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March 23, 2021; 96 (12) Article

Variability of FP-CIT PET Patterns Associated With Clinical Features of Multiple System Atrophy

Reeree Lee, Jung Hwan Shin, View ORCID ProfileHongyoon Choi, View ORCID ProfileHan-Joon Kim, View ORCID ProfileGi Jeong Cheon, Beomseok Jeon
First published February 3, 2021, DOI: https://doi.org/10.1212/WNL.0000000000011634
Reeree Lee
From the Department of Nuclear Medicine (R.R.), Chung-Ang University Hospital, and Departments of Neurology (J.H.S., H.-J.K., B.J.), and Nuclear Medicine (H.C., G.J.C.), Seoul National University Hospital, Korea.
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Jung Hwan Shin
From the Department of Nuclear Medicine (R.R.), Chung-Ang University Hospital, and Departments of Neurology (J.H.S., H.-J.K., B.J.), and Nuclear Medicine (H.C., G.J.C.), Seoul National University Hospital, Korea.
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Hongyoon Choi
From the Department of Nuclear Medicine (R.R.), Chung-Ang University Hospital, and Departments of Neurology (J.H.S., H.-J.K., B.J.), and Nuclear Medicine (H.C., G.J.C.), Seoul National University Hospital, Korea.
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  • ORCID record for Hongyoon Choi
Han-Joon Kim
From the Department of Nuclear Medicine (R.R.), Chung-Ang University Hospital, and Departments of Neurology (J.H.S., H.-J.K., B.J.), and Nuclear Medicine (H.C., G.J.C.), Seoul National University Hospital, Korea.
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Gi Jeong Cheon
From the Department of Nuclear Medicine (R.R.), Chung-Ang University Hospital, and Departments of Neurology (J.H.S., H.-J.K., B.J.), and Nuclear Medicine (H.C., G.J.C.), Seoul National University Hospital, Korea.
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Beomseok Jeon
From the Department of Nuclear Medicine (R.R.), Chung-Ang University Hospital, and Departments of Neurology (J.H.S., H.-J.K., B.J.), and Nuclear Medicine (H.C., G.J.C.), Seoul National University Hospital, Korea.
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Variability of FP-CIT PET Patterns Associated With Clinical Features of Multiple System Atrophy
Reeree Lee, Jung Hwan Shin, Hongyoon Choi, Han-Joon Kim, Gi Jeong Cheon, Beomseok Jeon
Neurology Mar 2021, 96 (12) e1663-e1671; DOI: 10.1212/WNL.0000000000011634

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Abstract

Objective To validate the role of the dopamine transporter (DAT) imaging as a biomarker in multiple system atrophy (MSA), we analyzed the association between spatial patterns of [18F]fluoro-propyl-carbomethoxy-iodophenyl-tropane ([18F]FP-CIT) PET and the clinical characteristics of MSA.

Methods Sixty-five patients with MSA who underwent [18F]FP-CIT PET between 2009 and 2018 were retrospectively enrolled. To identify spatial patterns of [18F]FP-CIT PET, principal component (PC) analysis was used and correlated with the clinical presentation.

Results Of the 65 patients, 42 presented with parkinsonian subtype of MSA, and 23 presented with cerebellar subtype of MSA (mean age 63.7 ± 9.3 years; disease duration, 1.8 ± 1.8 years). Each PC represents a specific pattern of degeneration: PC1 and PC2 were associated with the DAT binding of the entire putamen and the posterior putamen, respectively. PC3 was associated with increased [18F]FP-CIT uptake of the caudate and decreased uptake of the dorsal pons. PC2 was significantly correlated with the presence of parkinsonism (p = 5.34 × 10−5) and a positive levodopa response (p = 0.044), with age as a cofactor. PC3 was correlated with the presence of urinary incontinence (p = 0.036). Onset age was significantly correlated with both PC2 (R = 0.48, p = 5.0 × 10−5) and PC3 (R = −0.39, p = 0.0013).

Conclusions The spatial pattern of DAT binding can reflect distinct clinical features of MSA and provides insight into the underlying pathophysiology of a broad spectrum of clinical features in MSA.

Glossary

BR=
binding ratio;
DAT=
dopamine transporter;
DRPLA=
dentatorubral-pallidoluysian atrophy;
[18F]FP-CIT=
[18F]fluoro-propyl-carbomethoxy-iodophenyl-tropane;
MSA=
multiple system atrophy;
MSA-C=
cerebellar subtype of MSA;
MSA-P=
parkinsonian subtype of MSA;
PAG=
periaqueductal gray;
PC=
principal component;
SCA=
spinocerebellar ataxia

Footnotes

  • Go to Neurology.org/Nhttps://n.neurology.org/lookup/doi/10.1212/WNL.0000000000011634 for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵* These authors contributed equally to this work.

  • Received July 24, 2020.
  • Accepted in final form December 14, 2020.
  • © 2021 American Academy of Neurology
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