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To the Editor:
Some years ago I was asked by an asymptomatic cotwin of a patient with PD whether an [18F]dopa PET scan could predict whether he would develop the illness. Vieregge et al.’s article1 is the second recent study examining the progress of asymptomatic twins identified as having abnormal, and putatively presymptomatic, scans. The editor and authors should be congratulated for publishing what is essentially a negative study; not one of seven asymptomatic cotwins with an abnormal scan has developed PD in 6 years. An important explanation is omitted from the discussion. [18F]dopa PET is a technique that has limited reproducibility, numerous potential technical errors, and in the identification of preclinical disease, is likely to produce false positives and false negatives.2 Without reproducibility data, the authors and readership cannot be confident of the reliability of identification of abnormal subjects. This suggests that the technique may have erroneously identified preclinical subjects. The recent similar follow-up study from this country3 does not give any greater confidence in the technique. In that study, 10 of 18 asymptomatic monozygotic (MZ) cotwins and 3 …
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