THESES
Parkinson's disease: the role of dopamine transporter neuroimaging in clinically unclear cases (Abstract)
Doença de Parkinson: neuroimagem do transportador de dopamina em casos de dúvida diagnóstica (Resumo)
Andre Carvalho Felicio
Tese de doutorado, Universidade Federal de São Paulo UNIFESP (Área de concentração: Neurologia clínica)
Correspondence Correspondence: Andre Carvalho Felicio Rua Napoleão de Barros 865 04023-900, São Paulo SP - Brazil E-mail: cf.andre@gmail.com
ABSTRACT
INTRODUCTION: Misdiagnosis in Parkinson's disease (PD) can reach 25%. Recently, single-photon emission computer tomography (SPECT), using dopamine transporter (DAT) radioligands, has become useful to help diagnose clinically unclear cases of Parkinsonism (CUCP).
OBJECTIVES: Study 1 reported the rationale of molecular imaging in CUCP. Study 2 evaluated the role of DAT neuroimaging in CUCP. Study 3 studied a sub-group of CUCP with psychogenic Parkinsonism. Study 4 investigated the relationship between DAT and depression in PD.
METHODS: Brain SPECT imaging was undertaken using the DAT radiotracer [99mTc]-TRODAT-1 at baseline to determine pre-synaptic dopaminergic dysfunction. Patients were followed-up, and a final clinical diagnosis was made.
RESULTS: In study 1, convincing evidence showed that molecular imaging can reduce diagnostic uncertainty in PD. In study 2, disagreement rate between SPECT imaging versus golden standard clinical diagnosis reached 20%. Sensitivity and specificity (DAT scan) were, respectively, 100 and 70%. However, in study 3, two out of five subjects with psychogenic Parkinsonism had DAT densities under the cut-off suggesting a degenerative Parkinsonism. In study 4, DAT density was greater in PD patients with depression.
CONCLUSIONS: This thesis confirmed the useful role of molecular imaging in CUCP, and provided in vivo information about different underlying PD-related physiopathology mechanisms.
Key words: Parkinson's disease, photon emission computer tomography, dopamine transporter, depression.
Orientador: Professor Doutor Henrique Ballalai Ferraz.
Co-orientador: Professor Doutor Rodrigo Affonseca Bressan.
Support:Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).
Publication Dates
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Publication in this collection
15 May 2012 -
Date of issue
May 2012