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[ 18 F]-Flortaucipir PET/MRI Supports a 4R Tauopathy Phenotype in Corticobasal Degeneration
Michelle Chen1, Ana M Franceschi
1Department of Radiology, Neuroradiology Division, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
Abstract:
A 76-year-old woman presented with progressive left-sided motor incoordination, dystonia, and instability, clinically concerning for atypical parkinsonism. MRI showed Fazekas grade 1 chronic microvascular changes. ¹⁸F-FDG brain PET revealed asymmetric right cerebral hemisphere, sensorimotor cortex, and basal ganglia hypometabolism, suggestive of corticobasal degeneration. ¹⁸F-Florbetapir PET was negative. ¹⁸F-Flortaucipir PET demonstrated asymmetric right basal ganglia uptake, corresponding to hypometabolic regions and contralateral to left-sided symptoms. Although ¹⁸F-Flortaucipir demonstrates limited affinity for pure 4R tau and known off-target subcortical binding, the pronounced asymmetry in this Aβ-negative case of atypical parkinsonism supports a 4R tauopathy phenotype, illustrating potential utility beyond the current FDA-approved indication.
Insights
This study highlights how ¹⁸F-Flortaucipir PET scans can identify 4R tauopathy in atypical parkinsonism, even with known limitations. The findings suggest its potential use beyond current FDA-approved indications for diagnosing neurodegenerative diseases.
Area of Science:
- Neurology
- Nuclear Medicine
- Neuroimaging
Background:
- Atypical parkinsonism presents with complex motor symptoms, often challenging differential diagnosis.
- Distinguishing between different parkinsonian syndromes is crucial for appropriate management and prognosis.
- Corticobasal degeneration (CBD) is a progressive neurodegenerative disorder characterized by asymmetric motor deficits.
Purpose of the Study:
- To investigate the utility of ¹⁸F-Flortaucipir positron emission tomography (PET) in a patient with suspected corticobasal degeneration.
- To evaluate the correlation between tau PET findings and clinical presentation in atypical parkinsonism.
- To explore the potential of ¹⁸F-Flortaucipir PET in identifying 4R tauopathy phenotypes.
Main Methods:
- Case presentation of a 76-year-old woman with progressive left-sided motor incoordination, dystonia, and instability.
- Magnetic Resonance Imaging (MRI) to assess for chronic microvascular changes.
- ¹⁸F-Fluorodeoxyglucose (FDG) brain PET to evaluate regional glucose metabolism.
- ¹⁸F-Florbetapir PET to assess amyloid-beta (Aβ) burden.
- ¹⁸F-Flortaucipir PET to detect tau pathology.
Main Results:
- MRI revealed mild chronic microvascular changes (Fazekas grade 1).
- ¹⁸F-FDG PET showed asymmetric hypometabolism in the right cerebral hemisphere, sensorimotor cortex, and basal ganglia.
- ¹⁸F-Florbetapir PET was negative for amyloid plaques.
- ¹⁸F-Flortaucipir PET demonstrated asymmetric uptake in the right basal ganglia, contralateral to the patient's left-sided symptoms.
Conclusions:
- The asymmetric ¹⁸F-Flortaucipir uptake in an Aβ-negative patient with atypical parkinsonism supports a 4R tauopathy phenotype.
- Despite known limitations of ¹⁸F-Flortaucipir, its asymmetric pattern in this case suggests potential diagnostic utility for specific tauopathies.
- This case illustrates the potential value of ¹⁸F-Flortaucipir PET in characterizing neurodegenerative conditions beyond its current FDA-approved indications.
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