Objective: This study aimed to evaluate the diagnostic efficacy of DAT-FDG united PET imaging in differentiating PD from other parkinsonian disorders in real-world clinical settings and to determine the optimal sequential application of DAT-PET and FDG-PET in the diagnostic workup of PD.

Background: Parkinsonism is characterized by bradykinesia, rigidity, and resting tremor. Among the various disorders presenting with parkinsonism, Parkinson’s disease (PD) is the most prevalent recognized. Positron emission tomography (PET) imaging provides a crucial tool for the in vivo visualization of pathological and functional alterations in brains. The dopaminergic (DAT) PET imaging is currently a key diagnostic modality for PD, limited by its low specificity. The ¹⁸F-fluorodeoxyglucose (FDG) offer the potential for further differential diagnosis.

Method: 4,468 patients presenting with parkinsonism were retrospectively recruited from movement disorder clinic at Huashan Hospital, Fudan University, between January 2010 and August 2024. Following an initial pre-PET diagnosis at the outpatient clinic, all patients underwent DAT and FDG PET examination. A comprehensive final diagnosis was established after visual interpretation of the dual-tracer PET images and complete clinical assessment. Longitudinal follow-up (≥1 year) was available for 61.7% (n=2,755) of the patients.

Results:

 The cohort comprised 56.4% males (n=2,520) and 43.6% females (n=1,948), with a mean age of 61.0 years (±12.2). The DAT-FDG PET imaging demonstrated high diagnostic accuracy for PD, yielding a sensitivity of 95.1% and a specificity of 96.6%. Integration of dual-tracer PET findings into the standard diagnostic workup led to diagnostic revisions in 30% of patients. Decision-tree analysis indicated that performing DAT-PET followed by FDG-PET represented the most clinically efficient. A PD-like metabolic pattern significantly increased clinician-rated diagnostic confidence from 45% to 80% (p < 0.001) and resulted in more prescriptions of motor symptom medications.

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Conclusion:

  This large-scale real-world study highlights the substantial clinical utility of DAT-FDG united PET in enhancing diagnostic accuracy and optimizing therapeutic strategies for differentiating PD from other diseases, supporting its integration into routine clinical practice.​​​​​​​

Figure 1. Diagnosis changes

Figure 2. Decision-tree based analysis

Figure 3. Diagnostic performance

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-diagnostic-value-of-dopaminergic-glucose-united-pet-imaging-in-parkinsons-disease/