , atrophy , radiology , fluorodeoxyglucose , neuroradiology , pathology , neurology , disease , psychiatry
Background and purpose Brain imaging with positron emission tomography using [ 18 F]fluorodeoxyglucose ( FDG ‐ PET ) and transcranial B ‐mode sonography ( TCS ) improves the differential diagnosis of parkinsonism. The diagnostic merits of these approaches in identifying and differentiating atypical parkinsonian syndromes ( APS ) are compared. Methods Data were included from 36 patients with clinically suspected APS who underwent PET and TCS . FDG ‐ PET scans were analyzed by visual assessment (including voxel‐based statistical maps) of a priori defined disease‐specific metabolic patterns. Sonographers achieved diagnoses according to pre‐defined criteria for echogenicities of the substantia nigra and lenticular nucleus, and third ventricle diameter. Patients with APS were identified and allocated to the subgroups multiple system atrophy ( MSA ), progressive supranuclear palsy ( PSP ) or corticobasal degeneration ( CBD ). Results After a median follow‐up period of 9 months, the final clinical diagnoses (reference standard) were Parkinson's disease, n = 15; MSA , n = 9; PSP , n = 7; and CBD , n = 5 ( n = 21 APS in total). Six patients (4 APS ) showed an insufficient bone window for TCS . In the remaining 30 patients, sensitivity/specificity for diagnosing APS were 82%/100% and 82%/85% for FDG ‐ PET and TCS , respectively. Diagnostic accuracies did not differ between FDG ‐ PET (90%) and TCS (83%; P = 0.69). Likewise, overall accuracy of subgroup classification (non‐ APS , MSA , PSP and CBD ) did not differ between modalities ( FDG ‐ PET 87% and TCS 83%; P = 1.00). Conclusions FDG ‐ PET and TCS show comparable accuracies for differential diagnosis of neurodegenerative parkinsonism. This preliminary study supports the use of TCS and warrants further prospective validation.