Accurate differentiation of parkinsonism and essential tremor using visual assessment of [123I]-FP-CIT SPECT imaging: The [123I]-FP-CIT study group (original) (raw)
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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.