Idiopathic Parkinson disease is a common neurodegenerative disorder for which misdiagnosis occurs in up to 30% of patients after initial assessment and in 10%–15% even after long-term follow-up. Vesicular monoamine transporter type 2 (VMAT2) imaging with PET allows assessment of the integrity of the presynaptic dopaminergic pathway. We investigated the management impact of VMAT2 imaging in patients with clinically uncertain Parkinsonian syndromes. Methods: Forty-seven patients with clinically uncertain Parkinsonian syndromes (mean age ± SD, 56.9 ± 14.9 y; age range, 21–80 y) were referred from movement disorder specialists. All participants underwent a 20-min PET acquisition 2 h after injection of 250 MBq of ¹⁸F-AV-133, and the resulting images were quantitatively assessed. Clinical impact was recorded as high, moderate, or low based on diagnosis and management questionnaires completed by the referring specialists before and after release of the PET results. Management impact was high if there was a change in diagnostic category, moderate if there was a change in medication, and low if there was no change. Results: VMAT2 PET changed the diagnosis in 11 (23%) and medication in 25 (53%) participants. Management impact was high in 23%, moderate in 38%, and low in 39% of the participants. High diagnostic confidence increased from 11% of patients to 80% after the release of the scan results. Conclusion: ¹⁸F-AV-133 had substantial management impact in patients with clinically uncertain Parkinsonian syndromes. VMAT2 imaging with ¹⁸F-AV133 might improve diagnosis, prognosis, and appropriate use of medication, translating into better patient outcomes.

特发性帕金森病是一种常见的神经退行性疾病，初次评估后，多达30％的患者会发生误诊，即使经过长期随访，也有10％–15％的患者会误诊。用PET进行的2型囊泡单胺转运蛋白（VMAT2）成像可评估突触前多巴胺能途径的完整性。我们调查了VMAT2影像对临床不确定的帕金森综合症患者的管理影响。方法：从运动障碍专家那里转诊了47例临床上不确定的帕金森综合症患者（平均年龄±SD，56.9±14.9 y；年龄范围21–80 y）。250 MBq注入¹⁸后2小时，所有参与者均进行了20分钟的PET采集F-AV-133，并对所得图像进行定量评估。在PET结果发布前后，根据推荐专家完成的诊断和管理调查表，临床影响被记录为高，中或低。如果诊断类别发生变化，则管理影响较高；如果药物发生变化，则管理影响较低；如果没有变化，则管理影响较低。结果： VMAT2 PET改变了11位患者（23％）的诊断，改变了25位患者（53％）的用药。管理层的影响高，参与者为23％，中度为38％，低者为39％。扫描结果发布后，较高的诊断信心从11％的患者增加到80％的患者。结论： ¹⁸F-AV-133对临床不确定的帕金森综合症患者具有重大的管理影响。使用¹⁸ F-AV133的VMAT2成像可能会改善诊断，预后和适当使用药物，从而改善患者的预后。