18F-FDG PET Is an Early Predictor of Overall Survival in Suspected Atypical Parkinsonism

Early prognostic stratification is desirable in patients with suspected atypical parkinsonian syndromes (APSs) for optimal treatment and counseling. We investigated the prognostic value of imaging disease-specific metabolism patterns with 18F-FDG PET compared with that of clinical diagnosis. Methods: Seventy-eight patients with suspected APS at study inclusion underwent a follow-up of up to 5.9 y after prospective 18F-FDG PET imaging. Survival data were analyzed by Kaplan–Meier and Cox regression analyses according to diagnostic classifications provided by 18F-FDG PET at baseline and clinical diagnoses after a median follow-up of 1 y after PET. Results: Forty-four of 78 patients were alive 4.7 ± 0.6 y after PET. Patients diagnosed with an APS by PET or 1-y clinical follow-up showed a significantly shorter median survival time (4.1 y, age-adjusted hazard ratios [HRs] = 3.8 for both classifiers) than those diagnosed with Lewy-body diseases (LBDs; majority Parkinson disease [PD]; median survival time not reached). Subgroup classifications of progressive supranuclear palsy/corticobasal degeneration (PSP/CBD) or multiple-system atrophy (MSA) by PET and clinical follow-up were associated with significantly shorter survival than PD. Age-adjusted mortality was significantly increased for PSP/CBD (HR = 5.2) and MSA (HR = 5.6) classified by PET, but for PSP/CBD only when diagnosed by clinical follow-up (HR = 4.5). Patients with a PET pattern suggestive of PD with dementia/dementia with Lewy bodies (PDD/DLB) exhibited a trend toward shorter survival than those with PD (P = 0.07), whereas patients classified as PDD/DLB by clinical follow-up did not (P = 0.65). Conclusion: 18F-FDG PET is an early predictor of survival in patients with clinically suspected APS. Detection of cortical or subcortical hypometabolism by 18F-FDG PET is an unfavorable predictor. Risk stratification by 18F-FDG PET appears to be at least as predictive as the 1-y follow-up clinical diagnosis. This finding strongly supports the early inclusion of PET imaging in patient care.