Impact of DaTscan SPECT imaging on clinical management, diagnosis, confidence of diagnosis, quality of life, health resource use and safety in patients with clinically uncertain parkinsonian syndromes: a prospective 1-year follow-up of an open-label controlled study

Kupsch, Andreas; Bajaj, Nin; Weiland, Frederick L.; Tartaglione, Antonio; Klutmann, Susanne; Buitendyk, Melanie; Sherwin, Paul; Tate, Ann C.; Grachev, Igor D.

doi:10.1136/jnnp-2011-301695

Cited by 65 publications

(81 citation statements)

References 38 publications

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“…The 5 studies have been published (1)(2)(3)(4)(5)(6)(7)(8), including the inclusion/ exclusion criteria. Table 1 provides a summary of the details of the studies.…”

Section: Methodsmentioning

confidence: 99%

“…Each g camera system was capable of SPECT acquisition and reconstruction to produce transverse slices, including a clear visualization of the striatum (i.e., the head of the caudate nucleus and putamen). Images were acquired within 3-6 h after radiotracer injection (1)(2)(3)(4)(5)(6)(7)(8). Images were read on-site or by 3 or 5 BIE readers and classified as normal (SDD absent) or abnormal (SDD present) (9).…”

Section: Methodsmentioning

confidence: 99%

“…lack of specificity of signs and symptoms in the early stages of the disease (1,2). In some clinical situations, definitive diagnosis is only possible through postmortem neuropathology, and all in-life diagnoses are probable.…”

mentioning

confidence: 99%

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Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using ¹²³I-Ioflupane Injection (DaTscan) Imaging

et al. 2014

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Establishing an early, accurate diagnosis is fundamental for appropriate clinical management of patients with movement disorders or dementia. Ioflupane 123 I Injection (DaTscan, 123 I-ioflupane) is an important adjunct to support the clinical diagnosis. Understanding individualreader diagnostic performance of 123 I-ioflupane in a variety of clinical scenarios is essential. Methods: Sensitivity, specificity, interreader, and intrareader data from 5 multicenter clinical studies were reviewed. The different study designs offered an assortment of variables to assess the effects on the diagnostic performance of 123 I-ioflupane: on-site versus 3-5 blinded image readers, number of image evaluations, early/uncertain versus late/confirmed clinical diagnosis as reference standard, and subjects with movement disorders versus dementia. Results: Eight hundred eighteen subjects had individualreader efficacy data available for analysis. In general, sensitivity and specificity were high and comparable between on-site versus blinded independent readers. In subjects with dementia, when the clinical diagnosis was made at month 12 versus baseline, specificity improved from 77.4%-91.2% to 81.6%-95.0%. In subjects with movement disorders, this effect was observed to an even greater extent, when diagnostic performance using month-18 diagnosis as a reference standard (sensitivity, 67.0%-73.7%; specificity, 75.0%-83.3%) was compared versus month-36 diagnosis (77.5%-80.3% and 90.3%-96.8%, respectively). Diagnostic performance was similar in subjects with dementia (74.4%-89.9% and 77.4%-95.0%, respectively) and subjects with movement disorders (67.0%-97.9% and 71.4%-98.4%, respectively). In most of the comparisons, betweenreader agreement was very good (almost perfect), with κ ranging from 0.81 to 1.00. Within-reader agreement, measured in 1 study, was 100% for 3 blinded readers. Conclusion: Individual-reader diagnostic performance, as assessed by measuring sensitivity and specificity of 123 I-ioflupane to detect the presence or absence of striatal dopaminergic deficit, using the clinical diagnosis as a reference standard, was high in subjects with either movement disorders or dementia and was similar in on-site readers versus blinded analyses. Between-and within-reader agreements were very good (almost perfect). Longer follow-up between imaging and clinical diagnosis improved the diagnostic accuracy, most likely due to improvement in the clinical diagnosis reference standard, rather than changes in reader accuracy.

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“…The 5 studies have been published (1)(2)(3)(4)(5)(6)(7)(8), including the inclusion/ exclusion criteria. Table 1 provides a summary of the details of the studies.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using ¹²³I-Ioflupane Injection (DaTscan) Imaging

et al. 2014

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“…Other recent prospective multicentric studies have looked at the impact of 123 I-FP-CIT SPECT on clinically uncertain PS and demonstrated that for the subgroup of patients who underwent the scanning procedure, medication was changed at a significantly earlier time point and there was significantly greater confidence in the diagnosis 4 wk, 12 wk, and 1 y after the initial diagnosis. Inclusion of imaging, therefore, has had a significant impact on clinical management, diagnosis, and diagnostic confidence in a patient population with uncertain PS (82).…”

Section: Economic Considerationsmentioning

confidence: 99%

Nigrostriatal Dopamine Terminal Imaging with Dopamine Transporter SPECT: An Update

2013

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the radiopharmaceuticals used to evaluate nigrostriatal dopamine imaging; (2) the pattern of uptake of these radiopharmaceuticals in parkinsonian syndromes; and (3) the role of these radiopharmaceuticals in the evaluation of parkinsonian syndromes.Financial Disclosure: Dr. Tatsch is a meeting participant/lecturer for GE Healthcare. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, participants can access this activity through the SNMMI Web site (http:// www.snmmi.org/ce_online) through August 2016.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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“…Studies show that DaTSCAN improves confidence in diagnosis and management in clinically uncertain parkinsonian syndromes. 5 Cancer risk from any scan cannot be ignored. The 1 in 7,500 possible cancer risk 1 has to be compared to the greater chance of psychological trauma of a falsepositive PD diagnosis or the functional disability that may result from a missed PD diagnosis.…”

Section: Megan Alcauskas MD and Robert C Griggs Mdmentioning

confidence: 99%

Role of Datscan and Clinical Diagnosis in Pd

Bajaj¹,

Fuente‐Fernández²

2012

Neurology

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Impact of DaTscan SPECT imaging on clinical management, diagnosis, confidence of diagnosis, quality of life, health resource use and safety in patients with clinically uncertain parkinsonian syndromes: a prospective 1-year follow-up of an open-label controlled study

Abstract: DaTscan had a significant impact on clinical management, diagnosis and CoD in patients with CUPS. DaTscan is safe and well tolerated, and is a useful adjunct to differentiate a diagnosis of CUPS. Trial registration number http://ClinicalTrials.gov Identifier: NCT00382967.

Cited by 65 publications

References 38 publications

Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using ¹²³I-Ioflupane Injection (DaTscan) Imaging

Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using ¹²³I-Ioflupane Injection (DaTscan) Imaging

Nigrostriatal Dopamine Terminal Imaging with Dopamine Transporter SPECT: An Update

Role of Datscan and Clinical Diagnosis in Pd

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Impact of DaTscan SPECT imaging on clinical management, diagnosis, confidence of diagnosis, quality of life, health resource use and safety in patients with clinically uncertain parkinsonian syndromes: a prospective 1-year follow-up of an open-label controlled study

Abstract: DaTscan had a significant impact on clinical management, diagnosis and CoD in patients with CUPS. DaTscan is safe and well tolerated, and is a useful adjunct to differentiate a diagnosis of CUPS. Trial registration number http://ClinicalTrials.gov Identifier: NCT00382967.

Cited by 65 publications

References 38 publications

Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using 123I-Ioflupane Injection (DaTscan) Imaging

Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using 123I-Ioflupane Injection (DaTscan) Imaging

Nigrostriatal Dopamine Terminal Imaging with Dopamine Transporter SPECT: An Update

Role of Datscan and Clinical Diagnosis in Pd

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Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using ¹²³I-Ioflupane Injection (DaTscan) Imaging

Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using ¹²³I-Ioflupane Injection (DaTscan) Imaging