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Predictive value of dopamine transporter SPECT imaging with [123I]PE2I in patients with subtle parkinsonian symptoms

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To examine the diagnostic sensitivity and specificity of dopamine transporter SPECT imaging with a highly dopamine transporter selective radioligand. The study included consecutively enrolled, drug-naive patients with an average short history of parkinsonian motor symptoms, referred for diagnostic scanning.

Methods

The study group comprised 288 patients naive to antiparkinson treatment who were enrolled as they were admitted for a diagnostic SPECT scan with the radioligand [123I]-N-(3-iodoprop-2E-enyl)-2-β-carbomethoxy-3β-(4-methylphenyl)nortropane (123I-PE2I). After the diagnostic scanning, patients were followed clinically with an average follow-up of 19.7 ± 12.5 months.

Results

A diagnosis could be clinically settled in 189 patients and among these patients, a dopamine transporter scan had a sensitivity of 88% and a specificity of 91% for discrimination between patients with and without striatal neurodegeneration. In cognitively impaired patients (Mini Mental State Examination <27) the specificity was 75% and the sensitivity 95%. A striatal anterior–posterior ratio (APR) of >2 differentiated between idiopathic Parkinson’s disease and atypical parkinsonian syndromes with a specificity of 84% and a sensitivity of 63%.

Conclusion

In drug-naive patients with subtle clinical parkinsonian motor symptoms, dopamine transporter scan using 123I-PE21 has a high sensitivity and specificity in distinguishing between patients with and without striatal neurodegeneration. The specificity is lower in patients who are also cognitively impaired. Calculation of the striatal APR can assist in differentiating between idiopathic Parkinson’s disease and atypical parkinsonian syndromes.

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Acknowledgments

The authors thank Glenna Skouboe, Svitlana Olsen, Anita Dole and Karin Stahr for expert technical assistance. This work was supported by Rigshospitalet, The Lundbeck Foundation, the EC-FP6 project DiMI LSHB-CT-2005-512146, The Toyota Foundation, The University of Copenhagen, and HR (The Capital Region of Denmark).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Neurobiology Research Unit & Cimbi, Rigshospitalet and University of Copenhagen, N9201, 9 Blegdamsvej, Copenhagen, DK-2100, Denmark

    Morten Ziebell, Gerda Thomsen, Lars H. Pinborg, Steen G. Hasselbalch & Gitte M. Knudsen

  2. Memory Disorders Research Group, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark

    Birgitte B. Andersen & Steen G. Hasselbalch

  3. Epilepsy Clinic, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark

    Lars H. Pinborg

  4. Clinic for Movement Disorders, Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark

    Merete Karlsborg

Authors
  1. Morten Ziebell
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  2. Birgitte B. Andersen
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  4. Lars H. Pinborg
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  7. Gitte M. Knudsen
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Corresponding author

Correspondence to Morten Ziebell.

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Study funding

This work was supported by Rigshospitalet, the Lundbeck Foundation, the EC-FP6-project DiMI LSHB-CT-2005-512146, the University of Copenhagen, and The Capital Region of Denmark. The Danish Research Council and the Toyota Foundation are gratefully acknowledged for funding the SPECT scanner,

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Ziebell, M., Andersen, B.B., Thomsen, G. et al. Predictive value of dopamine transporter SPECT imaging with [123I]PE2I in patients with subtle parkinsonian symptoms. Eur J Nucl Med Mol Imaging 39, 242–250 (2012). https://doi.org/10.1007/s00259-011-1976-9

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  • DOI: https://doi.org/10.1007/s00259-011-1976-9

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