Objective:
To determine and compare the utility of Nigrosome 1 at 3T MRI and ¹⁸F-DOPA PET for the diagnosis of Parkinson´s disease.

Background:
Differential diagnosis of Parkinson´s disease (PD) is often challenging, with rate of approximately 30% of misdiagnosis especially at early stages. In the current study, we aimed to evaluate and compare whether visual analyses of nigrosome 1 (N1) imaging using susceptibility weighted imaging (SWI) 3T MRI in the substantia nigra and striatal 6-18F-fluoro-L-dopa (¹⁸F-FDOPA) are useful for the diagnosis of PD.

Method:
Twenty-eight patients with PD according to the UK Brain Bank Criteria and 31 patients with other non-PD diagnoses such as essential tremor underwent both 3T SWI MRI and ¹⁸F-DOPA PET imaging techniques. Two independent raters evaluated both imaging techniques twice in one month. N1 signals in the SN and striatal ¹⁸F-DOPA uptake were visually evaluated using a 4-point ordinal scale (normal, non-diagnostic, unilateral and bilateral diagnostic scans).

Results:
Absolute inter and intra-rater agreements for ¹⁸F-DOPA PET and SWI-MRI were 93.44% (kappa=0.891, p<0.001) and 54.11 % (kappa=0.310, p<0.001) respectively. 29/31 non-PD and 26/28 PD subjects were correctly diagnosed with ¹⁸F-DOPA PET. In addition 18/31 non-PD and 13/28 were correctly diagnosed with SWI-MRI with additional 9 subjects (5 PD and 4 non-PD) scored as non-diagnostic. The diagnostic sensitivity/specificity was 92.9 % and 93.5 % for ¹⁸F-DOPA PET and 53.6 % and 58.1 % for SWI-MRI respectively.

Conclusion:
Our findings demonstrate that visual analysis of ¹⁸F-DOPA PET shows higher diagnostic accuracy than detection of Nigrosome 1 MR imaging in the SN for the differential diagnosis of PD and other non-PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/visualization-of-nigrosome-1-at-3t-mri-and-18f-dopa-pet-for-the-diagnosis-of-parkinsons-disease/