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Year : 2015  |  Volume : 30  |  Issue : 2  |  Page : 185-186  

F-18 fluoro-d-glucose positron emission tomography/computed tomography in a patient with corticobasal degeneration


National Cancer Institute; IDIME, Medical Diagnosis Institute, Bogota, Colombia

Date of Web Publication11-Mar-2015

Correspondence Address:
Dr. Alejandro Marti
Calle 106A# 13A-40 Bogota
Colombia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.152991

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   Abstract 

Corticobasal degeneration is a rare neurodegenerative disorder that often eludes clinical diagnosis. The present case shows the F-18 fluoro-d-glucose positron emission tomography/computed tomography (PET/CT) of a 62-year-old man with a progressive movement disorder with asymmetric features. PET/CT examination showed a markedly right-brain hemispheric hypometabolism also involving basal ganglia.

Keywords: Corticobasal degeneration, fluoro-d-glucose, parkinsonian syndromes, positron emission tomography


How to cite this article:
Marti A. F-18 fluoro-d-glucose positron emission tomography/computed tomography in a patient with corticobasal degeneration. Indian J Nucl Med 2015;30:185-6

How to cite this URL:
Marti A. F-18 fluoro-d-glucose positron emission tomography/computed tomography in a patient with corticobasal degeneration. Indian J Nucl Med [serial online] 2015 [cited 2020 Jan 23];30:185-6. Available from: http://www.ijnm.in/text.asp?2015/30/2/185/152991

A 62-year-old man complaining of dystonia, akinesia and rigidity, ideomotor apraxia, alien limb phenomena with left-sided predominance, also impairments of speech, language and gait difficulty with little response to levodopa-carbidopa. He was referred for F-18 fluoro-d-glucose (FDG) positron emission tomography (PET) with a diagnosis of parkinsonian syndrome. The examination showed a markedly right-brain hemispheric hypometabolism also involving basal ganglia [Figure 1]. These types of abnormalities have been described and tend to be dominant in the contra-lateral hemisphere to the most affected body side in corticobasal degeneration. [1] The left-brain metabolism is also abnormal although a little less dramatic than right. Right basal ganglia and thalamus showed hypometabolism [Figure 2]. This is also a known feature of advanced corticobasal degeneration. [1] This disorder is thought to be caused by the deposition of abnormally phosphorylated tau protein in cortex and basal ganglia. [2] The characteristic pattern of hypometabolism in corticobasal degeneration is contra-lateral posterior frontal/anterior parietal hypometabolism, which involves the basal ganglia also. Depending on the extent of tau deposition this can be hemispheric as in this case. FDG PET is a powerful imaging tool for differentiating idiopathic Parkinson's disease from Parkinson plus syndromes. [2],[3],[4],[5] Severe hypometabolism in the left cerebellar hemisphere compared to the right (crossed cerebellar diaschisis) was also noticed [Figure 3]. This phenomenon is thought to be caused by interruption of cortico-ponto-cerebellar tract with secondary deafferentation and a transneural metabolic depression of the contra-lateral cerebellar hemisphere. [6] Differential diagnosis includes other Parkinson plus syndromes namely: Multiple system atrophy, progressive supranuclear palsy [7],[8] and  Creutzfeldt-Jakob disease More Details. [9]
Figure 1: Severe asymmetrical right hemisphere hypometabolism

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Figure 2: Right basal ganglia and thalamus showing severe hypoglycolisis

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Figure 3: Transaxial and coronal images showing severe hypometabolism in the left cerebellar hemisphere compared to the right (crossed cerebellar diaschisis)

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   References Top

1.
Eckert T, Barnes A, Dhawan V, Frucht S, Gordon MF, Feigin AS, et al. FDG PET in the differential diagnosis of parkinsonian disorders. Neuroimage 2005;26:912-21.  Back to cited text no. 1
    
2.
Tolosa E, Calandrella D, Gallardo M. Caribbean parkinsonism and other atypical parkinsonian disorders. Parkinsonism Relat Disord 2004;10 Suppl 1:S19-26.  Back to cited text no. 2
    
3.
Akdemir ÜÖ, Tokçaer AB, Karakuş A, Kapucu LÖ. Brain 18F-FDG PET imaging in the differential diagnosis of parkinsonism. Clin Nucl Med 2014;39:e220-6.  Back to cited text no. 3
    
4.
Hosaka K, Ishii K, Sakamoto S, Mori T, Sasaki M, Hirono N, et al. Voxel-based comparison of regional cerebral glucose metabolism between PSP and corticobasal degeneration. J Neurol Sci 2002;199:67-71.   Back to cited text no. 4
    
5.
Juh R, Kim J, Moon D, Choe B, Suh T. Different metabolic patterns analysis of parkinsonism on the 18F-FDG PET. Eur J Radiol 2004;51:223-33.  Back to cited text no. 5
    
6.
Agrawal KL, Mittal BR, Bhattacharya A, Khandelwal N, Prabhakar S. Crossed cerebellar diaschisis on F-18 FDG PET/CT. Indian J Nucl Med 2011;26:102-3.  Back to cited text no. 6
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7.
Kwon KY, Choi CG, Kim JS, Lee MC, Chung SJ. Comparison of brain MRI and 18F-FDG PET in the differential diagnosis of multiple system atrophy from Parkinson's disease. Mov Disord 2007;22:2352-8.  Back to cited text no. 7
    
8.
Mahapatra RK, Edwards MJ, Schott JM, Bhatia KP. Corticobasal degeneration. Lancet Neurol 2004;3:736-43.  Back to cited text no. 8
    
9.
Zhang Y, Minoshima S, Vesselle H, Lewis DH. A case of Creutzfeldt-Jakob disease mimicking corticobasal degeneration: FDG PET, SPECT, and MRI findings. Clin Nucl Med 2012;37:e173-5.  Back to cited text no. 9
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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