DOI: 10.1007/s00259-018-4031-2Pages: 1534-1545

Clinical utility of FDG PET in Parkinson’s disease and atypical parkinsonism associated with dementia

1. University College London, Division of Psychiatry

2. Essex Partnership University NHS Foundation Trust, St Margaret’s Hospital

3. IRCCS S. Giovanni di Dio, Fatebenefratelli, Alzheimer Operative Unit

4. Geneva University, Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospitals of Geneva

5. Vita-Salute San Raffaele University, Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute

6. University of Navarra, Department of Nuclear Medicine, Clinica Universidad de Navarra

7. VU University Medical Center, Department of Neurology & Alzheimer Center, Amsterdam Neuroscience

8. University of Cologne and German Center for Neurodegenerative Diseases (DZNE), Department of Nuclear Medicine, University Hospital of Cologne

9. German Center for Neurodegenerative Diseases (DZNE)

10. University of Queensland and the Mater Hospital, Queensland Brain Institute

11. University of Geneva, LANVIE (Laboratoire de Neuroimagerie du Vieillissement), Department of Psychiatry

12. IRCCS S. Giovanni di Dio, Fatebenefratelli, LANE – Laboratory of Alzheimer’s Neuroimaging & Epidemiology

13. University of Brescia, Department of Molecular and Translational Medicine

14. University of Genoa & Clinical Neurology Polyclinic IRCCS San Martino-IST, Department of Neuroscience (DINOGMI)

Correspondence to:
Flavio Nobili
Tel: 0039.010.3537568
Email: flaviomariano.nobili@hsanmartino.it

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Abstract

Purpose

There are no comprehensive guidelines for the use of FDG PET in the following three clinical scenarios: (1) diagnostic work-up of patients with idiopathic Parkinson’s disease (PD) at risk of future cognitive decline, (2) discriminating idiopathic PD from progressive supranuclear palsy, and (3) identifying the underlying neuropathology in corticobasal syndrome.

Methods

We therefore performed three literature searches and evaluated the selected studies for quality of design, risk of bias, inconsistency, imprecision, indirectness and effect size. Critical outcomes were the sensitivity, specificity, accuracy, positive/negative predictive value, area under the receiving operating characteristic curve, and positive/negative likelihood ratio of FDG PET in detecting the target condition. Using the Delphi method, a panel of seven experts voted for or against the use of FDG PET based on published evidence and expert opinion.

Results

Of 91 studies selected from the three literature searches, only four included an adequate quantitative assessment of the performance of FDG PET. The majority of studies lacked robust methodology due to lack of critical outcomes, inadequate gold standard and no head-to-head comparison with an appropriate reference standard. The panel recommended the use of FDG PET for all three clinical scenarios based on nonquantitative evidence of clinical utility.

Conclusion

Despite widespread use of FDG PET in clinical practice and extensive research, there is still very limited good quality evidence for the use of FDG PET. However, in the opinion of the majority of the panellists, FDG PET is a clinically useful imaging biomarker for idiopathic PD and atypical parkinsonism associated with dementia.

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  • Accepted: Apr 16, 2018
  • Online: May 19, 2018

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