123I-FP-CIT brain SPECT (DaTSCAN) imaging in the diagnosis of patients with movement disorders: First results

Abstract

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. Transverse slices were reconstructed using a 0.6 order Butterworth filter. Visual interpretation was based on striatal uptake, left to right asymmetry and substructures most affected. The ratio of binding for the entire striatum, caudate and putamen to nonspecific binding in occipital cortex was calculated. SPECT findings were categorized as normal and abnormal (incipient, moderate and severe presinaptic deficit). Results. 123I-FP-CIT uptake was reduced in the striatum of 6/7 patients with PD and 5/6 patients with AP. Two patients with PD and AP showed a negative finding. The remaining 2 negative results were obtained in the patients diagnosed with essential tremor and psychogenic tremor. The mean striato-occipital ratio (SDR) of the most affected side was lower in the patients with PD. Conclusion. Our first results confirm the usefulness of 123I-FPCIT brain SPECT in differential diagnosis of extrapyramidal diseases.Uvod/Cilj. Scintigrafija mozga pomocu 123I-FP-CIT (DaTSCAN) tehnikom jednofotonske emisione komjuterizovane tomografije (SPECT), omogucava ispitivanje strukturnog i biohemijskog integriteta presinaptickog dopaminergickog neurotransmiterskog sistema. Cilj ovog rada bio je procena doprinosa 123I-FP-CIT SPECT scintigrafije mozga kod bolesnika sa ekstrapiramidnim poremecajima. Metode. Ispitivanjem je bilo obuhvaceno 15 bolesnika (osam muskaraca i sedam zena), starosti 26-81 godine, sa klinickim manifestacijama ekstrapiramidnog sindroma. Od ukupnog broja bolesnika, kod sedam inicijalno je postavljena dijagnoza Parkinsonove bolesti (PD) ili sumnja na PD, kod sest bolesnika dijagnoza atipicnog parkinsonizma (AP), a kod dvoje dijagnoza esencijalnog, odnosno psihogenog tremora. Snimanje mozga radjeno je SPECT tehnikom, dvoglavom gama kamerom, 180 min posle davanja obelezivacke doze 123I-FP-CITa aktivnosti 185 MBq. Akvizicija 64 jednominutna frema vrsena je po necirkularnoj orbiti u matrici 128 ? 128. Transverzalni preseci su rekonstruisani koriscenjem 0,6-rednog Butterworth filtera. Vizuelna interpretacija nalaza bazirana je na nakupljanju radiofarmaka u strijatumu, asimetriji vezivanja levo/desno i najzahvacenijim supstrukturama. Indeks vezivanja je racunat na osnovu odnosa nakupljanja u strijatumu, kaudatumu i putamenu i nespecificnog nakupljanja u okcipitalnom korteksu. Nalazi SPECT-a su kategorizovani kao normalni i patoloski (pocetni, umereni i izrazeni presinapticki deficit). Rezultati. Nakupljanje 123I-FP-CIT bilo je oslabljeno u regiji strijatuma kod sest od sedam bolesnika sa pouzdanom dijagnozom ili sumnjom na PD, kao i kod pet od sest bolesnika sa AP. Dva negativna nalaza dobijena su kod dve bolesnice sa PD i AP. Preostala dva negativna nalaza dobijena su kod dva bolesnika sa esencijalnim, odnosno psihogenim tremorom. Srednja vrednost strijato-okcipitalnog indeksa vezivanja na zahvacenoj strani mozga bila je niza kod bolesnika sa PD. Zakljucak. Nasi prvi rezultati potvrdjuju doprinos 123I-FP-CIT SPECT scintigrafije mozga u diferencijalnoj dijagnostici bolesnika sa ekstrapiramidnim poremecajima.