Initial diagnostic workup of parkinsonism: Dopamine transporter positron emission tomography versus susceptibility map-weighted imaging at 3T

Evaluation of dorsal nigral hyperintensity on MRI can help detect nigrostriatal degeneration. We aimed to compare the diagnostic performance between susceptibility map-weighted imaging (SMWI) and N-3-fluoropropyl-2-β-carbomethoxy-3-β-(4-iodophenyl) nortropane (18F-FP-CIT) positron emission tomography (PET) as an initial diagnostic tool of parkinsonism. This local ethics committee-approved retrospective study enrolled 223 patients with parkinsonism and 15 healthy subjects (mean age, 69.7 years; 135 females) who underwent both SMWI at 3T and 18F-FP-CIT PET. The diagnostic performances of the two tests for nigrostriatal degeneration were compared by evaluating whether the 90% confidence interval (CI) of the difference between the two tests was within the equivalence margin by using the DTComPair package of R. The concordance rate was tested by Cohen's kappa. The diagnostic sensitivities of SMWI and 18F-FP-CIT PET were 94.5% and 100% per SN and 100% and 100% per participant, respectively; their specificities were 95.3% and 86.7% per SN and 94.4% and 84.0% per participant, respectively. While the diagnostic sensitivity was comparable between the two tests for each SN and participant, the lower 90% CI of the differences in the specificity were −0.086 per SN and −0.104 per participant, indicating a higher diagnostic specificity of SMWI than that of 18F-FP-CIT PET. When excluding 20 participants with basal ganglia lesions, the two tests exhibited similar diagnostic performance and had excellent agreement (k = 0.899 per SN; k = 0.945 per participant). For patients with parkinsonism, SMWI and 18F-FP-CIT PET exhibit similar diagnostic performance. •Diagnostic sensitivities are comparable between SMWI and 18F-FP-CIT PET.•SMWI and 18F-FP-CIT PET exhibit similar diagnostic performance for patients with parkinsonism.•SMWI is more specific than 18F-FP-CIT PET for striatal structural lesions.•SMWI can be used to predict normal presynaptic dopaminergic function.