Utility of 18F FDG-PET in Parkinsonism in an African population

Ferzana Hassan Amod; Ahmed Iqbal Bhigjee; Nozipho Nyakale

doi:10.1016/j.ensci.2022.100399

Utility of 18F FDG-PET in Parkinsonism in an African population

eNeurologicalSci. 2022 Mar 31:27:100399. doi: 10.1016/j.ensci.2022.100399. eCollection 2022 Jun.

Authors

Ferzana Hassan Amod^{1

2}, Ahmed Iqbal Bhigjee^{1

2}, Nozipho Nyakale³

Affiliations

¹ Department of Neurology, Inkosi Albert Luthuli Central Hospital, Cato Manor, Durban, South Africa.
² Department of Neurology, University of KwaZulu-Natal, Durban, South Africa.
³ Department of Nuclear Medicine, Inkosi Albert Luthuli Central Hospital, Cato Manor, Durban, South Africa, Head of Nuclear Medicine Department, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.

Abstract

Parkinson's Disease remains a diagnostic challenge. Misdiagnosis during life is approximately 25%. Diseases that resemble PD clinically, such as the Parkinsonianplus disorders usually have a poorer prognosis. A diagnostic biomarker is needed to differentiate PD from PPS. Geographical differences in PD prevalence, genetics and environmental factors may suggest a different pathogenesis of PD in Africa which may affect metabolic changes seen on 18F-FDG-PET. We investigated the utility of 18FFDG-PET in differentiating PD from PPS in a real-life clinical setting. The study was conducted at the Movement Disorder Clinic, South Africa. 81 patients with Parkinsonism had fluorine-18-labelled-fluorodeoxyglucose-PET; 53 PD and 28 PPS. Six persons living with HIV and Parkinsonism were included. Of the 22 Black African patients, 21 had PD and only one had a PPS. Image-based diagnosis was made by visual interpretation aided by statistical parametric mapping (SPM) analysis by a Nuclear Medicine Physician blinded to the clinical diagnosis. This was compared to the final clinical diagnosis made by two Movement disorder Neurologists blinded to the 18F-FDG-PET diagnosis. Patients were followed up for a median of 4 years. 18F-FDGPET diagnosis was in agreement with final clinical diagnosis in 91% of all subjects (90% PD, 93% all PPS). Our paper reports the clinically realistic sample of patients seen with Parkinsonism in Africa. The present data shows that 18F-FDG-PET can distinguish PD from PPS with good accuracy. Few Black Africans present with an Atypical Parkinsonian syndrome. The pattern of metabolism in PLH-PD is similar to PD patients without HIV.

Keywords: 18F-FDG-PET; Africa; Corticobasal degeneration; Dementia with lewy bodies; Multiple system atrophy; Parkinson's disease; Parkinsonian plus syndromes; Progressive supranuclear palsy.