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Comparison between visual assessment of dopaminergic degeneration pattern and semi-quantitative ratio calculations in patients with Parkinson’s disease and Atypical Parkinsonian syndromes using DaTSCAN® SPECT

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Abstract

Objective

To verify if 123I-FP-CIT, DaTSCAN® can differentiate early stages of Parkinson’s disease (PD) as well as patients with Atypical Parkinsonian syndromes (APS) from manifest Parkinson’s disease.

Methods

128 consecutive patients were investigated with 123I-FP-CIT SPECT during a 4-year period. All patients were diagnosed according to the established consensus criteria for diagnosis of PD (n = 53) and APS (n = 19). Remaining patients were grouped early PD (before onset of l-DOPA medication), (n = 20), vascular PD (n = 6), and non-PD syndromes (n = 30) and SWEDD (n = 1). SPECT images were analyzed visually according to a predefined ranking scale of dopaminergic nerve cell degeneration, distinguishing a posterior–anterior degeneration pattern (egg shape) from a more global and severe degeneration pattern (burst striatum). Striatum uptake ratios were quantitatively analyzed with the 3D software, EXINI.

Results

In the group of APS patients, the burst striatum pattern was most frequent and found in 61 % (11/18 patients). In PD patients, the egg shape pattern was dominating, especially in early PD where it was present in 95 % (19/20 patients). The positive predictive value for the egg shape pattern to diagnose PD was 92 % in this material (APS and all PD patients) and the specificity 90 % for the burst striatum pattern to exclude APS. The uptake ratios were reduced in both PD and APS patients and closely related to the image ranking.

Conclusion

In this study, we found that in more than half of the patients it was possible to differentiate between PD and APS by visual interpretation only. Similar results were obtained using semi-quantitative uptake ratios. Combining visual assessment with uptake ratios did not add to the discriminating power of DaTSCAN® SPECT in this material.

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Acknowledgments

The authors thank Mats Fredrikson, Linköping Academic Research Centre (LARC), Linköping University for statistical advice.

Conflict of interest

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Clinical Physiology, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 58185, Linköping, Sweden

    Anette Davidsson, Göran Granerus & Helene Zachrisson

  2. Division of Radiology, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden

    Charalampos Georgiopoulos

  3. Division of Neurology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden

    Nil Dizdar

  4. Department of Clinical Physiology, Heart and Medicine Centre, County Council of Östergötland, Linköping, Sweden

    Anette Davidsson, Göran Granerus & Helene Zachrisson

  5. Department of Neurology, Local Health Care Services in Central Östergötland, County Council of Östergötland, Linköping, Sweden

    Nil Dizdar

  6. Department of Radiology in Linköping, Centre for Diagnostics, County Council of Östergötland, Linköping, Sweden

    Charalampos Georgiopoulos

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  1. Anette Davidsson
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Correspondence to Anette Davidsson.

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Davidsson, A., Georgiopoulos, C., Dizdar, N. et al. Comparison between visual assessment of dopaminergic degeneration pattern and semi-quantitative ratio calculations in patients with Parkinson’s disease and Atypical Parkinsonian syndromes using DaTSCAN® SPECT. Ann Nucl Med 28, 851–859 (2014). https://doi.org/10.1007/s12149-014-0878-x

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  • DOI: https://doi.org/10.1007/s12149-014-0878-x

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