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Horowitz T, Guedj E, Eusebio A, Fluchère F, Azulay JP, Delmont E, Grimaldi S. Molecular Imaging in CANVAS: A Contribution for Differential Diagnosis? Mov Disord Clin Pract 2024. [PMID: 38576115 DOI: 10.1002/mdc3.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/02/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Phenotypes of CANVAS are increasingly diversified, including bradykinesia and dysautonomia, so that its primary differential diagnoses are multiple system atrophy-cerebellar type (MSA-c), and spinocerebellar ataxia type 3 (SCA3). This case series aims to highlight key molecular imaging findings in CANVAS. CASES We report a case series of six patients with CANVAS who underwent nuclear medicine examinations in our center and 13 patients from the literature. These include 18F-FDG brain positron emission tomography (PET), single photon emission computed tomography (SPECT) of dopamine transporter (DaT) activity, and 123I-MIBG cardiac scintigraphy of noradrenergic transmission. CONCLUSIONS In CANVAS, 18F-FDG brain PET mainly shows cerebellar hypometabolism, with preserved brainstem and striatum metabolism, contrasting with SCA3 and MSA-c. Dopaminergic denervation on scintigraphy seems to be associated with clinical parkinsonism, ranging from normal to severely impaired DaT SPECT. Additionally, 123I-MIBG cardiac scintigraphy might show denervation in CANVAS, similar to SCA3, but not in most MSA-c patients.
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Affiliation(s)
- Tatiana Horowitz
- Nuclear Medicine Department, Aix Marseille Univ, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Marseille, France
| | - Eric Guedj
- Nuclear Medicine Department, Aix Marseille Univ, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Marseille, France
| | - Alexandre Eusebio
- Neurology and Movement Disorders Department, APHM, Timone University Hospital, Marseille, France
| | - Frédérique Fluchère
- Neurology and Movement Disorders Department, APHM, Timone University Hospital, Marseille, France
| | - Jean-Philippe Azulay
- Neurology and Movement Disorders Department, APHM, Timone University Hospital, Marseille, France
| | - Emilien Delmont
- Neurology Department, Reference Center for Neuromuscular Diseases and ALS, Public Assistance Hospitals of Marseille, Timone University Hospital, Marseille, France
| | - Stephan Grimaldi
- Neurology and Movement Disorders Department, APHM, Timone University Hospital, Marseille, France
- CRMBM, CEMEREM, CNRS, Aix Marseille Univ, Marseille, France
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Villain N, Béra G, Habert MO, Kas A, Aubert J, Jaubert O, Valabregue R, Fernandez-Vidal S, Corvol JC, Mangone G, Lehéricy S, Vidailhet M, Grabli D. Dopamine denervation in the functional territories of the striatum: a new MR and atlas-based 123I-FP-CIT SPECT quantification method. J Neural Transm (Vienna) 2021; 128:1841-1852. [PMID: 34704162 DOI: 10.1007/s00702-021-02434-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
Abstract
Current quantification methods of 123I-FP-CIT SPECT rely on anatomical parcellation of the striatum. We propose here to implement a new method based on MRI segmentation and functional atlas of the basal ganglia (MR-ATLAS) that could provide a reliable quantification within the sensorimotor, associative, and limbic territories of the striatum. Patients with Parkinson's disease (PD), idiopathic rapid eye movement sleep behavioral disorder (iRBD), and healthy controls underwent 123I-FP-CIT SPECT, MRI, motor, and cognitive assessments. SPECT data were corrected for partial volume effects and registered to a functional atlas of the striatum to allow quantification in every functional region of the striatum (nucleus accumbens, limbic, associative, and sensorimotor parts of the striatum). The MR-ATLAS quantification method is proved to be reliable in every territory of the striatum. In addition, good correlations were found between cognitive dysexecutive tests and the binding within the functional (limbic) territories of the striatum using the MR-ATLAS method, slightly better than correlations found using the anatomical quantification method. This new MR-ATLAS method provides a robust and useful tool for studying the dopaminergic system in PD, particularly with respect to cognitive functions. It may also be relevant to further unravel the relationship between dopaminergic denervation and cognitive or behavioral symptoms.
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Affiliation(s)
- Nicolas Villain
- Department of Neurology, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France. .,Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France.
| | - G Béra
- Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France.,Department of Nuclear Medicine, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - M-O Habert
- Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France.,Department of Nuclear Medicine, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, CNRS, INSERM, Paris, France
| | - A Kas
- Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France.,Department of Nuclear Medicine, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, CNRS, INSERM, Paris, France
| | - J Aubert
- Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France
| | - O Jaubert
- Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France
| | - R Valabregue
- Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France
| | - S Fernandez-Vidal
- Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France
| | - J-C Corvol
- Department of Neurology, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.,Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France
| | - G Mangone
- Department of Neurology, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.,Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France
| | - S Lehéricy
- Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France.,Department of Neuroradiology, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - M Vidailhet
- Department of Neurology, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.,Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France
| | - D Grabli
- Department of Neurology, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.,Institut du Cerveau, ICM, Sorbonne Université, INSERM U1127, CNRS 7225, Paris, France
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Perlaki G, Szekeres S, Orsi G, Papp L, Suha B, Nagy SA, Doczi T, Janszky J, Zambo K, Kovacs N. Validation of an automated morphological MRI-based (123)I-FP-CIT SPECT evaluation method. Parkinsonism Relat Disord 2016; 29:24-9. [PMID: 27290659 DOI: 10.1016/j.parkreldis.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/18/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Dopamine transporter imaging with (123)I-FP-CIT single photon emission computed tomography (SPECT) is helpful for the differential diagnosis between Parkinsonian syndrome (PS) and essential tremor (ET). Although visual assessment and time-consuming manual evaluation techniques are readily available, a fully objective and automated dopamine transporter quantification technique is always preferable, at least in research and follow-up investigations. Our aim was to develop a novel automated magnetic resonance imaging (MRI)-based evaluation technique of dopamine transporter SPECT images and to compare its diagnostic accuracy with those of the gold-standard visual grading and manual dopamine transporter binding quantification methods. METHODS (123)I-FP-CIT SPECT and MRI sessions were conducted in 33 patients with PS (15 men; mean age: 60.3 ± 9.7 years) and 15 patients with ET (8 men; mean age: 54.7 ± 16.3 years). Striatal dopamine transporter binding was visually classified by 2 independent experts as normal or abnormal grade I, II and III. Caudal and putaminal specific uptake ratios were calculated by both automated MRI-based and manual evaluation techniques. RESULTS We found almost perfect agreement (κ = 0.829) between the visual scores by the 2 observers. The automated method showed strong correlation with the visual and manual evaluation techniques and its diagnostic accuracy (sensitivity = 97.0%; specificity = 93.3%) was also comparable to these methods. The automatically determined uptake parameters showed negative correlation with the clinical severity of parkinsonism. Based on ordinal regression modelling, the automated MRI-based method could reliably determine the visual grading scores. CONCLUSION The novel MRI-based evaluation of (123)I-FP-CIT SPECT images is useful for the differentiation of PS from ET.
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Affiliation(s)
- Gabor Perlaki
- MTA-PTE Clinical Neuroscience MR Research Group, H-7623 Pecs, Hungary; Pecs Diagnostic Centre, H-7623 Pecs, Hungary
| | - Sarolta Szekeres
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Gergely Orsi
- MTA-PTE Clinical Neuroscience MR Research Group, H-7623 Pecs, Hungary; Pecs Diagnostic Centre, H-7623 Pecs, Hungary
| | - Laszlo Papp
- Mediso Medical Imaging Systems, H-1022 Budapest, Hungary
| | - Balazs Suha
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Szilvia Anett Nagy
- Pecs Diagnostic Centre, H-7623 Pecs, Hungary; MTA-PTE Neurobiology of Stress Research Group, H-7624 Pecs, Hungary
| | - Tamas Doczi
- MTA-PTE Clinical Neuroscience MR Research Group, H-7623 Pecs, Hungary; Pecs Diagnostic Centre, H-7623 Pecs, Hungary; Department of Neurosurgery, University of Pecs, H-7623 Pecs, Hungary
| | - Jozsef Janszky
- MTA-PTE Clinical Neuroscience MR Research Group, H-7623 Pecs, Hungary; Department of Neurology, University of Pecs, H-7623 Pecs, Hungary
| | - Katalin Zambo
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Norbert Kovacs
- MTA-PTE Clinical Neuroscience MR Research Group, H-7623 Pecs, Hungary; Department of Neurology, University of Pecs, H-7623 Pecs, Hungary.
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