Quantitative simultaneous 99mTc-ECD/123I-FP-CIT SPECT in Parkinson’s disease and multiple system atrophy

  • Georges El FakhriEmail author
  • Marie-Odile Habert
  • Philippe Maksud
  • Aurélie Kas
  • Zoulikha Malek
  • Marie Foley Kijewski
  • Lucette Lacomblez
Short Communication



The purpose of this study was to investigate the feasibility and utility of dual-isotope SPECT for differential diagnosis of idiopathic Parkinson’s disease (IPD) and multiple system atrophy (MSA).


Simultaneous 99mTc-ECD/123I-FP-CIT studies were performed in nine normal controls, five IPD patients, and five MSA patients. Projections were corrected for scatter, cross-talk, and high-energy penetration, and iteratively reconstructed while correcting for patient-specific attenuation and variable collimator response. Perfusion and dopamine transporter (DAT) function were assessed using voxel-based statistical parametric mapping (SPM2) and volume of interest quantitation. DAT binding potential (BP) and asymmetry index (AI) were estimated in the putamen and caudate nucleus.


Striatal BP was lower in IPD (55%) and MSA (23%) compared to normal controls (p<0.01) , and in IPD compared to MSA (p<0.05). AI was greater for IPD than for MSA and controls in both the caudate nucleus and the putamen (p<0.05). There was significantly decreased perfusion in the left and right nucleus lentiformis in MSA compared to IPD and controls (p<0.05).


Dual-isotope studies are both feasible in and promising for the diagnosis of parkinsonian syndromes.


Idiopathic Parkinson’s disease Multiple system atrophy 99mTc-ECD 123I-FP-CIT Dual-isotope SPECT 



This work was supported in part by grants from the French Ministry of Health: FUSPARK project (Réseau National Technologie Santé), Partners Collaborative Research (grant 137561), and the National Institutes of Health (grants RO1-EB000802 and RO1-EB001989).


  1. 1.
    El Fakhri G, Maksud P, Kijewski MF, Habert MO, Todd-Pokropek A, Aurengo A, et al. Scatter and cross-talk corrections in simultaneous Tc-99m/I-123 brain SPECT using constrained factor analysis and artificial neural networks. IEEE Trans Nucl Sci 2000;47:1573–80CrossRefGoogle Scholar
  2. 2.
    El Fakhri G, Moore SC, Maksud P, Aurengo A, Kijewski MF. Absolute activity quantitation in simultaneous I-123/Tc-99m brain SPECT. J Nucl Med 2001;42:300–8PubMedGoogle Scholar
  3. 3.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinicopathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:1009–13PubMedGoogle Scholar
  4. 4.
    Gilman S, Low PA, Quinn N, Albanese A, Ben-Shlomo Y, Fowler CJ, et al. Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci 1999;163:94–8CrossRefPubMedGoogle Scholar
  5. 5.
    Friston KJ, Holmes AP, Worsley KJ, Poline JB, Frith C, Frackowiak R. Statistical parametric maps in functional imaging: a general linear approach. Hum Brain Mapp 1995;2:189–210CrossRefGoogle Scholar
  6. 6.
    Cointepas Y, Mangin JF, Garnero L, Poline JB, Benali H. BrainVISA: software platform for visualization and analysis of multi-modality brain data. Neuroimage 2001;13:S98CrossRefGoogle Scholar
  7. 7.
    Tzourio-Mazoyer N, Landeau B, Papathanassiou D, Crivello F, Etard O, Delcroix N, et al. Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. Neuroimage 2002;15:273–89CrossRefPubMedGoogle Scholar
  8. 8.
    Swanson RL, Newberg AB, Acton PD, Siderowf A, Wintering N, Alavi A, et al. Differences in [99mTc]TRODAT-1 SPECT binding to dopamine transporters in patients with multiple system atrophy and Parkinson’s disease. Eur J Nucl Med Mol Imaging 2004;32:302–7CrossRefPubMedGoogle Scholar
  9. 9.
    Thobois S, Jahanshahi M, Pinto S, Frackowiak R, Limousin-Dowseya P. PET and SPECT functional imaging studies in parkinsonian syndromes: from the lesion to its consequences. NeuroImage 2004;23:1–16CrossRefPubMedGoogle Scholar
  10. 10.
    Bosman T, Van Laere K, Santens P. Anatomically standardised 99mTc-ECD brain perfusion SPET allows accurate differentiation between healthy volunteers, multiple system atrophy and idiopathic Parkinson’s disease. Eur J Nucl Med 2003;30:16–24CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Georges El Fakhri
    • 1
    Email author
  • Marie-Odile Habert
    • 2
    • 3
  • Philippe Maksud
    • 2
    • 3
  • Aurélie Kas
    • 3
  • Zoulikha Malek
    • 2
    • 3
  • Marie Foley Kijewski
    • 1
  • Lucette Lacomblez
    • 4
    • 5
  1. 1.Division of Nuclear Medicine, Department of RadiologyHarvard Medical School and Brigham and Women’s HospitalBostonUSA
  2. 2.U678 INSERM - UPMCCHU Pitié-SalpêtrièreParisFrance
  3. 3.Department of Nuclear MedicineCHU Pitié-SalpêtrièreParisFrance
  4. 4.Fédération des Maladies du Système NerveuxCHU Pitié-SalpêtrièreParisFrance
  5. 5.Department of PharmacologyCHU Pitié-SalpêtrièreParisFrance

Personalised recommendations