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Dopamine transporter SPECT imaging in Parkinson's disease and atypical Parkinsonism: a study of 137 patients. Neurol Sci 2023; 44:1613-1623. [PMID: 36658411 DOI: 10.1007/s10072-023-06628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Differential diagnosis between Parkinson's disease (PD) and multiple system atrophy-parkinsonian type (MSA-P), corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP), collectively termed atypical Parkinsonism (AP), is challenging. Dopamine transporter density imaging with Ioflupane I123 (DaTscan) is a marker of presynaptic nigrostriatal dysfunction. The primary aim of this study was to investigate the utility of DaTscan in the differential diagnosis of MSA-P, CBD, and PSP. METHODS Patients examined at Eginition Hospital (2011-2021), with available DaTscan data and a diagnosis of probable AP, clinically established PD, as well as a neurological control (NC) group were included. Mean binding specific index (BSI), BSI of the most affected side, asymmetry index, laterality, and caudate/putamen ratio were recorded. Analyses were performed by Kruskal-Wallis and ANCOVA. RESULTS 137 patients were included (CBD: [Formula: see text]; MSA-P: [Formula: see text]; PSP: [Formula: see text]; PD: [Formula: see text]; NC: [Formula: see text]). There were significant differences when comparing CBS, PSP, and NC vs. all other groups combined. Pairwise between-group comparisons revealed significant differences between PSP and CBD (mean striatum BSI>1.95; sensitivity 74.1%; specificity 85.0%), CBD and MSA-P (mean striatum BSI>2.04; sensitivity 70.4%; specificity 86.7%), and CBD and PD (mean striatum BSI>2.11; sensitivity 66.7%; specificity 100.0%). There were no differences between PSP, MSA-P, and PD. PSP, MSA-P, and PD differed from NC subjects, with 100% specificity and high sensitivity. Differentiation of NC from CBD was suboptimal. DISCUSSION CBD patients exhibit relatively mild DaTscan abnormalities. DaTscan may assist in the differentiation of CBD from PSP. DaTscan does not differentiate among PD, MSA-P, and PSP.
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Massa J, Chahine LM. Revision of Diagnosis in Early Parkinsonism with Abnormal Dopamine Transporter Imaging. JOURNAL OF PARKINSONS DISEASE 2020; 9:327-334. [PMID: 30958313 DOI: 10.3233/jpd-181517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND In patients with early parkinsonism, misdiagnosis may occur in >30% of cases. This can have detrimental consequences clinically and in clinical trials. Dopamine transporter (DAT) SPECT imaging can help improve diagnostic accuracy. OBJECTIVE To describe characteristics of individuals initially diagnosed with idiopathic Parkinson's disease (iPD) and with abnormal DAT SPECT imaging who had a change in diagnosis on follow-up. METHODS Data were obtained from the biomarker study Parkinson's Progression Markers Initiative (PPMI). PPMI is a multicenter, observational study that enrolled 423 individuals with a diagnosis of iPD of ≤2 years duration and with abnormal DAT SPECT imaging. Participants were assessed at least annually, and diagnosis was documented by the site neurologist. Characteristics of those that had a change in diagnosis were compared to those with stable diagnosis. RESULTS 390 subjects were included. Eight (2%) had a change in diagnosis. The diagnosis was changed to multiple system atrophy in 5 cases, dementia with Lewy bodies in 2, and corticobasal degeneration in 1. Revision of diagnosis occurred 2-5.2 years from enrollment. Mean motor score was higher (26.9 vs 20.6; p = 0.01), DAT binding lower (1.056 vs 1.406; p = 0.01), genetic risk score lower (-0.016 vs -0.022; p = 0.0470), and olfaction score higher (28.75 vs 22.05; p = 0.03) in those whose diagnosis changed compared to those who did not. CONCLUSION Diagnosis remained stable in most individuals with early parkinsonism diagnosed with iPD and with abnormal DAT imaging. A small number had a revision in diagnosis. Clinical and biomarker abnormalities were greater at baseline in those whose diagnosis changed.
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Affiliation(s)
- Jason Massa
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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Matsusue E, Fujihara Y, Tanaka K, Aozasa Y, Shimoda M, Nakayasu H, Nakamura K, Ogawa T. The utility of the combined use of 123I-FP-CIT SPECT and neuromelanin MRI in differentiating Parkinson's disease from other parkinsonian syndromes. Acta Radiol 2019; 60:230-238. [PMID: 29804474 DOI: 10.1177/0284185118778871] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuromelanin magnetic resonance imaging (NmMRI) and 123I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) provide specific information that distinguishes Parkinson's disease (PD) from non-degenerative parkinsonian syndrome (NDPS). PURPOSE To determine whether a multiparametric scoring system (MSS) could improve accuracy compared to each parameter of DAT-SPECT and NmMRI in differentiating PD from NDPS. MATERIAL AND METHODS A total of 49 patients, including 14 with NDPS, 30 with PD, and five with atypical parkinsonian disorder (APD) underwent both NmMRI and DAT-SPECT and were evaluated. The average (Ave) and the asymmetry index (AI) were calculated in the substantia nigra compacta area (SNc-area), SNc midbrain-tegmentum contrast ratio (SNc-CR), and specific binding ratio (SBR). Cut-off values were determined, using receiver operating characteristic (ROC) analysis, for the differentiation of PD from NDPS on the statistically significant parameters. All cases were scored as either 1 (PD) or 0 (NDPS) for each parameter according to its threshold. These individual scores were totaled for each case, yielding a combined score for each case to obtain a cut-off value for the MSS. RESULTS The Ave-SNc-area, Ave-SNc-CR, and Ave-SBR in PD were significantly lower than those in NDPS. The AI-SNc-area and AI-SBR in PD were significantly higher than those in NDPS. Of the five parameters, the highest accuracy was 93% for the Ave-SNc-area. For the MSS, a cut-off value of 3 was the accuracy of 96%. Besides, no significant difference was observed between PD and APD on all parameters. CONCLUSION An MSS has comparable or better accuracy compared to each parameter of DAT-SPECT and NmMRI in distinguishing PD from NDPS.
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Affiliation(s)
- Eiji Matsusue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Yoshio Fujihara
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kenichiro Tanaka
- Department of Neurology, Tottori prefectural Central Hospital, Tottori, Japan
| | - Yuki Aozasa
- Department of Neurology, Tottori prefectural Central Hospital, Tottori, Japan
| | - Manabu Shimoda
- Department of Neurology, Tottori prefectural Central Hospital, Tottori, Japan
| | - Hiroyuki Nakayasu
- Department of Neurology, Tottori prefectural Central Hospital, Tottori, Japan
| | - Kazuhiko Nakamura
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological Therapeutic Science, Tottori University, Tottori, Japan
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Brumberg J, Isaias IU. SPECT Molecular Imaging in Atypical Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 142:37-65. [DOI: 10.1016/bs.irn.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Meles SK, Vadasz D, Renken RJ, Sittig-Wiegand E, Mayer G, Depboylu C, Reetz K, Overeem S, Pijpers A, Reesink FE, van Laar T, Heinen L, Teune LK, Höffken H, Luster M, Kesper K, Adriaanse SM, Booij J, Leenders KL, Oertel WH. FDG PET, dopamine transporter SPECT, and olfaction: Combining biomarkers in REM sleep behavior disorder. Mov Disord 2017; 32:1482-1486. [PMID: 28734065 PMCID: PMC5655750 DOI: 10.1002/mds.27094] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/09/2017] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic REM sleep behavior disorder is a prodromal stage of Parkinson's disease and dementia with Lewy bodies. Hyposmia, reduced dopamine transporter binding, and expression of the brain metabolic PD‐related pattern were each associated with increased risk of conversion to PD. The objective of this study was to study the relationship between the PD‐related pattern, dopamine transporter binding, and olfaction in idiopathic REM sleep behavior disorder. Methods In this cross‐sectional study, 21 idiopathic REM sleep behavior disorder subjects underwent 18F‐fluorodeoxyglucose PET, dopamine transporter imaging, and olfactory testing. For reference, we included 18F‐fluorodeoxyglucose PET data of 19 controls, 20 PD patients, and 22 patients with dementia with Lewy bodies. PD‐related pattern expression z‐scores were computed from all PET scans. Results PD‐related pattern expression was higher in idiopathic REM sleep behavior disorder subjects compared with controls (P = 0.048), but lower compared with PD (P = 0.001) and dementia with Lewy bodies (P < 0.0001). PD‐related pattern expression was higher in idiopathic REM sleep behavior disorder subjects with hyposmia and in subjects with an abnormal dopamine transporter scan (P < 0.05, uncorrected). Conclusion PD‐related pattern expression, dopamine transporter binding, and olfaction may provide complementary information for predicting phenoconversion. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sanne K Meles
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David Vadasz
- Department of Neurology, Philipps-Universität Marburg, Marburg, Germany
| | - Remco J Renken
- Neuroimaging Center, Department of Neuroscience, University of Groningen, Groningen, The Netherlands
| | | | - Geert Mayer
- Department of Neurology, Philipps-Universität Marburg, Marburg, Germany.,Hephata Klinik, Schwalmstadt, Germany
| | - Candan Depboylu
- Department of Neurology, Philipps-Universität Marburg, Marburg, Germany
| | - Kathrin Reetz
- Department of Neurology and JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Aachen University, Aachen, Germany
| | | | - Angelique Pijpers
- Kempenhaeghe Foundation, Sleep Medicine Centre, Heeze, The Netherlands
| | - Fransje E Reesink
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisette Heinen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura K Teune
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Helmut Höffken
- Department of Nuclear Medicine, Philipps-Universität Marburg, Marburg, Germany
| | - Marcus Luster
- Department of Nuclear Medicine, Philipps-Universität Marburg, Marburg, Germany
| | - Karl Kesper
- Department of Internal Medicine, Section Respiratory Diseases, Philipps Universität Marburg, Marburg, Germany
| | - Sofie M Adriaanse
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Klaus L Leenders
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wolfgang H Oertel
- Department of Neurology, Philipps-Universität Marburg, Marburg, Germany.,Institute for Neurogenomics, Helmholtz Center for Health and Environment, München, Germany
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Joling M, Vriend C, van den Heuvel OA, Raijmakers PG, Jones PA, Berendse HW, Booij J. Analysis of Extrastriatal 123I-FP-CIT Binding Contributes to the Differential Diagnosis of Parkinsonian Diseases. J Nucl Med 2016; 58:1117-1123. [DOI: 10.2967/jnumed.116.182139] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/07/2016] [Indexed: 11/16/2022] Open
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Rizzo G, Copetti M, Arcuti S, Martino D, Fontana A, Logroscino G. Accuracy of clinical diagnosis of Parkinson disease: A systematic review and meta-analysis. Neurology 2016; 86:566-76. [PMID: 26764028 DOI: 10.1212/wnl.0000000000002350] [Citation(s) in RCA: 407] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/16/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of clinical diagnosis of Parkinson disease (PD) reported in the last 25 years by a systematic review and meta-analysis. METHODS We searched for articles published between 1988 and August 2014. Studies were included if reporting diagnostic parameters regarding clinical diagnosis of PD or crude data. The selected studies were subclassified based on different study setting, type of test diagnosis, and gold standard. Bayesian meta-analyses of available data were performed. RESULTS We selected 20 studies, including 11 using pathologic examination as gold standard. Considering only these 11 studies, the pooled diagnostic accuracy was 80.6% (95% credible interval [CrI] 75.2%-85.3%). Accuracy was 73.8% (95% CrI 67.8%-79.6%) for clinical diagnosis performed mainly by nonexperts. Accuracy of clinical diagnosis performed by movement disorders experts rose from 79.6% (95% CrI 46%-95.1%) of initial assessment to 83.9% (95% CrI 69.7%-92.6%) of refined diagnosis after follow-up. Using UK Parkinson's Disease Society Brain Bank Research Center criteria, the pooled diagnostic accuracy was 82.7% (95% CrI 62.6%-93%). CONCLUSION The overall validity of clinical diagnosis of PD is not satisfying. The accuracy did not significantly improve in the last 25 years, particularly in the early stages of disease, where response to dopaminergic treatment is less defined and hallmarks of alternative diagnoses such as atypical parkinsonism may not have emerged. Misclassification rate should be considered to calculate the sample size both in observational studies and randomized controlled trials. Imaging and biomarkers are urgently needed to improve the accuracy of clinical diagnosis in vivo.
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Affiliation(s)
- Giovanni Rizzo
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy
| | - Massimiliano Copetti
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy
| | - Simona Arcuti
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy
| | - Davide Martino
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy
| | - Andrea Fontana
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy
| | - Giancarlo Logroscino
- From the Department of Clinical Research in Neurology (G.R., S.A., G.L.), University of Bari, Tricase; Department of Biomedical and Neuromotor Sciences (G.R.), University of Bologna; Unit of Biostatistics (M.C., A.F.), IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy; Department of Neurology (D.M.), King's College NHS Foundation Trust; Department of Neurology (D.M.), Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK; and Department of Basic Medical Science (G.L.), Neuroscience and Sense Organs, University of Bari, Italy.
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Long-term dopamine transporter imaging in Parkinson's disease treated with zona incerta stimulation. Nucl Med Commun 2015; 37:499-508. [PMID: 26716545 DOI: 10.1097/mnm.0000000000000469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The caudal zona incerta (cZI) is a promising, clinically beneficial target for deep brain stimulation (DBS) in Parkinson's disease (PD). To assess whether DBS of the cZI affects the rate of dopamine terminal dysfunction, PD patients with and without DBS were followed prospectively with I FP-Cit single photon emission tomography from the first diagnosis and up to 8 years. METHODS Six patients underwent DBS of the cZI during the survey period. Twenty-two PD patients only on pharmacotherapy served as controls. I FP-Cit and clinical assessment were performed at baseline and after 1, 3 and 5 years in all patients. Ten patients also underwent a I FP-Cit after 8 years. Image data were evaluated semiquantitatively. Mixed-model analysis was used to assess the relative change in I FP-Cit uptake and comparison between surgically and conservatively treated PD patients. RESULTS The relative decrease in I FP-Cit uptake was more pronounced in DBS-treated patients than in controls in the more affected caudate (P=0.037) and putamen (P=0.013). The annual decrease rates were higher in the less affected than the more affected putamen, and were slightly greater in DBS-treated patients (4.8%, 95%confidence interval: 8.5-2.2%) than in controls (4.0%, 95% confidence interval: 5.1-3.1%). CONCLUSION This long-term prospective study confirms that the underlying dopaminergic dysfunction continues despite clinical improvement in PD patients with DBS of the cZI. A slightly faster rate of decrease in I FP-Cit uptake in these patients compared with conservatively treated PD patients may reflect a more aggressive form of PD.
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Undetectable specific striatal [¹²³I]-ioflupane binding in patients with parkinsonism. J Neurol Sci 2014; 341:167-71. [PMID: 24814162 DOI: 10.1016/j.jns.2014.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/18/2014] [Accepted: 04/21/2014] [Indexed: 11/23/2022]
Abstract
[(123)I]-Ioflupane single photon emission computed tomography (SPECT) is widely used to evaluate the impairment of the nigrostriatal pathway in patients with parkinsonism. We describe a patient with visually undetectable specific striatal [123I]-ioflupane binding in the striatum. Of the 950 [123I]-ioflupane SPECT scans of patients acquired in our department, only one did not show any visually detectable striatal binding. To investigate this issue, we described multimodality imaging in this patient, including a second [123I]-ioflupane SPECT with a higher dose of [123I]-ioflupane, a [18F]-fluoro-l-dopa positron emission tomography (PET), a new MRI and an FDG-PET. Clinical and imaging data (FDG-PET and MRI) led to a diagnosis of progressive supranuclear palsy (PSP). Visual analysis of the second [(123)I]-ioflupane SPECT performed with a higher dose of [(123)I]-ioflupane confirmed nearly undetectable specific striatal binding of the tracer. The [(18)F]-fluoro-l-dopa-PET striatal binding was decreased. After ruling out all technical issues, an undetectable specific [(123)I]-ioflupane striatal binding in a patient with parkinsonism can be a sign of severe DaT loss as we have observed in a case of probable PSP even with moderate motor signs.
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Serotonin transporter availability in early stage Parkinson's disease and multiple system atrophy. ISRN NEUROLOGY 2014; 2014:345132. [PMID: 24693450 PMCID: PMC3945177 DOI: 10.1155/2014/345132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/23/2013] [Indexed: 11/21/2022]
Abstract
Background. Differentiating Parkinson's disease (PD) from multiple system atrophy (MSA) can be challenging especially early in the course of the disease. Previous studies have shown that midbrain serotonin transporter (SERT) availability in patients with established MSA was significantly lower compared to PD. It is unknown if this is also true for early-stage patients. Methods. 77 early-stage, untreated PD patients were recruited between 1995 and 1998, underwent [123I]β-CIT SPECT imaging, and were followed for at least five years. 16 patients were lost to followup, and in 4 the diagnosis was changed to another atypical parkinsonian syndrome, but not in MSA. In 50 patients, the PD diagnosis was unchanged at followup. In seven patients, the diagnosis was changed to MSA at followup. We retrospectively assessed baseline midbrain SERT availability as well as midbrain SERT-to-striatal dopamine transporter (DAT) ratios.
Results. No difference in baseline [123I]β-CIT SERT availability was found. The midbrain SERT-to-striatal DAT ratio for whole striatum was significantly lower in patients with PD compared to MSA (P = 0.049). However, when adjusting for the disease duration at imaging this difference is not significant (P = 0.070). Conclusion. Midbrain SERT availability is not different between early-stage PD and MSA. Therefore, SERT imaging is not useful to differentiate between early PD and MSA.
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Tatsch K, Poepperl G. Nigrostriatal dopamine terminal imaging with dopamine transporter SPECT: an update. J Nucl Med 2013; 54:1331-8. [PMID: 23864718 DOI: 10.2967/jnumed.112.105379] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This article gives an update on nigrostriatal dopamine terminal imaging, with emphasis on SPECT performed with the presynaptic dopamine transporter (DAT) ligand (123)I-FP-CIT. The paper covers the rational use of this technique in the diagnostic work-up of patients with known or suspected parkinsonian syndromes. In detail, it addresses the impact of the method for the proof or exclusion of neurodegenerative parkinsonism, for its early and preclinical diagnosis, and for the evaluation of disease progression. The importance of normal DAT binding for differentiating symptomatic parkinsonism and relevant tremor syndromes from neurodegeneration is highlighted. Particularly emphasized is the role of DAT SPECT for diagnosing Lewy body dementia and its separation from Alzheimer dementia. Finally, some remarks deal with the economic aspects of the use of these imaging techniques in the clinical setting.
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Affiliation(s)
- Klaus Tatsch
- Department of Nuclear Medicine, Municipal Hospital Karlsruhe, Inc, Karlsruhe, Germany.
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Suwijn SR, Berendse HW, Verschuur CV, Winogrodzka A, de Bie RM, Booij J. SERT-to-DAT ratios in early Parkinson's disease do not correlate with the development of dyskinesias. EJNMMI Res 2013; 3:44. [PMID: 23738774 PMCID: PMC3680321 DOI: 10.1186/2191-219x-3-44] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/23/2013] [Indexed: 11/17/2022] Open
Abstract
Background Although the treatment of Parkinson’s disease (PD) is very effective, in the course of the disease, 40% to 60% of patients develop dyskinesias. The pathophysiology of dyskinesias is still unclear. Results of preclinical research suggest that uptake and uncontrolled release of dopamine by serotonergic neurons is an important factor. Based on this model, we hypothesized that dyskinesias will develop predominantly in PD patients with a relatively preserved serotonergic system. Methods Between 1995 and 1998, 50 patients with early-stage untreated PD, diagnosed according to clinical criteria, and reduced striatal [123I]β-carboxymethyoxy-3-beta-(4-iodophenyl) tropane (CIT) single-photon emission computed tomography (SPECT) binding were recruited. To test our hypothesis, we retrospectively assessed baseline [123I]β-CIT SPECT scans for striatal dopamine transporter (DAT) and midbrain serotonin transporter (SERT) availability as well as the SERT-to-DAT ratios. We compared these data between patients that developed dyskinesias and patients that did not develop dyskinesias during a mean follow-up of 14.2 years. Results Approximately half of the PD patients developed dyskinesias. No differences in baseline [123I]β-CIT DAT availability, SERT availability, or SERT-to-DAT ratios were found between the dyskinetic and non-dyskinetic group. The development of dyskinesias was most strongly associated with the age of onset (P = 0.002). Conclusions SERT-to-DAT ratios in early-stage untreated PD do not correlate with the future development of dyskinesias. However, our study does not exclude the possibility that SERT-to-DAT ratios increase with disease progression in patients that develop dyskinesias because of a slower rate of degeneration of the serotonergic system.
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Affiliation(s)
- Sven R Suwijn
- Department of Neurology, H2-225, Academic Medical Center, University of Amsterdam, PO Box 22660, Amsterdam 1100 DD, The Netherlands.
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Predictive value of dopamine transporter SPECT imaging with [¹²³I]PE2I in patients with subtle parkinsonian symptoms. Eur J Nucl Med Mol Imaging 2011; 39:242-50. [PMID: 22095050 DOI: 10.1007/s00259-011-1976-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 10/14/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To examine the diagnostic sensitivity and specificity of dopamine transporter SPECT imaging with a highly dopamine transporter selective radioligand. The study included consecutively enrolled, drug-naive patients with an average short history of parkinsonian motor symptoms, referred for diagnostic scanning. METHODS The study group comprised 288 patients naive to antiparkinson treatment who were enrolled as they were admitted for a diagnostic SPECT scan with the radioligand [(123)I]-N-(3-iodoprop-2E-enyl)-2-β-carbomethoxy-3β-(4-methylphenyl)nortropane ((123)I-PE2I). After the diagnostic scanning, patients were followed clinically with an average follow-up of 19.7 ± 12.5 months. RESULTS A diagnosis could be clinically settled in 189 patients and among these patients, a dopamine transporter scan had a sensitivity of 88% and a specificity of 91% for discrimination between patients with and without striatal neurodegeneration. In cognitively impaired patients (Mini Mental State Examination <27) the specificity was 75% and the sensitivity 95%. A striatal anterior-posterior ratio (APR) of >2 differentiated between idiopathic Parkinson's disease and atypical parkinsonian syndromes with a specificity of 84% and a sensitivity of 63%. CONCLUSION In drug-naive patients with subtle clinical parkinsonian motor symptoms, dopamine transporter scan using (123)I-PE21 has a high sensitivity and specificity in distinguishing between patients with and without striatal neurodegeneration. The specificity is lower in patients who are also cognitively impaired. Calculation of the striatal APR can assist in differentiating between idiopathic Parkinson's disease and atypical parkinsonian syndromes.
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Cummings JL, Henchcliffe C, Schaier S, Simuni T, Waxman A, Kemp P. The role of dopaminergic imaging in patients with symptoms of dopaminergic system neurodegeneration. Brain 2011; 134:3146-66. [PMID: 21810889 DOI: 10.1093/brain/awr177] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diagnosis of neurological and psychiatric conditions associated with disturbances of dopaminergic functioning can be challenging, especially in the early stages, and may be assisted with biomarkers such as dopamine system imaging. Distinguishing between Alzheimer's disease and dementia with Lewy bodies is a major diagnostic challenge. Clinical diagnosis of Parkinson's disease is straightforward with classic presentation, but accurate distinction among Parkinsonian variants may be difficult; non-Parkinson's disease conditions are commonly misdiagnosed as Parkinson's disease, and ~20% of patients with Parkinson's disease are not clinically diagnosed despite coming to medical attention. Early and accurate diagnosis is desirable to improve management. Imaging of the dopamine transporter using single-photon emission computed tomography may be of particular utility in this regard. Abnormal imaging indicates underlying nigrostriatal neurodegeneration, supportive of a diagnosis of Parkinson's disease, atypical parkinsonism or dementia with Lewy bodies, and identifies patient groups in whom dopaminergic therapy may be beneficial. Normal imaging supports diagnosis of a condition not involving nigrostriatal neurodegeneration such as Alzheimer's disease, essential tremor or drug-induced parkinsonism and hence a different therapeutic approach. In patients in whom there was diagnostic uncertainty between degenerative parkinsonism and non-degenerative tremor disorders, baseline imaging with the dopamine transporter ligand [(123)I]ioflupane (DaTscan™) has shown 78% sensitivity and 97% specificity with reference to clinical diagnosis at 3 years, versus 93% and 46%, respectively, for baseline clinical diagnosis. In a Phase III trial of [(123)I]ioflupane in patients with initial clinical diagnosis of probable or possible dementia with Lewy bodies or non-Lewy body dementia, mean specificity for excluding non-Lewy body dementia (predominantly Alzheimer's disease) was 90.4%. Using clinical diagnosis as a reference against which to assess sensitivity and specificity of dopamine transporter imaging is a limitation, but definitive diagnosis via pathological confirmation is generally not feasible. In a series of patients with post-mortem brain examination, imaging using [(123)I]ioflupane has demonstrated higher sensitivity (88%) and specificity (100%) for differentiating dementia with Lewy bodies from non-Lewy body dementia than clinical diagnosis (75% and 42%, respectively). Dopaminergic system imaging may be particularly valuable in patients with clinically inconclusive parkinsonism or a clinical diagnosis of possible dementia with Lewy bodies; it is not helpful in differentiating between Parkinson's disease and atypical parkinsonism, although postsynaptic dopaminergic imaging may be of utility. Other potential uses of dopamine transporter imaging include identification of patients with premotor Parkinson's disease, monitoring disease progression in testing novel therapeutics, and as an inclusion criterion for entry into clinical trials.
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Südmeyer M, Antke C, Zizek T, Beu M, Nikolaus S, Wojtecki L, Schnitzler A, Müller HW. Diagnostic Accuracy of Combined FP-CIT, IBZM, and MIBG Scintigraphy in the Differential Diagnosis of Degenerative Parkinsonism: A Multidimensional Statistical Approach. J Nucl Med 2011; 52:733-40. [DOI: 10.2967/jnumed.110.086959] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gaenslen A, Unmuth B, Godau J, Liepelt I, Di Santo A, Schweitzer KJ, Gasser T, Machulla HJ, Reimold M, Marek K, Berg D. The specificity and sensitivity of transcranial ultrasound in the differential diagnosis of Parkinson's disease: a prospective blinded study. Lancet Neurol 2008; 7:417-24. [DOI: 10.1016/s1474-4422(08)70067-x] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vlaar AMM, van Kroonenburgh MJPG, Kessels AGH, Weber WEJ. Meta-analysis of the literature on diagnostic accuracy of SPECT in parkinsonian syndromes. BMC Neurol 2007; 7:27. [PMID: 17764571 PMCID: PMC2064928 DOI: 10.1186/1471-2377-7-27] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Accepted: 09/01/2007] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder. One of the most widely used techniques to diagnose PD is a Single Photon Emission Computer Tomography (SPECT) scan to visualise the integrity of the dopaminergic pathways in the brain. Despite this there remains some discussion on the value of SPECT in the differential diagnosis of PD. We did a meta-analysis of all the existing literature on the diagnostic accuracy of both pre- and post-synaptic SPECT imaging in the differential diagnosis of PD. METHODS Relevant studies were searched in Medline, EMBASE and Cochrane databases with back-searching of their reference lists. We limited our analysis to studies with a clinically relevant methodology: i.e. when they assessed the ability of the SPECT to provide 1. diagnosis of PD in an early phase vs. normalcy; 2 diagnostic differentiation between PD and essential tremor (ET); 3. distinguishing between PD and vascular parkinsonism (VP); 4. delineation of PD from atypical parkinsonian syndromes (APS). Gold standard was, dependent on the study type, clinical examination at initial visit or follow-up, and/or response to dopaminergic agents. RESULTS The search gave 185 hits, of which we deemed 32 suitable for our analysis. From these we recalculated the diagnostic odds ratio of SPECT for the clinical questions above. The pooled odds ratio (with 95%CI) for presynaptic SPECT scan's ability to distinguish between early PD and normalcy was 60 (13 - 277). For the ability to differentiate between PD and ET this ratio was 210 (79-562). The ratio for presynaptic SPECT's ability to delineate PD from VP was 105 (32 - 348). The mean odds ratio for the presynaptic SPECT scans to differentiate between PD and the two APS was 2 (1 - 4), and for the postsynaptic SPECT imaging this was 19 (9-36). CONCLUSION SPECT with presynaptic radiotracers is relatively accurate to differentiate patients with PD in an early phase from normalcy, patients with PD from those with ET, and PD from VP. The accuracy of SPECT with both presynaptic and postsynaptic tracers to differentiate between PD and APS is relatively low.
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Affiliation(s)
- Annemarie MM Vlaar
- Department of Neurology, University Hospital Maastricht, The Netherlands
| | | | - Alfons GH Kessels
- Department of Clinical Epidemiology and Technology Assessment, University Hospital Maastricht, The Netherlands
| | - Wim EJ Weber
- Department of Neurology, University Hospital Maastricht, The Netherlands
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Lindsey KP, Gatley SJ. Applications of Clinical Dopamine Imaging. PET Clin 2007; 2:45-65. [DOI: 10.1016/j.cpet.2007.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Recent technologic advances make it increasingly possible to image neurotransmitter systems in living human brain, The dopamine system has been most intensively studied owing to its involvement in several brain disorders such as Parkinson's disease and Huntington's disease, as well as psychiatric disorders such as schizophrenia, depression, and compulsive behavioral disorders of multiple types. A variety of aspects of dopamine receptor density, function, and dopaminergic terminal status can now be assessed using the minimally invasive neuroimaging techniques of positron emission tomography and single-photon emission computed tomography. Although these techniques are currently used most often in the context of research, clinical applications are rapidly emerging.
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Affiliation(s)
- Kimberly P Lindsey
- Department of Psychiatry, Harvard University Medical School, 115 Mill Street, Belmont, MA 02478, USA
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Shih MC, Hoexter MQ, Andrade LAFD, Bressan RA. Parkinson's disease and dopamine transporter neuroimaging: a critical review. SAO PAULO MED J 2006; 124:168-75. [PMID: 17119698 DOI: 10.1590/s1516-31802006000300014] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 05/30/2006] [Indexed: 11/22/2022] Open
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder that is mainly caused by dopaminergic neuron loss in the substantia nigra. Several nuclear medicine radiotracers have been developed to evaluate PD diagnoses and disease evolution in vivo in PD patients. Positron emission tomography (PET) and single photon computerized emission tomography (SPECT) radiotracers for the dopamine transporter (DAT) provide good markers for the integrity of the presynaptic dopaminergic system affected in PD. Over the last decade, radiotracers suitable for imaging the DAT have been the subject of most efforts. In this review, we provide a critical discussion on the utility of DAT imaging for Parkinson's disease diagnosis (sensitivity and specificity).
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Affiliation(s)
- Ming Chi Shih
- Laboratório Interdisciplinar de Neuroimagem e Cognição, Universidade Federal de São Paulo, Rua Dr. Bacelar 334, CEP 04026-001 São Paulo, Brazil.
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García Solís D. Imagen de neurotransmisión dopaminérgica en los síndromes parkinsonianos. ACTA ACUST UNITED AC 2005; 24:255-76. [PMID: 16122412 DOI: 10.1157/13076646] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- D García Solís
- U.D. de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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