Original Article

European Journal of Nuclear Medicine and Molecular Imaging

, Volume 37, Issue 11, pp 2154-2164

Pre- and postsynaptic dopamine SPECT in the early phase of idiopathic parkinsonism: a population-based study

  • Susanna Jakobson MoAffiliated withDepartment of Radiation Sciences, Diagnostic Radiology, Umeå University Email author 
  • , Jan LinderAffiliated withDepartment of Pharmacology and Clinical Neuroscience, Neurology, Umeå University
  • , Lars ForsgrenAffiliated withDepartment of Pharmacology and Clinical Neuroscience, Neurology, Umeå University
  • , Anne LarssonAffiliated withDepartment of Radiation Sciences, Radiation Physics, Umeå University
  • , Lennart JohanssonAffiliated withDepartment of Radiation Sciences, Radiation Physics, Umeå University
  • , Katrine RiklundAffiliated withDepartment of Radiation Sciences, Diagnostic Radiology, Umeå University

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Abstract

Purpose

The aim of this study was to assess the diagnostic contribution of pre- and postsynaptic dopamine SPECT in drug-naïve patients with early idiopathic parkinsonism and to investigate possible differences between idiopathic Parkinson’s disease (PD) and atypical parkinsonian syndromes (APS) and possible differences in motor subtypes of parkinsonism.

Methods

A group of 128 newly diagnosed idiopathic parkinsonian patients and 48 healthy controls was studied. Presynaptic baseline SPECT with 123I-FP-CIT was performed in all patients and in 120 patients also a baseline postsynaptic SPECT with 123I-IBZM. Clinical diagnoses were reassessed after 12 months.

Results

Presynaptic uptake in the putamen and caudate was significantly reduced in patients compared to controls. Presynaptic uptake ratios were not different between PD patients and patients with APS, and postsynaptic uptake in APS was not significantly reduced compared to PD or controls. In half of the APS patients both pre- and postsynaptic uptake ratios were reduced on the same side in the striatum. Impaired motor performance was associated with decreased presynaptic uptake in the putamen in PD. The postural instability and gait difficulty (PIGD) subtype of PD had lower presynaptic uptake ratios than patients with tremor-dominated (TD) symptoms.

Conclusion

Not only presynaptic putamen uptake ratios, but also caudate ratios were reduced in a majority of the patients in our study. At baseline scan, i.e. in an early stage of the disease, the accuracy of excluding APS in the whole study population was 85% using a combination of pre- and postsynaptic SPECT. Already at baseline, lower presynaptic SPECT ratios were seen in PD with PIGD at onset compared to those with TD subtype.

Keywords

Parkinson’s disease Parkinsonian syndromes 123I-IBZM 123I-FP-CIT SPECT