The utility of the combination of a SPECT study with [123I]-FP-CIT of dopamine transporters and [123I]-MIBG myocardial scintigraphy in differentiating Parkinson disease from other degenerative parkinsonian syndromes

Abstract

ObjectiveMolecular imaging of nigrostriatal dopamine transporters (DAT) and sympathetic cardiac innervation with single-photon emission computed tomography (SPECT) are useful tools for differentiating idiopathic Parkinson disease (PD) from other degenerative parkinsonian syndromes (non-PD). Nevertheless, these modalities are often insufficient for achieving a definite diagnosis. The aims of this study were to evaluate the diagnostic accuracy of the combination of these tools.Materials and methodsThe SPECT radiotracers [123I]-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)-nortropane (FP-CIT) and meta-[123I]-iodobenzylguanidine (MIBG) were used to research presynaptic dopaminergic projections (DAT SPECT) and myocardial adrenergic innervation (MIBG scintigraphy), respectively. PD patients (n=15; age: 61.5±13.6 years) and non-PD patients (n=19; age: 62.6±14.2 years) who underwent both tests were enrolled in this study. Receiver-operating characteristic analyses were used to set the cutoff values of the specific binding ratio in DAT SPECT and the heart to mediastinum ratio in delayed scan in MIBG scintigraphy for differentiating PD from non-PD. We calculated the sensitivity, specificity, and test accuracy of the individual methods and also the combination of these two modalities.ResultsWhen DAT SPECT and MIBG scintigraphy were used individually, they showed mild accuracy in differentiating PD from non-PD (DAT, 67.6%; MIBG, 67.6%). The combination of the two approaches using cutoff values of less than 3.24 for the specific binding ratio and less than 2.745 for the delayed heart to mediastinum ratio enabled more accurate differentiation between PD and non-PD. The accuracy of these indices in distinguishing PD from non-PD was 79.4%.ConclusionThese results suggested that the combination of DAT SPECT and MIBG scintigraphy may improve the diagnostic accuracy in differentiating PD from non-PD.

The Utility of the Combined Use of ¹²³I-FP-CIT and ¹²³I-MIBG Myocardial Scintigraphy in Differentiating Parkinson’s Disease from Other Parkinsonian Syndromes

“…Furthermore, mild to moderate accuracy has been reported for distinguishing PD from degenerative parkinsonian syndromes. 17,[20][21][22]35 It has been reported that the laterality of clinical symptoms in patients with PD contributes to the diagnosis of PD at an early stage. 36,37 On DAT-SPECT, the binding of ligands in the most affected side, which is the opposite side as the symptoms, results in a lower value.…”

“…Therefore, to overcome the shortcomings of each modality, the combination of DAT-SPECT and MIBG myocardial scintigraphy has been investigated for finding out PD in patients with parkinsonian syndrome. [13][14][15][16][17][18][19][20][21][22][23] According to the recent studies, Yoshii et al reported the combination of the SBR in DAT-SPECT and H/M ratio (delayed) in MIBG myocardial scintigraphy, using cut off values of less than 4.5 for the SBR and less than 2.2 for the H/M ratio (delayed) showed moderate accuracy (77.1%) in differentiating PD from APD. 20 Uyama et al reported the combination of the SBR in DAT-SPECT and H/M ratio (delayed) in MIBG myocardial scintigraphy, using cut off values of less than 3.24 for the SBR and less than 2.745 for the H/ M ratio (delayed) showed moderate accuracy (79.4%) in differentiating PD from APD.…”

“…8 The usefulness of the combination of DAT-SPECT and MIBG myocardial scintigraphy has been reported in patients with parkinsonian syndrome. [13][14][15][16][17][18][19][20][21][22][23] A multiparametric scoring system (MSS) is an original simple method using summed scores obtained by each parameter according to its threshold for discriminating two groups. In our previous studies, MSS has improved accuracy compared to each parameter of multiple physiologic MR studies including diffusion weighted imaging, perfusion weighted imaging, and MR spectroscopy in differentiating tumor progression from radiation change.…”

Impairments in gait kinematics and postural control may not correlate with dopamine transporter depletion in individuals with mild to moderate Parkinson's disease

“…An accurate diagnosis of PD can be challenging, remaining complex to differentiate PD from other parkinsonian syndromes (Uyama et al., ). Recently, molecular imaging techniques using single‐photon emission computed tomography (SPECT) have been widely employed in the identification of dopamine deficit, assessing the dopamine transporters (DAT) depletion (Brooks, ).…”

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“…This criterion has been recommended for the evaluation of PD in clinical practice 10,11 . Different ligands of DAT have been successful suggested in Positron Emission Tomography (PET) imaging scintigraphy and Single Photon Emission Computerized Tomography (SPECT) radioisotope scintigraphy for the diagnosis of PD 12 .…”