Objective: To detect the difference of dopaminergic integrity between PDs and healthy controls (HC) using [18F]-FP-DTBZ PET in vivo and to obtain the diagnostic value of standardized uptake value ratios (SUVRs) using Receiver Operating Characteristic (ROC) curve.

Background: [18F]-FP-DTBZ has been proven as a biomarker for quantification the density of presynaptic vesicular monoamine transporter 2 (VMAT2).

Method: A total of 34 PD and 31 HC participants were enrolled in the PET/MR derivation cohort; while 89 PD and 18 HC participants were recruited in the PET/CT validation cohort. The Hoehn-Yahr Scale and the third part of the MDS-Unified Parkinson’s Disease Rating Scale (MDSUPDRS-III) were used to evaluate the disease staging and severity. All assessment and PET scanning were performed in drug-off states. We segmented the striatum of each side into five subregions as following: caudate, anterior dorsal putamen, anterior ventral putamen, posterior dorsal putamen, posterior ventral putamen using automatic pipeline built with the PMOD software (version 4.105). The SUVRs of the targeted subregions were calculated using bilateral occipital cortex as the reference region.

Results: ROC curve showed that the diagnostic value of contralateral posterior dorsal putamen (SUVR = 3.43) had the best diagnostic accuracy (AUC =0.973; P < 0.001), with a sensitivity of 97.1% (95%CI: 82.9-99.8%), specificity of 100% (95%CI:86.3-100%), positive predictive value of 100% (95%CI: 87.0-100%), negative predictive value of 96.9% (95%CI: 82.0-99.8%) and an accuracy of 98.5% for the diagnosis of PD. Blind validation was done using the PET/CT cohort, and participants with a SUVR of the posterior dorsal putamen less than 3.43 were defined as PD. Kappa test showed a consistency of 0.933 (P < 0.001) between clinical diagnostic and imaging diagnosis, with a sensitivity of 98.9%(95%CI:93.0-99.9%),specificity of 94.4%(95%CI:70.6-99.7%), positive predictive value of  98.9%(95%CI:93.0-99.9%), negative predictive value of 94.4%(95%CI:70.6-99.7%), and a diagnostic accuracy of 98.1%.

Conclusion: Our results showed the SUVR of 3.43 in the posterior dorsal putamen could effectively distinguish PD participants from HC.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnostic-value-of-striatal-18f-fp-dtbz-pet-in-parkinsons-disease/