Cost‐effectiveness of<sup>123</sup>I‐FP‐CIT SPECT in the differential diagnosis of essential tremor and Parkinson's disease in Italy

Antonini, Angelo; Berto, Patrizia; Lopatriello, Stefania; Tamma, Filippo; Annemans, Lieven; Chambers, Mike

doi:10.1002/mds.22278

Cited by 53 publications

(72 citation statements)

References 14 publications

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“…Meta-analysis confirmed the role of radionuclide imaging in this setting [1] and further cost-effectiveness studies showed the economic benefits of this diagnostic procedure [2,3]. Recently, we read with great interest the paper of Badiavas and colleagues [4] published in your journal.…”

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confidence: 69%

FP-CIT SPECT evaluation: time to go beyond visual assessment!

Skanjeti

Angusti

Margheron

et al. 2012

Eur J Nucl Med Mol Imaging

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Dear Sir, Nowadays, FP-CIT single photon emission computed tomography (SPECT) is used in the assessment of patients with extrapyramidal syndrome. Meta-analysis confirmed the role of radionuclide imaging in this setting [1] and further cost-effectiveness studies showed the economic benefits of this diagnostic procedure [2,3]. Recently, we read with great interest the paper of Badiavas and colleagues [4] published in your journal. The authors presented a stimulating review about SPECT imaging in movement disorders and focused on the semi-quantitative evaluation after referring to tracer kinetic models. They reviewed several semiquantitative methods: manual positioning of anatomical regions of interest (ROIs), an expedient approach to avoid the partial volume effect (PVE), advanced automated quantification methods (in particular BasGan) and voxel-based statistical methods (such as SPM and NEUROSTAT). In conclusion it was remarked that, despite both the need of experience for a correct visual assessment and strong European Association of Nuclear Medicine (EANM) encouragement for semi-quantitative evaluation, no semi-quantitative method has been accepted as a standard. Consequently, qualitative evaluation is still the standard. In the authors' view, a perfect software should be PC-based, automated (i.e. would analyse raw or mildly processed data), should give reproducible output and should not depend on a specific gamma camera. An ideal software will also perform a comparison with a database of values from normal subjects.BasGan is a PC-based software freely available from the Associazione Italiana di Medicina Nucleare (AIMN) site. It is not dependent on a specific gamma camera (it analyses DICOM images after transaxial reconstruction) and performs a comparison with a database of normal results. Furthermore, the BasGan creators announced at the last EANM congress the final phase of a European project aiming to realize a database with values from healthy subjects acquired from all around the European continent [5]. On the other hand, to the best of our knowledge, no published study evaluated BasGan in a patient population, except for a small population study performed by the above-mentioned group. So, the utility of BasGan needs to be confirmed in a larger population from multicentre trials. These should validate normal references and demonstrate their usefulness to correctly establish the presence of disease. Indeed, BasGan should be useful to improve FP-CIT SPECT reports in different centres, from several countries, acquired with distinct gamma camera models and reconstructed with diverse processing applications.In our institution we evaluated the role of BasGan in 59 consecutive patients (mean age 68 years, 32 men and 27 women). FP-CIT SPECTs obtained in 2006 and 2007 were analysed with the above-mentioned software and then correlated with final diagnosis. Disease (if any) was established by the neurologists in light of all relevant data; however, given the long follow-up (at least 3 years), we think that the diagno...

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mentioning

confidence: 69%

FP-CIT SPECT evaluation: time to go beyond visual assessment!

Skanjeti

Angusti

Margheron

et al. 2012

Eur J Nucl Med Mol Imaging

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“…Some studies have already focused on this issue. For example, an Italian study reported an overall decrease of costs for the health care system by implementing 123 I-FP-CIT SPECT for differential diagnosis of ET versus IPS, as compared with the conventional diagnostic pathway based on clinical judgment alone (81). 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.…”

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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“…Although DAT imaging may be expensive, the cost effectiveness of DAT imaging is reported to be good (49)(50)(51). For example, Van Laere et al (51) analyzed the cost FIGURE 6.…”

Section: Cost Effectiveness Of Dat Imagingmentioning

confidence: 99%

A New Era of Clinical Dopamine Transporter Imaging Using 123I-FP-CIT

Park

2012

Journal of Nuclear Medicine Technology

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123 I-labeled 2b-carbomethoxy-3b-(4-iodophenyl)-N-(3-fluoropropyl)nortropane ( 123 I-FP-CIT) was approved for clinical use in 2011 by the Food and Drug Administration. 123 I-FP-CIT is a radioligand for brain dopamine transporter (DAT) imaging that is useful for the differential diagnosis of Parkinson disease (PD) and other diseases that mimic PD. The sensitivity and specificity of 123 I-FP-CIT SPECT for PD diagnosis are more than 90% and equivalent to those of other DAT SPECT methods. In the near future, the clinical indications of DAT imaging are expected to be broadened; for example, including treatment response assessment, disease progression monitoring, and early diagnosis of premotor PD in each individual patient. Parki nson disease (PD) is the second most common neurodegenerative disorder after Alzheimer dementia (1). Studies suggest that PD affects at least 500,000 people in the United States (2), and 1%-2% of people over 65 y old have PD (3). Approximately 50,000 new cases are diagnosed each year (4). The financial and public health impact of this disease is expected to increase as the average age of the population increases (2).The classic motor symptoms of PD are tremor of a limb, rigid limbs, slow movement, and balance problems. The tremor often begins insidiously on one side of the body and spreads to the other side with a slowly deteriorating course (5,6). These symptoms are attributed mostly to dopamine deficit, secondary to progressive loss of dopamine-secreting neurons projecting from the substantia nigra to the striatum (7,8). Dopamine is a neurotransmitter that regulates movement, and therefore the lack of dopamine produces abnormal movement. The dopamine transporter (DAT) controls the intensity and duration of dopaminergic neurotransmission by rapid reuptake of dopamine into presynaptic terminals (9-11). DAT density correlates with the density of dopaminergic neurons and is used as an imaging biomarker for diagnosing PD. Striatal uptake of 123 I-FP-CIT is reduced in patients with PD, which is a motor system disorder resulting from dopaminergic neurodegeneration. DAT DENSITY AND 123 I-FP-CIT UPTAKEDAT is a sodium chloride-dependent transmembrane protein on the presynaptic dopaminergic nerve terminal that controls dopamine levels by active reuptake of dopamine from the synaptic cleft after its interaction with the postsynaptic receptor (11,13). Striatal 123 I-FP-CIT uptake is correlated with DAT density (14). With dopaminergic neurodegeneration, DAT density decreases and therefore striatal 123 I-FP-CIT uptake is reduced on DAT imaging. WHY DO WE IMAGE STRIATAL DAT DENSITY?Why do we image DAT density in the striatum when the major pathology of PD is in the neurodegeneration of dopaminergic cells in the substantia nigra? The reason is that DAT is specific to dopaminergic neurons and best correlates with the density of dopaminergic neurons. Imaging other aspects of dopaminergic neuronal function-for example, dopamine synthesis rate or dopamine receptor density-can evaluate dopaminergic neurodegener...

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Cost‐effectiveness of¹²³I‐FP‐CIT SPECT in the differential diagnosis of essential tremor and Parkinson's disease in Italy

Cited by 53 publications

References 14 publications

FP-CIT SPECT evaluation: time to go beyond visual assessment!

FP-CIT SPECT evaluation: time to go beyond visual assessment!

Nigrostriatal Dopamine Terminal Imaging with Dopamine Transporter SPECT: An Update

A New Era of Clinical Dopamine Transporter Imaging Using 123I-FP-CIT

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Cost‐effectiveness of123I‐FP‐CIT SPECT in the differential diagnosis of essential tremor and Parkinson's disease in Italy

Cited by 53 publications

References 14 publications

FP-CIT SPECT evaluation: time to go beyond visual assessment!

FP-CIT SPECT evaluation: time to go beyond visual assessment!

Nigrostriatal Dopamine Terminal Imaging with Dopamine Transporter SPECT: An Update

A New Era of Clinical Dopamine Transporter Imaging Using 123I-FP-CIT

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Cost‐effectiveness of¹²³I‐FP‐CIT SPECT in the differential diagnosis of essential tremor and Parkinson's disease in Italy