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The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes

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Abstract

The aim of the study was to compare the efficacy of olfactory testing and presynaptic dopamine imaging in diagnosing Parkinson’s disease (PD) and atypical parkinsonian syndromes (APS); to evaluate if the combination of these two diagnostic tools can improve their diagnostic value. A prospective investigation of 24 PD patients, 16 APS patients and 15 patients with non-parkinsonian syndromes was performed during an 18-month period. Single photon emission computed tomography with the presynaptic radioligand 123I-FP-CIT (DaTSCAN®) and olfactory testing with the Brief 12-item Smell Identification Test (B-SIT) were performed in all patients. DaTSCAN was analysed semi-quantitatively, by calculating two different striatal uptake ratios, and visually according to a predefined ranking scale. B-SIT score was significantly lower for PD patients, but not significantly different between APS and non-parkinsonism. The visual assessment of DaTSCAN had higher sensitivity, specificity and diagnostic accuracy compared to olfactory testing. Most PD patients (75 %) had visually predominant dopamine depletion in putamen, while most APS patients (56 %) had visually severe dopamine depletion both in putamen and in caudate nucleus. The combination of DaTSCAN and B-SIT led to a higher rate of correctly classified patients. Olfactory testing can distinguish PD from non-parkinsonism, but not PD from APS or APS from non-parkinsonism. DaTSCAN is more efficient than olfactory testing and can be valuable in differentiating PD from APS. However, combining olfactory testing and DaTSCAN imaging has a higher predictive value than these two methods separately.

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Acknowledgments

This study was supported by grants from Östergötland County Council (ALF) and from the Swedish Parkinson’s Foundation. The authors would like to thank Karl Wahlin and Mats Fredrikson from Linköping Academic Research Centre (LARC) for statistical help.

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    Authors and Affiliations

    1. Department of Radiology, Linköping University, 581 85, Linköping, Sweden

      Charalampos Georgiopoulos

    2. Department of Clinical Physiology, Linköping University, 581 85, Linköping, Sweden

      Anette Davidsson & Helene Zachrisson

    3. Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden

      Charalampos Georgiopoulos, Anette Davidsson, Maria Engström & Helene Zachrisson

    4. Department of Surgical Sciences/Radiology, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden

      Elna-Marie Larsson

    5. Department of Neurology, Linköping University, 581 85, Linköping, Sweden

      Nil Dizdar

    6. Department of Clinical and Experimental Medicine, Linköping University, 581 85, Linköping, Sweden

      Nil Dizdar

    7. Center for Medical Image Science and Visualization (CMIV), Linköping University, 581 85, Linköping, Sweden

      Charalampos Georgiopoulos & Maria Engström

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    1. Charalampos Georgiopoulos
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    Correspondence to Charalampos Georgiopoulos.

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    The authors declare that they have no conflict of interest.

    Ethical standards

    This study was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments, and was approved by the Regional Ethical Review Board in Linköping, Sweden (registration number 2011/415-31). Informed consent was obtained from all individual participants included in the study.

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    H. Zachrisson and N. Dizdar have contributed equal parts for last authorship.

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    Georgiopoulos, C., Davidsson, A., Engström, M. et al. The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes. J Neurol 262, 2154–2163 (2015). https://doi.org/10.1007/s00415-015-7830-4

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    • DOI: https://doi.org/10.1007/s00415-015-7830-4

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