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. 2018;2(1):10.
doi: 10.1186/s41824-018-0028-0. Epub 2018 May 21.

Interpreting 123I-ioflupane dopamine transporter scans using hybrid scores

Kenneth J Nichols  1   2 , Brandon Chen  1 , Maria B Tomas  1   2 , Christopher J Palestro  1   2
Affiliations

Interpreting 123I-ioflupane dopamine transporter scans using hybrid scores

Kenneth J Nichols et al. Eur J Hybrid Imaging. 2018.

Abstract

Background: Dopamine 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).

Methods: Data 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.

Results: Thirty-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.

Conclusions: Our 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.

Keywords: 123I–ioflupane; Brain SPECT; DaT; Dementia with Lewy bodies; Dopamine transporters; Parkinson’s disease.

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Conflict of interest statement

The Institutional Review Board approved this retrospective study and the requirement to obtain informed consent was waived. All data were handled in compliance with the Health Insurance Portability and Accountability Act of 1996.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
DaT scan examples. DaT scan transaxial SPECT sections for: (a) a patient with essential tremor, showing high symmetric uptake in both caudate and putamen regions; (b) a patient with Parkinson’s disease, showing markedly reduced putamen activity and asymmetric caudate activity; (c) a patient with dementia with Lewy bodies, showing nearly absent caudate and putamen uptake
Fig. 2
Fig. 2
Physical phantom. a Physical phantom with syringes loaded with radioactivity representing caudate (C) and putamen (P) structures, and radioactivity loaded into surrounding water background (B). Reconstructed phantom images for simulations representing (b) essential tremor and (c) Parkinson’s disease
Fig. 3
Fig. 3
Putamen specific binding ratios. Putamen specific binding ratio (PSBR) plotted for patients with essential tremor (ET), Parkinson’s disease (PD), multiple system atrophy (MA) and dementia with Lewy bodies (DLB)
Fig. 4
Fig. 4
Visual scores. a Visual scores plotted for patients with ET, PD, MA and DLB. 4 (b) Indexed visual scores plotted for patients with ET, PD, MA and DLB
See this image and copyright information in PMC

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