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We read with interest the article by Ribeiro et al.¹ Although the ¹⁸F-dopa positron emission tomographic (PET) scan is the current imaging gold standard for the diagnosis of early Parkinson disease (PD) and for measuring disease progression in clinical trials, the authors concluded that the ligand, ⁷⁶Br-FE-CBT, that binds to the dopamine transporter (DAT) may be more suitable for detecting cases of early PD and assessing disease progression than ¹⁸F-dopa. This is because ¹⁸F-dopa uptake depends not only on the density of dopaminergic terminals in the striatum but also on dopamine turnover, which may be compensatorily increased in early PD.^2-3 Thus, ¹⁸F-dopa uptake might overestimate the number of striatal dopaminergic nerve terminals in these patients.

In support of this theory, we recently described 2 patients who had typical early PD, both with unilateral rest tremor, bradykinesia, and rigidity. They had a positive response to dopamine agonists and underwent ¹⁸F-dopa PET . . . [Full Text of this Article]

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