Clinical features, MRI, and 18F-FDG-PET in differential diagnosis of Parkinson disease from multiple system atrophy

Abstract

Objective: This study aimed to differentiate the variations in the clinical characteristics, MRI irregularity, and glucose metabolism on 18F-FDG-PET for the differential diagnosis of Parkinson's Disease (PD), MSA with predominant Parkinsonism (MSA-P), and MSA with predominant cerebellar features (MSA-C). Methods: Thirty PD patients, 22 MSA-P patients, and 28 MSA-C patients received an MRI and 20 PD patients, 11 MSA-P patients, and 13 MSA-C patients received 18F-FDG-PET. Results: Firstly, we found that the clinical data presented a tremor at rest, bradykinesia, and postural instability that was predominated in PD (100%), MSA-P (86.4%), and MSA-C (53.6%) patients, respectively. Then, we used MRI analyses and found that putamina atrophy and hyperintensive rim (T2WI) were characteristic features in MSA-P and cerebellar atrophy, the “hot cross bun” sign and signal rise in the middle cerebellar peduncle were more obvious in MSA-C. To further explore the distinctions among the 3 diseases, we also used 18F-FDG-PET technology for our examination and found a decrease in glucose metabolism in the parietal area for Parkinson's Disease (PD), in the bilateral putamen for MSA-P, and in the bilateral cerebellum for MSA-C. Conclusion: This study identified the distinctive features of the clinic symptoms, MRI irregularity, and glucose metabolism on 18F-FDG-PET, which provided a new basis for the differential diagnosis of Parkinson's Disease (PD), MSA with predominant Parkinsonism (MSA-P), and MSA with predominant cerebellar features (MSA-C).