|Year : 2021 | Volume
| Issue : 4 | Page : 468
Evaluation of multiple system atrophy subtypes with FDG-PET
Institute of Clinical Neurobiology, Vienna, Austria
|Date of Submission||20-Jan-2021|
|Date of Acceptance||20-Jan-2021|
|Date of Web Publication||09-Jul-2021|
Dr. Kurt Jellinger
Institute of Clinical Neurobiology Alberichgasse 5/13, A-1150 Vienna
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jellinger K. Evaluation of multiple system atrophy subtypes with FDG-PET. Ann Indian Acad Neurol 2021;24:468
Seniaray N, et al. Recently analysed the functional spectrum of multiple system atrophy (MSA) using 18F-FDG PET/CT and 99mTc TRODAT-1 SPECT in 67 patients with clinically diagnosed MSA (29 MSA-P, 25 MSA-C and 13 mixed subtypes). While dopamine transporter (DAT) imaging with TRODAT-1 SPECT cannot distinguish between MSA, PD, DLB and PSP and cannot differentiate MSA-P from PD and MSA-C, subtypes show characteristic patterns of FDG uptake on PET scan: MSA-P subjects showed diffuse hypometabolism in putamen-pallidum with relative sparing of the caudate nuclei, while in MSA-C patients hypometabolism was seen in cerebellum and brainstem. In mixed subtypes, variable hypometabolism in basal ganglia, cerebellum and brainstem was associated with that in fronto-parietal regions. Thus, FDG-PET may help in differentiating the subtypes of MSA in the presence of overlapping syndromes.
Targeting postsynaptic dopaminergic function using [123I] FP-CIT SPECT does not differentiate PD from MSA (both showing normal or increased signal), DAT imaging showed more prominent and earlier DAT loss in anterior caudate and ventral putamen in MSA, although normal DAT imaging does not exclude MSA. In autopsy-confirmed cases, a greater asymmetry of striatal binding was seen in MSA than in PD, but it is highly correlated with substantia nigra cell loss. 18F-DOPA-PET showed more widespread basal ganglia dysfunction in MSA than in PD without evidence of early compensatory increase in DOPA uptake. The above FDG-PET data confirm previous studies showing different patterns of decreased glucose metabolism between MSA-P and PD with a positive predictive value of 95%,, while MSA-related patterns of metabolic topographies discriminated between normal, MSA, PSP and PD, and correlate with standard ratings of clinical stages and motor symptoms in MSA. Moreover, they show further possibilities in differentiating the various subtypes of MSA. In conclusion, 18F-FDG PET provides a new basis for the differentiation of MSA-P and MSA-C, reflecting distinct clinical features of MSA. Future neuroimaging studies, such as Tau-PET will enlarge the diagnostic spectrum of MSA, its functional subtypes and its differentiation from other parkinsonian syndromes.
The author thanks Erich Mitter-Ferstl, PhD, for secretarial work.
| References|| |
Seniaray N, Verma R, Ranjan R, Belho E, Mahajan H. Comprehensive Functional Evaluation of the Spectrum of Multi-System Atrophy with 18F-FDG PET/CT and 99mTc TRODAT-1 SPECT: 5 Year’s Experience from a Tertiary Care Center. Ann Indian Acad Neurol 2021;24:490-4. [Full text]
Brooks DJ, Seppi K. Proposed neuroimaging criteria for the diagnosis of multiple system atrophy. Mov Disord 2009;24:949-64.
Nocker M, Seppi K, Donnemiller E, Virgolini I, Wenning GK, Poewe W, et al
. Progression of dopamine transporter decline in patients with the Parkinson variant of multiple system atrophy: A voxel-based analysis of [123I] beta-CIT SPECT. Eur J Nucl Med Mol Imaging 2012;39:1012-20.
McKinley J, O'Connell M, Farrell M, Lynch T. Normal dopamine transporter imaging does not exclude multiple system atrophy. Parkinsonism Relat Disord 2014;20:933-4.
Perju-Dumbrava LD, Kovacs GG, Pirker S, Jellinger K, Hoffmann M, Asenbaum S, et al
. Dopamine transporter imaging in autopsy-confirmed Parkinson's disease and multiple system atrophy. Mov Disord 2012;27:65-71.
Kraemmer J, Kovacs GG, Perju-Dumbrava L, Pirker S, Traub-Weidinger T, Pirker W. Correlation of striatal dopamine transporter imaging with post mortem substantia nigra cell counts. Mov Disord 2014;29:1767-73.
Levin J, Maass S, Schuberth M, Höglinger G. Multiple system atrophy. In: Falup-Pecurariu C, Ferreira J, Martinez-Martin P, Chaudhuri KR, editors. Movement Disorders Curricula. Wien: Springer; 2017. 183-92.
Tang CC, Eidelberg D. Abnormal metabolic brain networks in Parkinson's disease from blackboard to bedside. Prog Brain Res 2010;184:161-76.
Grimaldi S, Boucekine M, Witjas T, Fluchere F, Renaud M, Azulay JP, et al
. Multiple system atrophy: Phenotypic spectrum approach coupled with brain 18-FDG PET. Parkinsonism Relat Disord 2019;67:3-9.
Shen B, Wei S, Ge J, Peng S, Liu F, Li L, et al
. Reproducible metabolic topographies associated with multiple system atrophy: Network and regional analyses in Chinese and American patient cohorts. Neuroimage Clin 2020;28:102416.
Zhao P, Zhang B, Gao S, Li X. Clinical features, MRI, and 18F-FDG-PET in differential diagnosis of Parkinson disease from multiple system atrophy. Brain Behav 2020;10:e01827.
Lee R, Shin JH, Choi H, Kim HJ, Cheon GJ, Jeon B. Variability of FP-CIT PET patterns associated with clinical features of multiple system atrophy. Neurology 2021;online Feb 3: doi 10.1212/WNL.0000000000011634.