Clinical features, MRI, and 18F‐FDG‐PET in differential diagnosis of Parkinson disease from multiple system atrophy

OBJECTIVE: This study aimed to differentiate the variations in the clinical characteristics, MRI irregularity, and glucose metabolism on (18)F‐FDG‐PET for the differential diagnosis of Parkinson's Disease (PD), MSA with predominant Parkinsonism (MSA‐P), and MSA with predominant cerebellar features (MSA‐C). METHODS: Thirty PD patients, 22 MSA‐P patients, and 28 MSA‐C patients received an MRI and 20 PD patients, 11 MSA‐P patients, and 13 MSA‐C patients received (18)F‐FDG‐PET. RESULTS: Firstly, we found that the clinical data presented a tremor at rest, bradykinesia, and postural instability that was predominated in PD (100%), MSA‐P (86.4%), and MSA‐C (53.6%) patients, respectively. Then, we used MRI analyses and found that putamina atrophy and hyperintensive rim (T(2)WI) were characteristic features in MSA‐P and cerebellar atrophy, the “hot cross bun” sign and signal rise in the middle cerebellar peduncle were more obvious in MSA‐C. To further explore the distinctions among the 3 diseases, we also used 18F‐FDG‐PET technology for our examination and found a decrease in glucose metabolism in the parietal area for Parkinson's Disease (PD), in the bilateral putamen for MSA‐P, and in the bilateral cerebellum for MSA‐C. CONCLUSION: This study identified the distinctive features of the clinic symptoms, MRI irregularity, and glucose metabolism on (18)F‐FDG‐PET, which provided a new basis for the differential diagnosis of Parkinson's Disease (PD), MSA with predominant Parkinsonism (MSA‐P), and MSA with predominant cerebellar features (MSA‐C).