Reliability of visual assessment by non-expert nuclear medicine physicians and appropriateness of indications of [123I]FP-CIT SPECT imaging by neurologists in patients with early drug-naive Parkinson’s disease

Abstract

Purpose To determine the reliability of visual assessment of [ 123 I]FP-CIT SPECT imaging by non-experts in dopamine transporter (DAT) SPECT imaging in patients with early drug-naive Parkinson’s disease (PD). Also, we explored the indications of DAT SPECT imaging in clinical practice by neurologists. Methods We collected [ 123 I]FP-CIT SPECT scans of the Levodopa in EArly Parkinson’s disease (LEAP) trial participants that were made prior to recruitment, as part of routine clinical work-up. All scans were reassessed by an expert in DAT imaging. A survey on the use of DAT SPECT imaging was sent to all referring neurologists. Results The concordance of the initial local assessment and the expert reassessment was 98.7%. The survey showed that neurologists requested DAT SPECT imaging in only 73.6% of patients to differentiate between a neurodegenerative disease and non-neurodegenerative parkinsonism. Conclusions Visual assessment of [ 123 I]FP-CIT SPECT imaging by community nuclear medicine physicians in patients with early PD is reliable. Neurologists who request DAT SPECT scans are not always aware that the high accuracy is limited only to the differentiation between neurodegenerative and non-neurodegenerative parkinsonism. A significant portion of neurologists who request DAT SPECT scans is not always aware that the high accuracy is limited to the differentiation between neurodegenerative and non-neurodegenerative parkinsonism as DAT SPECT cannot reliably distinguish the various Parkinsonian syndromes.

Parkinson’s disease prognostic scores for progression of cognitive decline

“…As was explained above in the Introduction, early accurate diagnosis of PD is difficult because of its heterogeneity and poor distinguishability from other DaT deficit Parkinsonian syndromes, including dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, and cortical basal syndrome 35,36 . Therefore, it was acknowledged that the PPMI PD cohort used in the current study is likely to include a small number of participants with the indicated atypical Parkinsonian syndromes, although at each study visit (at PPMI) the PD diagnosis was reassessed to identify and exclude non-PD subjects 35 .…”

A systematic review of the potential effects of medications and drugs of abuse on dopamine transporter imaging using [123I]I-FP-CIT SPECT in routine practice

“…In addition to visual interpretation, semi-quantitative analysis is recommended in EANM/SNMMI guidelines to objectively assess striatal DAT binding [6,7]. Although semi-quantification is very useful to combine with the visual read as a tool to provide a more objective analysis of DAT scans, we believe that a careful visual evaluation of DAT scans should always be done (even when using quantification), and in some hospitals, it is the only method used [108][109][110][111]. Therefore, we focused on drugs that may influence significantly the visual read of [ 123 I]I-FP-CIT SPECT imaging (and the semi-quantification as well).…”

Path analysis of biomarkers for cognitive decline in early Parkinson’s disease

“…The current study considered 269 patients from the PPMI database, who satisfied the following inclusion criteria: (1) all participants had been diagnosed with idiopathic PD within two years prior to the initial screening visit and record of their baseline characteristics in the PPMI database [25]; (2) the period of observation of each participant after the initial visit was no less than 48 months; (3) none of the participants were treated for PD prior to recording their baseline characteristics in the PPMI database; (4) all participants displayed dopamine transporter deficit on the DaT scan at baseline, which was determined using the dopamine transporter single-photon emission computer tomography (DaT) averaged over the striatum [43][44][45]; (5) participants had asymmetric resting tremor or asymmetric bradykinesia, or at least two of the following: resting tremor, bradykinesia, and rigidity; (6) all participants had mild to moderate disease severity (Hoehn and Yahr stages I or II [46]) at baseline; and (7) participant's age was � 30 years.…”

“…Fourteen other demographic, clinical, and pathological measures evaluated at baseline were also considered, including: age, years of prior education, gender, University of Pennsylvania Smell Identification Test score, baseline combined score for Sections 1, 2 and 3 of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (UPDRS 1-3 ), rapid eye movement sleep behavior disorder score (RBD), Geriatric Depression Scale score (GDS), total State-Trait Anxiety Inventory score, DaT variable [43,45] calculated as the average specific binding ratio over the dorsal striatum including the caudate nucleus and putamen, plasma levels of insulin-like growth factor 1, and four CSF measures: alpha synuclein (α-syn), total tau (t-tau), phosphorylated tau 181 (p-tau), and amyloid beta 1-42 (Aβ 1-42 ). The collection process for the CSF measures was described elsewhere [25].…”