Interpretation of presynaptic dopaminergic PET imaging results / 中华核医学与分子影像杂志

Presynaptic dopaminergic PET imaging is a useful method for the diagnosis of parkinsonism. Based on the expert consensus on operation and clinical application of dopamine transporter brain PET imaging technology published in 2020, this paper further recommends the relevant elements of result interpretation of presynaptic dopaminergic PET imaging.

Establishment and clinical verification of brain template for analyzing 11C-CFT PET imaging data / 中华核医学与分子影像杂志

Objective:To establish standard spatial brain template and ROIs template of 11C-methyl- N-2β-carbomethoxy-3β-(4-fluorophenyl)tropane (CFT) PET images for automated quantitative analysis of dopamine transporter (DAT) distribution. Methods:From May 2014 to December 2015, 11C-CFT PET and MRI T 1 brain images of 16 healthy volunteers (3 males, 13 females; age (63.3±6.9) years) from Huashan Hospital, Fudan University were co-registered and smoothed using statistical parametric mapping(SPM)5 software based on MATLAB to create a standard spatial brain template. The ROIs template was established by ScAnVp procedures. These templates were clinically verified by using 11C-CFT PET images of 37 healthy volunteers (23 males, 14 females; age (61.7±7.1) years), 32 Parkinson′s disease (PD) patients (20 males, 12 females; age (61.1±5.4) years), 10 multiple system atrophy with predominant parkinsonism (MSA-P) patients (7 males, 3 females; age (60.8±7.1) years) and 10 progressive supranuclear palsy (PSP) patients (5 males, 5 females; age (58.4±6.1) years) from Huashan Hospital, Fudan University between January 2014 and March 2019. One-way analysis of variance was used to analyze data. Results:Based on the 11C-CFT PET images and MRI T 1 images of healthy volunteers, a standard spatial brain template for normalization of 11C-CFT PET images was created. The ROIs template was established including seven regions: bilateral caudate, anterior putamen, posterior putamen (along the long axis) and the occipital cortex. The ROIs template was accurately aligned in each verification group. The normal reference values of semi-quantitative DAT distribution in caudate, anterior putamen and posterior putamen were obtained (1.84±0.13, 2.18±0.16, 1.77±0.11). The semi-quantitative values of 11C-CFT uptake in each ROI in patients were significantly lower than those in healthy volunteers ( F values: 49.79-283.83, all P<0.05). Conclusion:The established brain templates with accurate spatial alignment for 11C-CFT image analysis can provide foundational tools for the application of 11C-CFT PET imaging in clinical practice and scientific research.

Application of combining 18F-FDG PET imaging and radiomics in the diagnosis of Parkinson′s disease and atypical parkinsonian syndromes / 中华核医学与分子影像杂志

Objective:To explore the potential application of combining 18F-FDG PET imaging and radiomics in the diagnosis of Parkinson′s disease (PD) and atypical parkinsonian syndromes (APS). Methods:A total of 154 subjects of two cohorts (training set and validation set) were enrolled from Huashan Hospital, Fudan University from March 2015 to August 2020 in this cross-sectional study, including 40 normal controls (NC; 23 males and 17 females, age: (60.2±10.5) years), 40 PD patients (20 males and 20 females, age: (64.7±6.3) years), 40 progressive supranuclear palsy (PSP) patients (20 males and 20 females, age: (64.1±5.9) years), and 34 multiple system atrophy (MSA) patients (19 males and 15 females, age: (65.0±9.2) years). 18F-FDG PET images and clinical scale were selected, and one-way analysis of variance was used to compare differences of clinical scale among groups. Radiomic features extraction and feature selection were carried out. Two and three classification models were constructed based on logistic regression, and the ROC curves of clinical model, radiomics model and combined model were calculated. Independent classification tests were conducted 100 times with 5-fold cross validation in two cohorts. Results:There were significant differences in the scores of unified PD Rating Scale (UPDRS) and Hoehn-Yahr rating scale (H&Y) among different groups in cohort 1 and cohort 2 respectively ( F values: 4.83-17.95, all P<0.05). A total of 2 444 imaging features were extracted from each subject, and after features selection, 15 features for classification were obtained. In the two classification experiment, the AUCs of the three models in binary classification of PD/MSA/PSP/NC group were 0.56-0.68, 0.74-0.93 and 0.72-0.93, respectively. The classification effects of the radiomics model were significantly better than those of the clinical model ( z values: 1.71-2.85, all P<0.05). In the three classification experiment, the sensitivity of the radiomics model reached 80%, 80% and 77% for PD, MSA and PSP, respectively. Conclusion:18F-FDG imaging combined with radiomics has potential in the diagnosis of PD and APS.

Quality control of the multi-centre clinical trial on PET/CT brain imaging / 中华核医学与分子影像杂志

Multi-centre clinical trials on PET/CT brain imaging are complex to organize and require careful co-ordination and management. This article describes considerations, which are necessary when designing and starting a multi-centre clinical trial on PET/CT brain imaging, based on guidelines and multi-center clinical brain imaging studies, providing references for further studies.

Characteristics of brain glucose metabolism in patients with anti- N-methyl- D-aspartate receptor encephalitis underlying different inducing factors / 中华核医学与分子影像杂志

Objective:To investigate characteristics and differences of cerebral glucose metabolism in patients with anti- N-methyl- D-aspartate receptor (NMDAR) encephalitis from the perspective of different trigger factors of antibodies. Methods:A total of 15 patients (8 males, 7 females, age (30.5±17.7) years) with anti-NMDAR encephalitis between January 2016 and January 2019 in Huashan Hospital, Fudan University were recruited retrospectively. All patients underwent resting state cerebral 18F-FDG PET imaging. The characteristics of brain glucose metabolism were analyzed, and the SUV ratio (SUVR) was semi-quantitatively compared with that in 12 healthy subjects (HS; 7 males, 5 females, age (51.5±9.6) years). Independent-sample t test was used to analyze the data. Results:Among 15 patients, 5 patients were viral encephalitis-related anti-NMDAR encephalitis, showing focal decreased metabolism in unilateral temporal lobe or basal ganglia (SUVR: patients: 0.659±0.219; HS: 1.754±0.203; t=-9.58, P<0.001), with increased metabolism in contralateral temporal lobe or basal ganglia (SUVR: patients: 2.275±0.244; HS: 1.960±0.227; t=2.55, P=0.022) in 18F-FDG PET imaging. Six patients were cryptogenic anti-NMDAR encephalitis, showing asymmetric increased metabolism in frontal, temporal, parietal and basal ganglia (SUVR: patients: 2.482±0.395; HS: 1.754±0.203; t=5.23, P<0.001), with decreased metabolism in bilateral occipital lobes. The remaining 4 cases were paraneoplastic origin accompanied by teratoma, showing increased metabolism in bilateral temporal and basal ganglia (SUVR: patient: 2.359±0.181; HS: 1.960±0.227; t=3.16, P=0.007), with mild decreased metabolism in bilateral occipital lobe. Conclusions:The abnormal changes of cerebral glucose metabolism in patients with anti-NMDAR encephalitis can be divided into at least three patterns according to different trigger factors. A comprehensive understanding of these characteristic metabolic changes is helpful for detecting disease, and may provide potential value in indicating different causes.

Characteristics of clinical and neuroimage findings in patients with corticobasal syndrome / 中华神经科杂志

Objective:To investigate the clinical, neuropsychological, and neuroimage characteristics in patients with corticobasal syndrome (CBS), and to elucidate the exact diagnosis of CBS patients.Methods:Twelve CBS cases admitted to the Department of Neurology, Huashan Hosiptal,Fudan University from April 2019 to July 2021 were retrospectively enrolled in this study. Those data, including clinical features (demographic data and clinical characteristics of cortical dysfunction and movement disorder), neuropsychological assessment [Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales score], brain magnetic resonance imaging (MRI) and multi-mode positron emission tomography (PET)/CT, were collected and carefully reviewed. Exact diagnosis of these patients was given according to the disease diagnosis criteria.Results:Cortical dysfunction and asymmetrical movement disorders were found in all cases, with poor response to levodopa. Patients suffered from cognitive impairment (MMSE score 16.16±9.82, MoCA score 13.44±7.35). The cranial MRI demonstrated significant asymmetric atrophy of frontal and parietal lobes, especially in the pre- and post-central gyrus. Fluorodeoxyglucose PET of 12 patients showed asymmetric frontal lobe and basal ganglia (especially caudate and putamen) hypometabolism (obviously on the contralateral side of the affected limb). Tau PET was implemented in 11 patients and displayed that abnormal tau protein deposition was positive in the cortex and/or subcortex in all patients. Of the 4 cases, who completed amyloid PET, amyloid protein deposition was positive in the cortex of 2 patients. As a result, 6 patients were diagnosed as progressive supranuclear palsy, 1 patient was diagnosed as corticobasal degeneration, and 5 patients were diagnosed as Alzheimer′s disease.Conclusions:The etiology of CBS is heterogeneous. The combination of clinical manifestation, cranial MRI and multi-mode PET/CT helps the differential diagnosis of CBS.

Effects of short-term deep brain stimulation in subthalamic nucleus on glucose metabolism in Parkinson's disease / 中华核医学与分子影像杂志

Objective To study the effect of short-term treatment of subthalamic nucleus ( STN ) deep brain stimulation (DBS) on cerebral glucose metabolism in patients with Parkinson's disease (PD) and its relationship with the change of brain motor-related nerve pathways. Methods Five patients ( 2 males, 3 females;age:(63.6±11.8) years) with PD who underwent STN DBS between January 2014 and December 2018 were enrolled in this study. All patients underwent 18F-fluorodeoxyglucose (FDG) PET in "DBS-off"state before and 3 months after operation. Quantitative expression of PD-related metabolic pattern (PDRP) were calculated by scaled subprofile model/principal component analysis ( SSM/PCA) on PET images. Brain regions with changes of glucose metabolism after DBS were located by statistical parametric mapping (SPM) paired t test. Results Compared with pre-operation, PDRP expression (5.1±1.3 vs 2.9±1.8) and unified Parkinson's disease rating scale (UPDRS) motor score (50.2±8.2 vs 28.0±5.4) of PD patients were significantly decreased 3 months after STN DBS (t values:6.17 and 3.88, both P<0.05). After DBS, the glucose metabolism of bilateral globus pallidus/putamen, caudate nucleus, thalamus, insula, pons and cer-ebellum decreased, while the glucose metabolism of bilateral prefrontal motor area and parietooccipital lobe increased ( t=3.75, P<0.01) . Conclusions Short-term STN DBS therapy can inhibit the cortico-striatum-pallidum-hypothalamus-cortex motor loop, which is abnormally excitable in the brain of PD. PDRP, as an imaging characterization of the regulation of this loop, is expected to become an imaging marker for monito-ring the treatment of PD.

Differential diagnosis value of single-case statistical parametric mapping analysis with 18F-FDG PET imaging for Parkinsonism / 中华核医学与分子影像杂志

Objective To investigate the value of statistical parametric mapping (SPM) analysis of 18F-fluorodeoxyglucose (FDG) PET imaging in the differential diagnosis of Parkinsonism in single-case level.Methods SPM software was used to retrospectively analyze the 18F-FDG PET images of 160 patients (104males,56 females,age:30-82 years) who were suspected with Parkinsonism at baseline and were clinical confirmed by follow-up from April 2010 to December 2017.18F-FDG PET images of patients was compared with those of age-matched healthy controls in single-case level using two-sample t test in SPM software to obtain the imaging diagnosis.By comparing imaging diagnosis with the final clinical diagnosis,the diagnostic accuracy of SPM in the overall cohort as well as the early subcohort (duration of disease less than 2 years (56 males,22 females,age:50-82 years)) were calculated respectively.Results Among 160 patients with Parkinsonism,146(91.2％) had the same 18F-FDG PET diagnosis as their final clinical diagnosis.The diagnostic sensitivity for Parkinson's disease (PD),multiple system atrophy (MSA),progressive supranuclear palsy (PSP) and cortical basal ganglia degeneration (CBD) were 93.5％ (86/92),92.3％ (24/26),84.0％(21/25) and 15/17,respectively.The specificity were 95.6％(65/68),95.5％(128/134),96.3％ (130/135) and 100％(143/143),respectively.In the early subcohort,the analysis also achieved similar differential diagnosis effectiveness(92.3％).Conclmion The single-case 18F-FDG PET imaging SPM analysis can be helpful in the early differential diagnosis of Parkinsonism effectively.

Effects of short-term deep brain stimulation in subthalamic nucleus on glucose metabolism in Parkinson′s disease / 中华核医学与分子影像杂志

Objective@#To study the effect of short-term treatment of subthalamic nucleus (STN) deep brain stimulation (DBS) on cerebral glucose metabolism in patients with Parkinson′s disease (PD) and its relationship with the change of brain motor-related nerve pathways.@*Methods@#Five patients (2 males, 3 females; age: (63.6±11.8) years) with PD who underwent STN DBS between January 2014 and December 2018 were enrolled in this study. All patients underwent 18F-fluorodeoxyglucose (FDG) PET in " DBS-off" state before and 3 months after operation. Quantitative expression of PD-related metabolic pattern (PDRP) were calculated by scaled subprofile model/principal component analysis (SSM/PCA) on PET images. Brain regions with changes of glucose metabolism after DBS were located by statistical parametric mapping (SPM) paired t test.@*Results@#Compared with pre-operation, PDRP expression (5.1±1.3 vs 2.9±1.8) and unified Parkinson′s disease rating scale (UPDRS) motor score (50.2±8.2 vs 28.0±5.4) of PD patients were significantly decreased 3 months after STN DBS (t values: 6.17 and 3.88, both P<0.05). After DBS, the glucose metabolism of bilateral globus pallidus/putamen, caudate nucleus, thalamus, insula, pons and cerebellum decreased, while the glucose metabolism of bilateral prefrontal motor area and parietooccipital lobe increased (t=3.75, P<0.01).@*Conclusions@#Short-term STN DBS therapy can inhibit the cortico-striatum-pallidum-hypothalamus-cortex motor loop, which is abnormally excitable in the brain of PD. PDRP, as an imaging characterization of the regulation of this loop, is expected to become an imaging marker for monitoring the treatment of PD.

Differential diagnosis value of single-case statistical parametric mapping analysis with 18F-FDG PET imaging for Parkinsonism / 中华核医学与分子影像杂志

Objective@#To investigate the value of statistical parametric mapping (SPM) analysis of 18F-fluorodeoxyglucose (FDG) PET imaging in the differential diagnosis of Parkinsonism in single-case level.@*Methods@#SPM software was used to retrospectively analyze the 18F-FDG PET images of 160 patients (104 males, 56 females, age: 30-82 years) who were suspected with Parkinsonism at baseline and were clinical confirmed by follow-up from April 2010 to December 2017. 18F-FDG PET images of patients was compared with those of age-matched healthy controls in single-case level using two-sample t test in SPM software to obtain the imaging diagnosis. By comparing imaging diagnosis with the final clinical diagnosis, the diagnostic accuracy of SPM in the overall cohort as well as the early subcohort (duration of disease less than 2 years (56 males, 22 females, age: 50-82 years)) were calculated respectively.@*Results@#Among 160 patients with Parkinsonism, 146(91.2%) had the same 18F-FDG PET diagnosis as their final clinical diagnosis. The diagnostic sensitivity for Parkinson′s disease (PD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and cortical basal ganglia degeneration (CBD) were 93.5%(86/92), 92.3%(24/26), 84.0%(21/25) and 15/17, respectively. The specificity were 95.6%(65/68), 95.5%(128/134), 96.3%(130/135) and 100%(143/143), respectively. In the early subcohort, the analysis also achieved similar differential diagnosis effectiveness(92.3%).@*Conclusion@#The single-case 18F-FDG PET imaging SPM analysis can be helpful in the early differential diagnosis of Parkinsonism effectively.

Characteristics of cerebral glucose metabolism in patients with corticobasal degeneration / 中华核医学与分子影像杂志

Objective To identify abnormal cerebral glucose metabolism characteristics in patients with corticobasal degeneration (CBD) using 18 F-fluorodeoxyglucose (FDG) PET imaging. Methods From January 2014 to January 2017, resting-state brain 18 F-FDG PET imaging was performed in 10 CBD patients (5 males, 5 females; average age: (63.4±6.2) years) and 20 age-matched healthy subjects (8 males, 12 female; average age: (63.6±6.2) years). Voxel-based statistical parametric mapping (SPM) was used to analyze images to obtain the CBD-related brain metabolic characteristics. The regional cerebral metabolic rate of glucose (rCMRglc) was compared between 2 groups by two-sample t test. Results Compared with healthy controls, CBD group demonstrated asymmetrically decreased glucose metabolism mainly in the cere-bral hemisphere opposite to the more clinically affected body side, including the superior, middle and inferi-or frontal gyrus, the precentral gyrus, the superior and inferior parietal lobule, the angular gyrus, the supra-marginal gyrus, the precuneus, the middle occipital gyrus, the middle and inferior temporal gyrus, Heschl gyrus, the fusiform gyrus, the insula and the thalamus. And relatively increased glucose metabolism was present in ipsilateral precentral and postcentral gyrus, hippocampus, insula and putamen, bilateral cerebel-lum, paracentral lobules and pontine. The rCMRglc in those regions was significantly different between CBD patients and healthy controls (t values: 4.236-9.044, all P<0.01). Conclusion The asymmetric cerebral glucose metabolism features in CBD based on 18 F-FDG PET imaging contribute to the differential diagnosis between CBD patients and healthy subjects.

Feasibility of domestic 18F-DOPA PET/CT scanning in the differential diagnosis of pancreatic lesions in children with hyperinsulinemic hypoglycemia / 中华儿科杂志

Objective@#To study the feasibility of 18F-fluoro-L-dihydroxyphenylalanine positron emission tomography/Computed tomography (18F-DOPA PET/CT) scanning in the localization and differential diagnosing of focal versus diffuse form of pancreas lesions in patients with hyperinsulinemic hypoglycemia (HH).@*Method@#Twenty-four patients were diagnosed with HH between January, 2016 and February, 2017 in the Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children′s Hospital of Fudan University using an integrated clinical and biochemical diagnostic protocol, domestic 18F-DOPA PET/CT imaging technique were applied after MRI and ultrasound failed to detect pancreas lesions. Pancreas 18F-DOPA standardized uptake values (SUV) were measured, and pancreas′ lesions were dually analyzed via visual method and pancreas percentage SUV method. Among these patients, 9 patients received surgical pancreatic lesion resections, the correlations among surgical outcomes, histopathological findings and 18F-DOPA PET/CT scan results were analyzed.@*Result@#Seven patients were detected with focal form of pancreas lesions, the mean peak of SUV was 4.7±1.7(2.6-7.1), and 17 patients were found to have diffuse form lesions after 18F-DOPA-PET/CT scanning. Among the 24 cases, 9 patients (7 showed focal and 2 showed diffuse 18F-DOPA PET/CT pancreatic uptake)were euglycemic without any medical support after surgery; the resected pancreatic tissue histopathological results were consistent with that of PET/CT imaging. Only one patient, who responded to medical treatment before surgery, had temporary hyperglycemia after operation.@*Conclusion@#Domestic 18F-DOPA PET/CT could successfully locate and differentiate the pancreatic lesions and thus improve the success of surgery.

Characteristics of cerebral glucose metabolism on 18F-FDG PET imaging in patients with Parkinson's disease / 中华核医学与分子影像杂志

Objective To validate the reproducibility of abnormal cerebral metabolic characteristics in PD patients from different medical centers using 18F-FDG PET imaging.Methods A total of 108 subjects who were referred for resting-state brain 18 F-FDG PET imaging were retrospectively reviewed.Thirtythree PD patients (15 males,18 females,age:38-79 years) and 33 age-matched healthy controls (15 males,18 females,age:40-77 years) underwent evaluation at Shanghai Huashan Hospital Affiliated to Fudan University.Seventeen PD patients (10 males,7 females,age:44-74 years) and 17 age-matched healthy controls (6 males,11 females,age:42-67 years) underwent evaluation at the First Affiliated Hospital of Sun Yat-sen University.SPM was used to investigate the cerebral metabolic characteristics of the patients with two-sample t test.Statistically significant voxels were obtained by using familywise error rate (FWE;P＜0.05).Two sets of PD patients with abnormal glucose metabolism of brain regions were obtained and the cerebral metabolic characteristics were compared.Results Regarding the PD patients from Shanghai Huashan Hospital,the features of cerebral glucose metabolism by SPM analysis were demonstrated as follows:increased metabolism was found in the region of pons,cerebellum,thalamus,putamen and pallidum,while decreased metabolism was displayed in the region of parietal lobe and occipital lobe.The increased regions referred to 8 110 voxels and decreased regions referred to 2 810 voxels (P＜0.05).The similar metabolic pattern was found in PD patients from the First Affiliated Hospital of Sun Yat-sen University.The increased metabolism was shown in the regions of pons,cerebellum,thalamus,putamen and pallidum,and referred to 15 573 voxels.The metabolism-decreased regions included parietal lobe,occipital lobe and frontal lobe,and referred to 3 945 voxels (P＜0.05).Conclusions 18F-FDG PET/CT imaging results demonstrate similar metabolic pattern in PD patients from different medical centers,in whom the metabolism-increased regions are found in the pons,cerebellum,thalamus and pallidum and decreased regions were demonstrated in the parietal lobe and occipital lobe.The reproducibility from 18F-FDG PET/CT imaging provides reliable evidence for the multi-center study in the differential diagnosis of PD.

The 2-[18F] fluoro-2-deoxy-D-glucose PET-CT manifestations of patients with anti-N-methyl-D-aspartate receptor encephalitis at different stages / 中华神经科杂志

Objective To demonstrate the manifestations on positron emission tomographycomputed tomography (PET-CT) at different stages in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.Methods PET-CT was performed in 10 patients with anti-NMDAR encephalitis at different clinical stages,and the images were analyzed to investigate the relation of metabolic patterns in the images with clinical presentations.Results Except for normal PET-CT images in 2 patients,images in 8 patients at early stage of the disease showed generally increased 2-[18F] fluoro-2-Deoxy-D-glucose(18F-FDG) uptake at frontal and temporal lobe,basal ganglion and cerebellum,indicating hyper-metabolism in these areas,while 2 of them also had mixture of hyper-and hypo-metabolism in parietal-occipital region.In longitudinal analysis of PET-CT images in these 8 cases,starting at basal ganglion,18 F-FDG uptake gradually decreased bilaterally,prominently at left dominant hemisphere and right cerebellum.Conclusions During the course of anti-NMDAR encephalitis,18F-FDG metabolism markedly increases at early stage and then gradually declines at late stage,at frontal,temporal,parietal and occipital lobes,basal ganglion and cerebellum,predominantly at left dominant hemisphere and right cerebellum.However,in relapsing anti-NMDAR encephalitis,18 F-FDG metabolism in brain does not show these characteristics.