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Unexpected (123I)FP-CIT SPECT findings: SWIDD, SWEDD and all DAT

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A Correction to this article was published on 09 December 2021

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Abstract

Although the diagnosis of Parkinson’s disease (PD) is essentially clinical, the implementation of imaging techniques can improve diagnostic accuracy. While some techniques (e.g. magnetic resonance imaging—MRI, computerized tomography—CT) are used to exclude secondary syndromes, presynaptic dopaminergic imaging including imaging of dopamine transporter (DAT)—can help the Neurologist in the differential diagnosis between neurodegenerative parkinsonian syndromes and parkinsonism without dopamine deficiency. DAT imaging can be useful in cases in which the clinical picture is not univocal, as in case of overlapping clinical features in patients with early disease, atypical syndromes or unsatisfying response to therapy. Currently, (123I)FP-CIT ([123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane) (trade name DaTSCAN) is the only agent approved by international regulatory agencies for this purpose. With the increasing use of this technique, some unexpected findings have been reported, including patients clinically diagnosed with PD with a normal SPECT scan [e.g. Scans Without Evidence of Dopaminergic Deficit (SWEDD)]; PD patients with a greater dopaminergic deficit in the striatum ipsilateral to the clinically more affected side [e.g. Scans With Ipsilateral Dopaminergic Deficit (SWIDD)]; as well as some artifacts. Moreover, the neurologist must remember that structural lesions and administration of some drugs might alter the result of DAT imaging. Unexpected findings, artifacts, and misinterpretation of imaging findings can lead to an erroneous diagnosis and inappropriate therapy, neglect of other medical conditions that might explain the clinical picture, and undermine the selection phase in clinical trials. The aim of the present review is to bring clarity on these controversial (and sometimes erroneous) results, in order to inform of these possibilities the clinicians requesting a DaTSCAN in clinical practice.

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Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Balestrino Roberta

  2. Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Balestrino Roberta & Filippi Massimo

  3. Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Neuroscience Section, University of Salerno, Baronissi, SA, Italy

    Barone Paolo & Erro Roberto

  4. Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy

    Filippi Massimo

  5. Vita-Salute San Raffaele University, Milan, Italy

    Filippi Massimo

Authors
  1. Balestrino Roberta
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  2. Barone Paolo
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  3. Filippi Massimo
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  4. Erro Roberto
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Contributions

RB: review of literature, interpretation of data, drafting of manuscript. PB: interpretation of data and critical revision of the manuscript. MF: interpretation of data and critical revision of the manuscript. RE: conception and design, interpretation of data, and critical revision of the manuscript.

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Correspondence to Filippi Massimo.

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Conflicts of interest

RB declares no conflict of interest. PB received consultancies as a member of the advisory board for Zambon, Lundbeck, UCB, Chiesi, Abbvie, and Acorda. FM is Editor-in-Chief of the Journal of Neurology and Associate Editor of Radiology, Human Brain Mapping and Neurological Sciences, received compensation for consulting services and/or speaking activities from Almiral, Alexion, Bayer, Biogen, Celgene, Eli Lilly, Genzyme, Merck-Serono, Novartis, Roche, Sanofi, Takeda, and Teva Pharmaceutical Industries, and receives research support from Biogen Idec, Merck-Serono, Novartis and Roche. RE received royalties from the publication of “Paroxysmal Movement Disorders” (Springer, 2020) and honoraria for speaking from the Movement Disorder Society.

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Roberta, B., Paolo, B., Massimo, F. et al. Unexpected (123I)FP-CIT SPECT findings: SWIDD, SWEDD and all DAT. J Neurol 269, 758–770 (2022). https://doi.org/10.1007/s00415-021-10809-x

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  • DOI: https://doi.org/10.1007/s00415-021-10809-x

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