The diagnostic accuracy of dopamine transporter SPECT imaging to detect nigrostriatal cell loss in patients with Parkinson’s disease or clinically uncertain parkinsonism: a systematic review

Abstract

In specialized movement disorder centers, Parkinson’s disease (PD) is wrongly diagnosed in 6 to 25% of cases. To improve the accuracy of the clinical diagnosis, it is necessary to have a reliable and practical reference standard. Dopamine transporter single-photon emission computed tomography (DAT SPECT) imaging might have the potential (high diagnostic accuracy and practical to use) to act as reference standard in detecting nigrostriatal cell loss in patients with (early stage) parkinsonism. We performed a systematic review to evaluate if DAT SPECT imaging can be used as such. Relevant studies were searched in the MEDLINE and EMBASE databases. Studies were selected when they met the following criteria: (1) all patients were adults with a clinical diagnosis of PD or clinically uncertain parkinsonism and (2) the study reported original data. In addition, studies needed to fulfill one of the two following criteria: (1) patients underwent at least one DAT SPECT and had a neuropathological confirmed diagnosis and (2) patients underwent at least two DAT SPECT scans, performed at least 2 years apart. The search identified 1,649 articles. Eight studies fulfilled our selection criteria and were included in this review. There was only one study including patients with diagnostic uncertainty. Sensitivity and specificity of DAT SPECT imaging to detect nigrostriatal cell loss were 98%. The other studies included patients with a diagnosis of PD in whom there was no uncertainty. In these studies, sensitivity was 100%. Our systematic review indicates that DAT SPECT imaging seems to be accurate to detect nigrostriatal cell loss in patients with parkinsonism.Electronic supplementary materialThe online version of this article (doi:10.1186/s13550-015-0087-1) contains supplementary material, which is available to authorized users.

Application of texture analysis to DAT SPECT imaging: Relationship to clinical assessments

“…The somewhat subjective nature of UPDRS evaluation makes this scale also prone to inter-rater variability. There have been multiple attempts to improve the reliability and accuracy of disease metrics and establishing early diagnosis, such as feature extraction algorithms using MRI data (Noh et al, 2015, Singh and Samavedham, 2015), population-based modeling using a combination of genetic and clinical data (Nalls et al, 2015) or combination of DAT SPECT and clinical data (Suwijn et al, 2015). Despite this, though we recognize uncertainties associated with onset (both time of diagnosis and time of first reported symptom) and disease metrics, the present framework with image-driven textural features had to rely on standard and validated data such as UPDRS and best available date of first symptom/diagnosis.…”

Neuroimaging of Parkinson's disease: Expanding views

“…One of the most repeated observations is that PD patients compared with healthy controls show decreased dopamine function in the striatum (caudate and putamen) (Bajaj et al, 2013; Brooks & Pavese, 2011; Suwijn et al, 2015). This has been observed in PET/SPECT studies of aromatic acid decarboxylase activity, dopamine receptors, and dopamine and vesicular monoamine transporters (Table 2).…”

Semi-Automatic Signature-Based Segmentation Method for Quantification of Neuromelanin in Substantia Nigra

“…Positron emission tomography (PET) offers a reliable distinction between patients with Parkinsonian disorders and healthy subjects and can differentiate between PD and Parkinson plus syndromes [5][6][7]. Dopamine transporter single-photon emission computed tomography (DaT-SPECT) can reliably differentiate some, but not all, parkinsonian syndromes [8][9][10]. Moreover, both PET and SPECT emit X-rays [11].…”