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

  • Morten Ziebell
  • Birgitte B. Andersen
  • Gerda Thomsen
  • Lars H. Pinborg
  • Merete Karlsborg
  • Steen G. Hasselbalch
  • Gitte M. Knudsen
Original Article

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.

Keywords

Predictive value Parkinsonism SPECT Dopamine transporter 

Supplementary material

259_2011_1976_MOESM1_ESM.doc (120 kb)
ESM 1(DOC 119 kb)

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Morten Ziebell
    • 1
  • Birgitte B. Andersen
    • 2
  • Gerda Thomsen
    • 1
  • Lars H. Pinborg
    • 1
    • 3
  • Merete Karlsborg
    • 4
  • Steen G. Hasselbalch
    • 1
    • 2
  • Gitte M. Knudsen
    • 1
  1. 1.Neurobiology Research Unit & CimbiRigshospitalet and University of CopenhagenCopenhagenDenmark
  2. 2.Memory Disorders Research Group, Department of NeurologyRigshospitalet and University of CopenhagenCopenhagenDenmark
  3. 3.Epilepsy Clinic, Department of NeurologyRigshospitalet and University of CopenhagenCopenhagenDenmark
  4. 4.Clinic for Movement Disorders, Department of NeurologyBispebjerg HospitalCopenhagenDenmark

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