F-18 FP-CIT PET in Multiple System Atrophy of the Cerebellar Type: Additional Role in Treatment

We evaluated the difference in the status of dopamine transporters (DATs) depending on Parkinsonism, cerebellar, and autonomic features using F-18 FP-CIT positron emission tomography (PET) in multiple system atrophy with cerebellar ataxia (MSA-C). We also assessed whether the DAT PET could be useful in the management of MSA-C. Forty-nine patients who were clinically diagnosed as possible to probable MSA-C were included. Based on the F-18 FP-CIT PET results, patients were classified into normal (𝑛 = 25) and abnormal (𝑛 = 24) scan groups. There were statistically significant differences in rigidity, bradykinesia, postural instability, asymmetry, and specific uptake ratio (SUR) between the two groups but no significant differences in tremor and cerebellar/autonomic symptoms. Dopaminergic medications were administered to 22 patients. All seven patients with normal scans showed no change, while 10 of the 15 patients with abnormal scans showed clinical improvement. There was a trend of a negative correlation between levodopa equivalent dose and SUR, but it was not statistically significant. DAT imaging, such as F-18 FP-CIT PET, may be useful in predicting the response to dopaminergic medication regardless of cerebellar/autonomic symptoms in MSA-C. In addition to being used for the diagnosis of the disease, it may be used as a treatment decision index.