Is There a Role for DAT-SPECT Imaging in a Specialty Movement Disorders Practice?

Bega, Danny; Gonzàlez‐Latapi, Paulina; Zadikoff, Cindy; Spies, William G.; Simuni, Tanya

doi:10.1159/000370116

Cited by 18 publications

(17 citation statements)

References 11 publications

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“…One study found that 97% of patients with a normal DaT scan do not have a form of neurodegenerative PS at 3 year follow-up (Marshal et al, 2009 ). A DaT scan often changes management, and medication or diagnosis changes were seen in 59% of patients following a DaT scan at a major tertiary care center (Bega et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Interpreting 123I–ioflupane dopamine transporter scans using hybrid scores

Nichols

Chen

Tomas

et al. 2018

European J Hybrid Imaging

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BackgroundDopamine transporter (DaT) 123I–FP-CIT scans most commonly are interpreted visually. Alternatively, absolute quantitation of radiopharmaceutical uptake may improve scan accuracy. However, neither approach accomodates dependence of striatal uptake on age and gender. We investigated whether demographic indexing of visual and numerical variables improve discrimination of patients with essential tremor (ET), Parkinson’s disease (PD), and dementia with Lewy bodies (DLB).MethodsData of 132 consecutive patients undergoing DaT SPECT scans were reviewed retrospectively. The clinical impression in the latest neurology note was utilized as the final clinical diagnosis. Caudate and putamen specific binding ratio (PSBR) were computed. 123I calibration phantoms were constructed to enable absolute quantitation of putamen radiopharmaceutical uptake. A single experienced nuclear medicine physician graded visual certainty on a 3-level scale. Demographic indexing normalized metrics to published normal PSBR values. Methods were compared by simultaneous ROC analyses to identify the technique of maximal accuracy.ResultsThirty-four patients (26%) were diagnosed with ET, 85 (64%) with PD, 6 (5%) with multiple system atrophy, and 7 (5%) with DLB. For discriminating DLB from PD, visual analysis was significantly less specific and accurate than the other techniques. However, indexing significantly improved specificity and accuracy of visual scores, such that indexed visual scores were statistically equivalent to all other methods. Indexed PSBR yielded essentially the same results as non-indexed PSBR, for which highest overall test efficacy was achieved.ConclusionsOur results in this small series of patients with DLB suggest that if 123I–FP-CIT visual scores are to be used to discriminate DLB from other neurologic disorders, demographic indexing should be applied. However, best results overall are obtained using quantified parameters, regardless of whether or not demographic indexing is applied to these values.

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Section: Discussionmentioning

confidence: 99%

Interpreting 123I–ioflupane dopamine transporter scans using hybrid scores

Nichols

Chen

Tomas

et al. 2018

European J Hybrid Imaging

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“…Moreover, it has been suggested that DAT SPECT imaging has a significant impact on clinical diagnosis even in tertiary movement disorder clinics. Studies have reported that 59-63% of cases with diagnostic uncertainty seen at a tertiary referral center who underwent DAT SPECT resulted in a change in clinical approach 15,16 . More recently, Graebner et al reported their experience in 27 cases seen at a movement disorder center; they found that 88.9% of the cases resulted in changes on subsequent clinical decisions after the DAT SPECT imaging was performed 17 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Utility of [11C]DTBZ Positron Emission Tomography In Clinically Uncertain Parkinsonism: Experience of a Single Tertiary Center

Perez‐Lohman

Kerik

Díaz-Meneses

et al. 2018

RIC

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Background: The use of single-photon emission computed tomography and positron emission tomography (PET) has proven to be helpful in differentiating Parkinson's disease (PD) from other movement disorders with a sensitivity of up to 95%. Objective: The objective of this study was to determine the accuracy of [ 11 C]DTBZ PET imaging in patients with clinically uncertain parkinsonism from a tertiary referral center in Mexico City. Materials and Methods: Patients who underwent [ 11 C]DTBZ PET brain scan due to clinically uncertain parkinsonism where divided into two groups: PD or non-PD. A scan was considered positive when visual assessment revealed a decrease in [ 11 C]DTBZ uptake typical for PD; a scan was considered negative when visual assessment showed no decrease in [ 11 C]DTBZ uptake or showed a decrease in tracer uptake in a non-PD pattern. Sensitivity, specificity, and positive and negative predictive values were calculated using a 2 × 2 table, with a 95% confidence interval. Results: A total of 39 patients were included in the study. 14 PET studies were deemed positive and 25 PET studies were deemed negative; 12 true positives and 23 true negatives were found. This yielded a sensitivity of 92.9% (95% CI, 66.1-99.8),

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“…A recent retrospective analysis from a subspecialty movement disorder clinic in a US academic medical center reports that a change in diagnosis or medication regimen occurred in 59% of patients within one visit after dopamine transporter imaging [ 16 ]. The greatest impact on change to clinical diagnosis and/or medication regimen was found for patients with a pre-imaging diagnosis of essential tremor vs Parkinson’s disease.…”

Section: Discussionmentioning

confidence: 99%

Patient Survey on Satisfaction and Impact of 123I-Ioflupane Dopamine Transporter Imaging

Covington

Sherman²,

Lewis³

et al. 2015

PLoS ONE

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Patients were surveyed to assess the impact of dopamine transporter imaging on diagnostic confidence, change in treatment plan, effect on medication compliance, and subjective well-being. Surveys were sent to 140 patients who completed dopamine transporter imaging an average of 18 months prior. Sixty-five surveys from patients (46%) were returned. Questions assessed patients’ perceived impact of the imaging on their care. Increased diagnostic confidence following imaging was reported by 69% of patients. Changes to treatment plan from imaging were reported by 24% of patients. Overall satisfaction with the study and its impact was reported by 70% of patients. Dopamine transporter imaging increased diagnostic confidence among patients and overall patient satisfaction with the impact of imaging on clinical care was high.

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Is There a Role for DAT-SPECT Imaging in a Specialty Movement Disorders Practice?

Cited by 18 publications

References 11 publications

Interpreting 123I–ioflupane dopamine transporter scans using hybrid scores

Interpreting 123I–ioflupane dopamine transporter scans using hybrid scores

Diagnostic Utility of [11C]DTBZ Positron Emission Tomography In Clinically Uncertain Parkinsonism: Experience of a Single Tertiary Center

Patient Survey on Satisfaction and Impact of 123I-Ioflupane Dopamine Transporter Imaging

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