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Review
. 2024 Apr 22:15:1395413.
doi: 10.3389/fneur.2024.1395413. eCollection 2024.

Practical use of DAT SPECT imaging in diagnosing dementia with Lewy bodies: a US perspective of current guidelines and future directions

Deirdre M O'Shea  1 , Alexander Arkhipenko  2 , Douglas Galasko  3 , Jennifer G Goldman  4   5 , Zulfiqar Haider Sheikh  6 , George Petrides  7 , Jon B Toledo  8 , James E Galvin  1
Affiliations
Review

Practical use of DAT SPECT imaging in diagnosing dementia with Lewy bodies: a US perspective of current guidelines and future directions

Deirdre M O'Shea et al. Front Neurol. .

Abstract

Background: Diagnosing Dementia with Lewy Bodies (DLB) remains a challenge in clinical practice. The use of 123I-ioflupane (DaTscan™) SPECT imaging, which detects reduced dopamine transporter (DAT) uptake-a key biomarker in DLB diagnosis-could improve diagnostic accuracy. However, DAT imaging is underutilized despite its potential, contributing to delays and suboptimal patient management.

Methods: This review evaluates DLB diagnostic practices and challenges faced within the U.S. by synthesizing information from current literature, consensus guidelines, expert opinions, and recent updates on DaTscan FDA filings. It contrasts DAT SPECT with alternative biomarkers, provides recommendations for when DAT SPECT imaging may be indicated and discusses the potential of emerging biomarkers in enhancing diagnostic approaches.

Results: The radiopharmaceutical 123I-ioflupane for SPECT imaging was initially approved in Europe (2000) and later in the US (2011) for Parkinsonism/Essential Tremor. Its application was extended in 2022 to include the diagnosis of DLB. DaTscan's diagnostic efficacy for DLB, with its sensitivity, specificity, and predictive values, confirms its clinical utility. However, US implementation faces challenges such as insurance barriers, costs, access issues, and regional availability disparities.

Conclusion: 123I-ioflupane SPECT Imaging is indicated for DLB diagnosis and differential diagnosis of Alzheimer's Disease, particularly in uncertain cases. Addressing diagnostic obstacles and enhancing physician-patient education could improve and expedite DLB diagnosis. Collaborative efforts among neurologists, geriatric psychiatrists, psychologists, and memory clinic staff are key to increasing diagnostic accuracy and care in DLB management.

Keywords: 123I-ioflupane; Alzheimer’s disease; DLB; DaTscan; Parkinson’s disease; SPECT imaging; clinical diagnosis; dementia with Lewy bodies.

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Conflict of interest statement

Authors AA and ZS are employed by GE Healthcare. The authors declare that this study received funding from GE HealthCare. The funder had the following involvement in the study: originating and contributing to the conceptualization of the article, reviewing and providing critical scientific evaluation of the manuscript. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Examples of normal and abnormal DAT SPECT scans. (A) DAT signal in a healthy individual. Note the symmetric uptake of the tracer in the caudate and putamen that appears “comma-shaped”. (B1) Mild asymmetric putaminal reduction. (B2) Moderate/severe asymmetric putaminal reduction. Marked loss of activity in the putamen. (C) Balanced loss across the striata with relatively raised background activity. (D) Bilateral loss of DAT signal in the putamen with relative preservation in the caudate resulting in a “dot-shape” or “egg-shape” appearance. (E) Very little DAT signal at the striata evident by the marked background activity relative to the striatum sometimes known as “burst striata”.
Figure 2
Figure 2
Proposed diagnostic algorithm for Dementia with Lewy Bodies (DLB).
See this image and copyright information in PMC

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