Accurate differentiation of parkinsonism and essential tremor using visual assessment of [123I]-FP-CIT SPECT imaging: The [123I]-FP-CIT study group (original) (raw)
Frontiers in Aging Neuroscience, 2014
The [ 123 I]ioflupane-a dopamine transporter radioligand-SPECT (DaT-SPECT) has proven to be useful in the differential diagnosis of tremor. Here, we investigate the diagnoses behind patients with hard-to-classify tremor and normal DaT-SPECT. Therefore, 30 patients with tremor and normal DaT-SPECT were followed up for 2 years. In 18 cases we were able to make a diagnosis. The residual 12 patients underwent a second DaT-SPECT, were then followed for additional 12 months and thereafter the diagnosis was reconsidered again. The final diagnoses included cases of essential tremor, dystonic tremor, multisystem atrophy, vascular parkinsonism, progressive supranuclear palsy, corticobasal degeneration, fragile X-associated tremor ataxia syndrome, psychogenic parkinsonism, iatrogenic parkinsonism and Parkinson's disease. However, for 6 patients the diagnosis remained uncertain. Larger series are needed to better establish the relative frequency of the different conditions behind these cases.
[123I]FP-CIT (DaTscan) SPECT Brain Imaging in Patients with Suspected Parkinsonian Syndromes
Journal of Neuroimaging, 2011
To review [ 123 I]FP-CIT (Ioflupane I 123, DaTscan) SPECT imaging and its role in clinical practice. BACKGROUND [ 123 I]FP-CIT is a radiopharmaceutical that binds reversibly to striatal presynaptic dopamine transporters. METHODS We review the two principal multicenter clinical trials of [ 123 I]FP-CIT SPECT imaging and provide additional, previously unreported information. Study 1 was a trial of [ 123 I]FP-CIT SPECT in patients with early suspected parkinsonism that compared baseline scans to the consensus clinical diagnosis established 3 years later. Study 2 was a trial of [ 123 I]FP-CIT SPECT in patients with established diagnoses of parkinsonian syndrome (PS) or essential tremor (ET). RESULTS In Study 1, positive percent agreement (abnormal baseline scan and clinical diagnosis of PS at 36 months [n = 71]) was 78-79%. Negative percent agreement (normal baseline scan and a clinical diagnosis of non-PS at 36 months [n = 28]) was 97%. In study 2, positive percent agreement (abnormal scan and a clinical diagnosis of PS [n = 158]) was 92-97%. Negative percent agreement (normal scan and a clinical diagnosis of ET [n = 27]) was 74-96%. CONCLUSION [ 123 I]FP-CIT SPECT brain imaging is used to assist in the evaluation of adult patients with suspected PS and may help differentiate ET from PS as an adjunct to other diagnostic evaluations.
Brain FP-CIT spect in the contemporary diagnostics of parkinson's disease
Scripta Scientifica Medica, 2010
The contemporary diagnostic process in Parkinson's disease is based on the well-known clinical criteria and on some neuroimaging methods. Brain FP-CIT SPECT was introduced in Europe in 2003. In Bulgaria this method is available only in the university hospitals in Varna and Sofia. The present study aimed at assessing the diagnostic value of FP-CIT SPECT in the diagnostics of Parkinson's disease in 35 patients, in a local clinical setting. Twenty-six of the patients had been previously diagnosed as clinically possible or definite Parkinson's disease, while the remaining 9, as essential tremor. Brain FP-CIT SPECT scanning was performed in all subjects. The results were assessed visually for normal or abnormal ligand striatal uptake. Abnormal results were found in 25 of 26 patients diagnosed clinically as having Parkinson's disease. The remaining 9 patients with clinical diagnosis of essential tremor showed normal scan results. Sensitivity of the method for the clinical diagnosis of Parkinson's disease was 96% and the specificity for essential tremor was 100%. Our results for specificity and sensitivity of the method are similar to those previously published in the literature and would thus allow us to emphasize on the high informative value of the method in our clinical setting.
Movement disorders : official journal of the Movement Disorder Society, 2011
To elucidate whether Parkinson's disease subtypes show a different pattern of Iodine-123 fluoropropyl-;carbomethoxy-3 β-(FP-CIT) single photon emission computed tomography (SPECT) binding in accordance with neuropathological findings. We analyzed a database of consecutive patients with FP-CIT scan (n = 190) over a 3-year period and identified 122 patients (50 women, 72 men, mean age 62 ± 11.1 years) with a diagnosis of idiopathic Parkinson's disease. Patient's characteristics and FP-CIT scan results were analyzed and compared for the subgroups tremor-dominant versus akinetic-rigid and equivalent type of Parkinson's disease. The analysis of all Parkinson's disease patients showed a significant difference between the FP-CIT uptake in the subgroups tremor-dominant and akinetic-rigid. After matching these samples for age, disease duration, disease severity (Hoehn & Yahr grade, Unified Parkinson's Disease Rating Scale score), and levodopa-equivalent dose, these fi...
123I-IPT brain SPECT study in essential tremor and Parkinson's disease
Neurology, 1999
Objective: To investigate nigral neuronal damage in patients with isolated postural tremor and those with postural and rest tremor without parkinsonism.Methods: Using [123I]-N-(3-iodopropen-2-yl)-2β-carbomethoxy-3β-(4-chlorophenyl) tropane SPECT, we measured the basal ganglia-occipital cortex/occipital cortex ([BG-OCC]/OCC) uptake ratios in 21 control subjects and patients with isolated postural tremor (n = 9), postural and rest tremor (n = 6), and PD (n = 11).Results: In the patients with PD, the means (±SD) of the (BG-OCC)/OCC ratios of the ipsilateral (2.35 ± 0.37) and the contralateral (1.97 ± 0.33) sides to the more severely affected limbs were significantly lower than the mean of the bilateral (BG-OCC)/OCC ratios of the age-matched control subjects (3.83 ± 0.66). The mean (±SD) of the bilateral (BG-OCC)/OCC ratios of the patients with isolated postural tremor (3.60 ± 0.83) was comparable with that of the age-matched control subjects. However, the mean (±SD) of the bilateral (B...
Combined use of DAT-SPECT and cardiac MIBG scintigraphy in mixed tremors
Movement Disorders, 2009
The cooccurrence of rest and postural tremor (mixed tremor) as the predominant clinical manifestation in patients who do not fulfill diagnostic established criteria for essential tremor (ET) or Parkinson's disease (PD) poses a clinical diagnostic challenge. Twenty-two patients with mixed tremor and additional mild extrapyramidal features, such as bradykinesia and rigidity, 20 patients with probable PD, 10 patients with probable ET, and 18 controls were investigated through the combined use of dopamine transporter 123 I-FP-CIT-single-photon emission tomography (DAT-SPECT) and cardiac 123 metaiodobenzylguanidine (MIGB) scintigraphy. Six of the 22 mixed-tremor patients had normal DAT-SPECT, a condition usually found in patients with ET, whereas 16 patients showed damage to the nigrostriatal system. Cardiac MIBG allowed further differentiation between these 16 patients because eight of them had decreased tracer uptakes (heart/mediastinum [H/M] ratio in delayed image, H/M ratio delayed: 1.16 6 0.11, P < 0.001 vs controls), indicating a PD, whereas the remaining eight had normal cardiac tracer uptakes, a finding suggestive of a parkinsonian syndrome (H/M ratio delayed: 1.90 6 0.13). Both DAT-SPECT and cardiac MIBG scintigraphies were abnormal in the 20 patients with probable PD, whereas these were normal in both the patients with probable ET as well as in the controls. Our study suggests that the combined use of both DAT-SPECT and MIBG scintigraphy in mixed tremors with additional extrapyramidal features can help distinguish patients with ET from those with PD and parkinsonism.
Annals of Nuclear Medicine, 2012
The differential diagnosis between essential tremor (ET) and Parkinson's disease (PD) may be, in some cases, very difficult on clinical grounds alone. In addition, it is accepted that a small percentage of ET patients presenting symptoms and signs of possible PD may progress finally to a typical pattern of parkinsonism. Ioflupane, N-u-fluoropropyl-2a-carbomethoxy-3a-(4-iodophenyl) nortropane, also called FP-CIT, labelled with (123)I (commercially known as DaTSCAN) has been proven to be useful in the differential diagnosis between PD and ET and to confirm dopaminergic degeneration in patients with parkinsonism. The aim of this study is to identify dopaminergic degeneration in patients with PD and distinguish them from others with ET using semi-quantitative SPECT (123)I-Ioflupane (DaTSCAN) data in comparison with normal volunteers (NV), in addition with the respective ones of patients referred as suffering from ET, as well as, of patients with a PD diagnosis at an initial stage with a unilateral presentation of motor signs. Twenty-eight patients suffering from ET (10 males plus 18 females) and 28 NV (12 males and 16 females) were enroled in this study. In addition, 33 patients (11 males and 22 females) with an established diagnosis of PD with unilateral limb involvement (12 left hemi-body and 21 right hemi-body) were included for comparison with ET. We used DaTSCAN to obtain SPECT images and measure the radiopharmaceutical uptake in the striatum (S), as well as the caudate nucleus (CN) and putamen (P) in all individuals. Qualitative (Visual) interpretation of the SPECT data did not find any difference in the uptake of the radiopharmaceutical at the level of the S, CN and P between NV and ET patients. Reduced accumulation of the radiopharmaceutical uptake was found in the P of all PD patients. Semiquantitative analysis revealed significant differences between NV and ET patients in the striatum, reduced in the latter. There was also a significant reduction in the tracer accumulation in the left putamen of patients with right hemi-parkinsonism compared to ET and NV. Patients with left hemi-parkinsonism, demonstrated reduced radioligand uptake in the right putamen in comparison with ET and NV. Clinical follow-up of 20 patients with ET at (so many months afterwards) revealed no significant change in clinical presentation, particularly no signs of PD. Follow-up DaTSCAN performed in 10 of them (so many months afterwards) was negative in all but one. This one had an equivocal baseline study which deteriorated 12 months later. Our results do not support the hypothesis of a link between essential tremor and Parkinson's disease. However, it appears that ET patients have a small degree of striatal dopaminergic degeneration. If this is due to alterations in the nigrostriatl pathway or of other origin it is not clear. Follow-up studies of essential tremor patients are warranted to assess progression of disease and to understand better the possible cause for striatal dopaminergic degeneration.
SPECT imaging evaluation in movement disorders: Far beyond visual assessment
European Journal of Nuclear Medicine and Molecular Imaging, 2011
Single photon emission computed tomography (SPECT) imaging with 123 I-FP-CIT is of great value in differentiating patients suffering from Parkinson's disease (PD) from those suffering from essential tremor (ET). Moreover, SPECT with 123 I-IBZM can differentiate PD from Parkinson's "plus" syndromes. Diagnosis is still mainly based on experienced observers' visual assessment of the resulting images while many quantitative methods have been developed in order to assist diagnosis since the early days of neuroimaging. The aim of this work is to attempt to categorize, briefly present and comment on a number of semi-quantification methods used in nuclear medicine neuroimaging. Various arithmetic indices have been introduced with region of interest (ROI) manual drawing methods giving their place to automated procedures, while advancing computer technology has allowed automated image registration, fusion and segmentation to bring quantification closer to the final diagnosis based on the whole of the patient's examinations results, clinical condition and response to therapy. The search for absolute quantification has passed through neuroreceptor quantification models, which are invasive methods that involve tracer kinetic modelling and arterial blood sampling, a practice that is not commonly used in a clinical environment. On the other hand, semi-quantification methods relying on computers and dedicated software try to elicit numerical information out of SPECT images. The application of semi-quantification methods aims at separating the different patient categories solving the main problem of finding the uptake in the structures of interest. The semi-quantification methods which were studied fall roughly into three categories, which are described as classic methods, advanced automated methods and pixel-based statistical analysis methods. All these methods can be further divided into various subcategories. The plethora of the existing semi-quantitative methods reinforces the feeling that visual assessment is still the base of image interpretation and that the unambiguous numerical results that will allow the absolute differentiation between the known diseases have not been standardized yet. Switching to a commonly agreed-ideally PC-based-automated software that may take raw or mildly processed data (checked for consistency and maybe corrected for attenuation and/or scatter and septal penetration) as input, work with basic operator's inference and produce validated numerical results that will support the diagnosis is in our view the aim towards which efforts should be directed. After all, semi-quantification can improve sensitivity, strengthen diagnosis, aid patient's follow-up and assess the response to therapy. Objective diagnosis, altered diagnosis in marginal cases and a common approach to multicentre trials are other benefits and future applications of semi-quantification.
Movement Disorders, 2010
To investigate over time changes in striatal dopamine transporter (DAT), we performed two sequential N-xfluoropropyl-2b-carbomethoxy-3b-(4-iodophenyl) tropane single photon computed tomography (SPECT) scans in 20 subjects with essential tremor (ET), in 13 with Parkinson disease (PD) and in 23 healthy controls (HC, one scan only). We also performed an [ 99m Tc]ethyl cysteinate dimer bicisate SPECT exam for regional brain network analysis in 9 ET, in a second group of 18 PD (9 with tremor, tPD and 9 akineticrigid dominant, arPD) and in 8 HC. PD subjects had a reduced DAT binding in comparison to ET and HC with an annual decline rate of 7.3% in the contralateral putamen. There were no mean uptake differences between ET and HC at baseline and no uptake loss over time in ET. A discriminant analysis grouped 30% (first scan) and 5% (second scan) of ET as PD and a partition analysis showed overlap between ET and PD for caudate nucleus uptake. Spatial covariance analysis revealed that the expression of the PD-related regional pattern separated both tPD and arPD from ET and HC. In conclusion, PD and ET do not share a common pattern of dopaminergic loss over time. However, mild impairment of dopamine transporter in the caudate nucleus may contribute to tremor onset in ET.
Role of DAT-SPECT in the diagnostic work up of Parkinsonism
Movement Disorders, 2007
The diagnosis of idiopathic Parkinson's disease (PD) can be achieved with high degrees of accuracy in cases with full expression of classical clinical features. However, diagnostic uncertainty remains in early disease with subtle or ambiguous signs. Functional imaging has been suggested to increase the diagnostic yield in parkinsonian syndromes with uncertain clinical classification. Loss of striatal dopamine nerve terminal function, a hallmark of neurodegenerative Parkinsonism, is strongly related to decreases of dopamine transporter (DAT) density, which can be measured by single photon emission computed tomography (SPECT). The use of DAT-SPECT fa-cilitates the differential diagnosis in patients with isolated tremor symptoms not fulfilling PD or essential tremor criteria, drug-induced, psychogenic and vascular Parkinsonism as well as dementia when associated with Parkinsonism. This review addresses the value of DAT-SPECT in early differential diagnosis, and its potential as a screening tool for subjects at risk of developing PD as well as issues around the assessment of disease progression.
The Open Neurology Journal
Introduction: Patients with essential tremor (ET) have 3.5 times greater risk of developing Parkinson's disease (PD) throughout their lives, also known as PD with antecedent ET (ET-PD). Single photon emission computed tomography with radiotracer imaging of dopamine transporters (TRODAT-SPECT) can help differentiate these two diseases. Method: Relate the results of TRODAT-SPECT imaging in patients with ET to potential progress to ET-PD. Thirty-six patients with ET were evaluated by neurological examination, the Archimedes spiral, and the MDS-UPDRS III scale on two occasions, after a mean interval of three years. SPECT was performed on all patients after the first visit. Results: Overall, six patients (16.6%) progressed clinically to ET-PD. Patients with ET-PD were older, and the age of tremor onset was later. The ET-PD group scored higher on the MDS-UPDRS III scale, especially for the presence of bradykinesia. SPECT imaging was altered in 83.3% of the ET-PD patients compared to 3...
Vojnosanitetski pregled, 2012
Background/Aim. 123I-FP-CIT brain single-photon emission computed tomography (SPECT), DaTSCAN imaging, offers a possibility to study structural and biochemical integrity of presinaptic dopaminergic neurotransmitter system. The aim of this study was to evaluate the usefulness of 123I-FP-CIT brain SPECT scintigraphy in patients with extrapyramidal diseases. Methods. Fifteen patients (8 males and 7 females), aged 26-81 years, presenting with extrapyramidal symptoms entered the study. Out of them, 7 patients were diagnosed with definite clinical form of idiopathic Parkinson?s disease (PD) or clinical probable for PD clinical stage 2-4 using the Hoehn&Yahr scale (H&Y); 6 patients were with atypical parkinsonism (AP), 1 patient with essential, and 1 with psychogenic tremor. SPECT was performed 180 min after injection of 185 MBq 123IFP- CIT using a dual head Gamma camera. Sixty four one minutes? frames were acquired using a noncircular rotation mode into a 128 ? 128 image matrix. Transvers...
Burden of non-motor symptoms in unclear parkinsonism and tremor: A study with [123I]FP-CIT SPECT
Journal of the Neurological Sciences, 2019
Background: Non-motor symptoms (NMSs) are clearly more prevalent in Parkinson's disease (PD) patients compared to healthy individuals. However, NMSs are also common in the elderly and other neurological conditions, and thus, it is not known whether NMSs could be used to differentiate PD from parkinsonism/tremor without dopamine deficiency. Methods: We prospectively evaluated NMSs immediately before brain dopamine transporter (DAT) [ 123 I]FP-CIT SPECT scanning in 193 patients with unclear parkinsonism/tremor. According to the clinical follow-up and imaging results, 84 patients had PD. NMSs and their correlations with striatal DAT binding were investigated in PD patients and in parkinsonism/tremor patients with normal dopamine function. Results: Total NMS burden, anxiety or depression did not differ between PD patients and patients with normal DAT binding. DAT-normal patients reported more perception-related (p = 0.045) and attention/memory-related NMSs than PD patients (p < 0.001). Total NMS score did not correlate with striatal DAT binding in either group. Conclusions: In clinically uncertain cases, the total NMS burden cannot be used as a tool in distinguishing PD patients from patients with non-dopaminergic parkinsonism/tremor. Clinical screening of NMSs appears equally important in all patients with parkinsonism.
Nuclear medicine review. Central & Eastern Europe: journal of Bulgarian, Czech, Macedonian, Polish, Romanian, Russian, Slovak, Yugoslav societies of nuclear medicine and Ukrainian Society of Radiology
In this article the role of molecular imaging with SPECT and PET in patients with movement disorders is reviewed. It is mentioned that SPECT and PET imaging with cocaine analogues ((123)I-beta-CIT,(123)I-FP-CIT, (18)F-DOPA), radioligands labeling the presynaptic dopamine transporters, is of value for the differentiation of patients with PD or Parkinson-plus syndromes with individuals with essential tremor. In addition the clinical impact of this procedure, the role of molecular imaging in the preclinical diagnosis and in the follow-up of patients with PD, as well as, in the differential diagnosis between Alzheimer's disease and Lewy-body dementia, is evaluated. Finally, the clinical impact of (123)I-IBZM-SPECT imaging, a radiopharmaceutical which labels the postsynaptic D(2) receptors and the discrimination between idiopathic PD and Parkinson-plus syndromes (multiple system atrophy, progressive supranuclear palsy and corticobasal ganglia degeneration), is mentioned.
Molecular imaging (SPECT and PET) in the evaluation of patients with movement disorders
Nuclear Medicine Review Central Eastern Europe Journal of Bulgarian Czech Macedonian Polish Romanian Russian Slovak Yugoslav Societies of Nuclear Medicine and Ukrainian Society of Radiology, 2006
In this article the role of molecular imaging with SPECT and PET in patients with movement disorders is reviewed. It is mentioned that SPECT and PET imaging with cocaine analogues ((123)I-beta-CIT,(123)I-FP-CIT, (18)F-DOPA), radioligands labeling the presynaptic dopamine transporters, is of value for the differentiation of patients with PD or Parkinson-plus syndromes with individuals with essential tremor. In addition the clinical impact of this procedure, the role of molecular imaging in the preclinical diagnosis and in the follow-up of patients with PD, as well as, in the differential diagnosis between Alzheimer's disease and Lewy-body dementia, is evaluated. Finally, the clinical impact of (123)I-IBZM-SPECT imaging, a radiopharmaceutical which labels the postsynaptic D(2) receptors and the discrimination between idiopathic PD and Parkinson-plus syndromes (multiple system atrophy, progressive supranuclear palsy and corticobasal ganglia degeneration), is mentioned.
Evaluation of Brain SPECT with 99mTc-TRODAT-1 in the Differential Diagnosis of Parkinsonism
Parkinson's Disease, 2022
Introduction. Brain SPECT with 99m Tc-TRODAT-1 (SPECT-TRODAT) may be a useful tool in the differential diagnosis of Parkinsonism. Objective. To compare results of SPECT-TRODAT with clinical findings in patients with Parkinsonism. Methods. We evaluated 153 outpatients. SPECT-TRODAT results were visually analyzed into normal, abnormal, symmetric, and asymmetric, and according to the degree of impairment into mild, moderate, marked, and severe (1-4). Results. A direct relationship was found between motor scores severity (MDS-UPDRS-III) and SPECT-TRODAT-reduced binding in general, in the group of patients with synucleinopathies (rho � 0.258, p � 0.005), especially in patients with Parkinson's disease (rho � 0.204, p � 0.049). Changes in SPECT-TRODAT had high correspondence with symmetry in all Parkinsonism. When comparing groups to the correspondence predominantly bilateral or unilateral impairment in SPECT, there was a difference between patients with SNP (p � 0.041) and between this group and patients with secondary Parkinsonism (SP) (p < 0.0001). It was handy in differentiating drug-induced Parkinsonism from synucleinopathies. In the group of drug-induced Parkinsonism, younger people were the ones who showed the most significant reductions in radiotracer uptake. In this group, nonmotor signs resulted in examinations with more significant reductions in radiotracer uptake. When the scans without alterations and those that did not correspond to the symmetry were considered negative, SPECT-TRODAT's accuracy and specificity to differentiate PD from other forms of Parkinsonism were low. ere was an inverse correlation between the severity of the SPECT-TRODAT result and the absence of nonmotor signs in patients with drug-induced Parkinsonism. Conclusion. e authors concluded that the SPECT with 99mTc-TRODAT-1 was mainly useful in differentiating between synucleinopathies and secondary Parkinsonism.
Movement Disorders, 2009
Overdiagnosis of Parkinson's disease (PD) is suggested by specialist review of community diagnosis, and in postmortem studies. In specialist centers 4 to 15% of patients entered into clinical trials as early PD do not have functional imaging support for a PD diagnosis. In a European multicenter, prospective, longitudinal study, we compared clinical diagnosis with functional SPECT imaging using [ 123 I]FP-CIT (DaTSCAN TM , GE Healthcare). Repeat observations were performed over 3 years in patients with tremor and/or parkinsonism in whom there was initial diagnostic uncertainty between degenerative parkinsonism and nondegenerative tremor disorders. Video-recording of clinical features was scored independently of functional imaging results by two blinded clinicians at 36 months (5 gold standard clinical diagnosis). Three readers, unaware of the clinical diagnosis, classified the images as normal or abnormal by visual inspection. The main endpoint was the sensitivity and specificity of SPECT imaging at baseline compared with the gold standard. In 99 patients completing the three serial assessments, on-site clinical diagnosis overdiagnosed degenerative parkinsonism at baseline in diagnostically uncertain cases compared with the gold standard clinical diagnosis (at 36 months), the latter