Positron Emission Tomography (PET) in Differentiating Manganism from Idiopathic Parkinsonism

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It is difficult to distinguish manganism and idiopathic parkinsonism from each other, especially in the settings where an isolated patient with parkinsonism has spent time in a manganese (Mn)-exposed working environment. We performed clinical examinations and laboratory studies including mangetic resonance imaging (MRI) and positron emission tomography (PET) in two Mn-exposed workers (cases 1 and 2) who had parkinsonian features. The clinical features of case 1 , however, were rather different from those of case 2, although both of them have some common parkinsonian features such as bradykinesia, tremor and rigidity. MRI in case 1 showed no abonormaities, but in case 2 showed symmetrical high signal intensities in the globus pallidus on a T1 weighted image. On PET findings, Ki values in the striatum were within the normal range in case 1, but reduced ^<18>F-6-fluorodopa uptake in the left putamen was seen in case 2. PET provides information of considerable value in discriminating between idiopathic parkinsonism and mangnism.
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