Parkinsonism has heterogeneous nature, showing distinctive patterns of disease progression and prognosis. We aimed to find clusters of parkinsonism based on ¹⁸F‐fluoropropyl‐carbomethoxyiodophenylnortropane (FP‐CIT) PET as a data‐driven approach to evaluate heterogenous dopaminergic neurodegeneration patterns. Two different cohorts of patients who received FP‐CIT PET were collected. A labeled cohort (n = 94) included patients with parkinsonism who underwent a clinical follow‐up of at least 3 years (mean 59.0 ± 14.6 months). An unlabeled cohort (n = 813) included all FP‐CIT PET data of a single‐center. All PET data were clustered by a dimension reduction method followed by hierarchical clustering. Four distinct clusters were defined according to the imaging patterns. When the diagnosis of the labeled cohort of 94 patients was compared with the corresponding cluster, parkinsonism patients were mostly included in two clusters, cluster “0” and “2.” Specifically, patients with progressive supranuclear palsy were significantly more included in cluster 0. The two distinct clusters showed significantly different clinical features. Furthermore, even in PD patients, two clusters showed a trend of different clinical features. We found distinctive clusters of parkinsonism based on FP‐CIT PET‐derived heterogeneous neurodegeneration patterns, which were associated with different clinical features. Our results support a biological underpinning for the heterogeneity of neurodegeneration in parkinsonism.

中文翻译：

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多巴胺转运蛋白 PET 成像的无监督聚类发现帕金森病的异质性。

帕金森病具有异质性，表现出独特的疾病进展和预后模式。我们的目的是寻找基于¹⁸ F-氟丙基-碳甲氧基碘苯基去甲托烷 (FP-CIT) PET的帕金森症群，作为评估异质多巴胺能神经变性模式的数据驱动方法。收集了两个不同队列的接受 FP-CIT PET 的患者。一个标记队列 ( n = 94) 包括接受至少 3 年临床随访（平均 59.0 ± 14.6 个月）的帕金森综合征患者。一个未标记的队列 ( n= 813) 包括单中心的所有 FP-CIT PET 数据。通过降维方法对所有 PET 数据进行聚类，然后进行层次聚类。根据成像模式定义了四个不同的集群。当 94 名患者的标记队列的诊断与相应的集群进行比较时，帕金森病患者大多被包括在两个集群中，集群“0”和“2”。具体而言，进行性核上性麻痹的患者明显更多地包括在集群 0 中。这两个不同的集群显示出显着不同的临床特征。此外，即使在 PD 患者中，两个集群也显示出不同临床特征的趋势。我们发现了基于 FP-CIT PET 衍生的异质神经变性模式的独特的帕金森综合征簇，这些模式与不同的临床特征相关。