Amyloid PET/CT Brain There is no relevant literature to support the use of amyloid PET/CT in the initial imaging evaluation of a patient with Parkinsonian syndrome. FDG-PET/CT Brain Despite widespread use of FDG-PET/CT in clinical practice and extensive research, there is still very limited good- quality evidence for the use of FDG-PET/CT in Parkinsonian syndromes. FDG-PET is useful for discriminating PSP from idiopathic PD on the presence of a typical metabolic pattern for PSP, which is not present in PD. PSP is characterized by hypometabolism in the medial frontal and anterior cingulated cortices, striatum, and midbrain. FDG-PET may therefore be useful in early stages of the disease when the clinical diagnosis is less certain. In PD- related cognitive decline, FDG-PET have a typical pattern of hypometabolism mainly affecting the posterior cortical areas [31]. Ioflupane SPECT/CT Brain I-123 ioflupane SPECT/CT is a valuable test used to differentiate Parkinsonian syndromes (PD, MSA, PSP, CBD) from essential tremor and drug-induced tremor, demonstrating abnormality early in the disease course compared with anatomic imaging such as standard CT or MRI [32]. A normal I-123 ioflupane SPECT/CT essentially excludes Parkinsonian syndromes. I-123 ioflupane binds to the dopamine transporters and can be used to demonstrate the loss of presynaptic dopaminergic neurons in PD. It can demonstrate decreased radiotracer uptake in the striatum, usually in a posterior to anterior direction from the putamen to the caudate nuclei. I-123 ioflupane SPECT would demonstrate abnormal patterns of dopaminergic depletion for patients with PD, MSA, PSP, and CBD [33-39]. Note is made of a steady emergence of new nuclear medicine tracers, which are yet to be approved by the US FDA for clinical use, designed to target the postsynaptic dopamine receptors (D1 and D2), including 11C-raclopride-PET and I-123-iodobenzamide SPECT scans.
Movement Disorders and Neurodegenerative Diseases. Amyloid PET/CT Brain There is no relevant literature to support the use of amyloid PET/CT in the initial imaging evaluation of a patient with Parkinsonian syndrome. FDG-PET/CT Brain Despite widespread use of FDG-PET/CT in clinical practice and extensive research, there is still very limited good- quality evidence for the use of FDG-PET/CT in Parkinsonian syndromes. FDG-PET is useful for discriminating PSP from idiopathic PD on the presence of a typical metabolic pattern for PSP, which is not present in PD. PSP is characterized by hypometabolism in the medial frontal and anterior cingulated cortices, striatum, and midbrain. FDG-PET may therefore be useful in early stages of the disease when the clinical diagnosis is less certain. In PD- related cognitive decline, FDG-PET have a typical pattern of hypometabolism mainly affecting the posterior cortical areas [31]. Ioflupane SPECT/CT Brain I-123 ioflupane SPECT/CT is a valuable test used to differentiate Parkinsonian syndromes (PD, MSA, PSP, CBD) from essential tremor and drug-induced tremor, demonstrating abnormality early in the disease course compared with anatomic imaging such as standard CT or MRI [32]. A normal I-123 ioflupane SPECT/CT essentially excludes Parkinsonian syndromes. I-123 ioflupane binds to the dopamine transporters and can be used to demonstrate the loss of presynaptic dopaminergic neurons in PD. It can demonstrate decreased radiotracer uptake in the striatum, usually in a posterior to anterior direction from the putamen to the caudate nuclei. I-123 ioflupane SPECT would demonstrate abnormal patterns of dopaminergic depletion for patients with PD, MSA, PSP, and CBD [33-39]. Note is made of a steady emergence of new nuclear medicine tracers, which are yet to be approved by the US FDA for clinical use, designed to target the postsynaptic dopamine receptors (D1 and D2), including 11C-raclopride-PET and I-123-iodobenzamide SPECT scans.