Session Information
Date: Tuesday, September 24, 2019
Session Title: Parkinsonisms and Parkinson-Plus
Session Time: 1:45pm-3:15pm
Location: Agora 3 West, Level 3
Objective: To evaluate utility of l-3,4-dihydroxy-6-[18F] fluoro-phenylalanine (18F-FDOPA) PET-CT imaging for cardiac sympathetic denervation in conjunction with nigrostriatal imaging in patients with early Parkinson disease (EPD) and Atypical parkinsonian syndromes (APS).
Background: Newer algorithm employing use of nigrostriatal and cardiac sympathetic imaging utilizing different radioligands with different imaging sessions is being proposed for accurate diagnosis of Parkinsonism.
Method: 18F-FDOPA PET-CT cardiac and brain scans were performed in patients with EPD (9 men and 6 women with mean age,57.3±9.91 years),APS (10 men and 5 women with mean age, 57.9 ± 6.44 years) and controls (age and sex matched) referred for indications other than PD (6 men and 9 women with mean age,52.2±7.07 years) with detailed clinical evaluation.Visual and semiquantitative analysis using SUVmax of cardiac and brain images was done. Global and regional myocardium to liver ratio (MLR) and myocardium to mediastinal ratio (MMR) were calculated for apex, septum, inferior, anterior and lateral wall in cardiac scans and regional striatal-to-occipital ratios (SORs) of caudate, anterior and posterior putamen were calculated in brain scans for each group of patients.
Results: The mean global MLR and MMR in patients with EPD (0.80±0.10, 1.40±1.20 respectively) were significantly reduced compared to controls (1.52± 0.17, 1.99±0.29, p<0.001) and patients with APS (1.16±0.28,1.75±0.29, p<0.05).Regional cardiac ratios corroborated global cardiac ratios with segmental pattern showing least uptake in lateral wall. SORs of patients with EPD revealed asymmetric pattern with least uptake in contralateral posterior putamen(1.25± 0.22) and highest in ipsilateral anterior caudate(2.58±0.65) following anteroposterior gradient and were significantly reduced compared to controls(p<0.001for all regional SORs).Patients with APS too showed reduced striatal uptake albeit in symmetrical pattern and significantly higher compared to patients with EPD in contralateral anterior putamen and bilateral posterior putamen(p<0.05).
Conclusion: 18F-FDOPA PET CT Imaging has potential utility to study cardiac sympathetic denervation in addition to nigrostriatal dopaminergic function simultaneously paving way for single tracer single session dual imaging in diagnostic algorithm of early PD and APS.
To cite this abstract in AMA style:
K C. Chudasama, VG. Goyal, C P. Patel, MV. Srivastava, MBS. Singh, MT. Tripathi, VY. Y, AR. Roy. Study of cardiac sympathetic denervation by 18F-FDOPA PET-CT Imaging in early Parkinson disease (EPD) and Atypical parkinsonian syndromes (APS) [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/study-of-cardiac-sympathetic-denervation-by-18f-fdopa-pet-ct-imaging-in-early-parkinson-disease-epd-and-atypical-parkinsonian-syndromes-aps/. Accessed June 24, 2025.« Back to 2019 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/study-of-cardiac-sympathetic-denervation-by-18f-fdopa-pet-ct-imaging-in-early-parkinson-disease-epd-and-atypical-parkinsonian-syndromes-aps/