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123I-FP-CIT striatal binding ratios do not decrease significantly with age in older adults

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Annals of Nuclear Medicine Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 29 July 2019

Abstract

Objective

I-123-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)nortropane (FP-CIT) imaging is an established biomarker used in the diagnosis of Lewy body disease. Images are often reported with the aid of striatal binding ratios (SBRs), comparing uptake to a normal database via Z scores. It is well known that SBRs are age dependent. However, previous studies cover wide age ranges between 20 and 80 years, rather than focusing on older adults. Typically a linear relationship is reported, but some authors have suggested that SBRs do not decline as rapidly in old age. Commercial software packages usually adjust the SBR Z score to attempt to compensate for age-related decline, but the model used varies. Ensuring age correction is appropriate for older adults is important, given that the majority of patients referred for FP-CIT scans are aged over 60 years. We examined the relationship of SBR with age in older adults and the effect of age correction using research scans from 123 adults over 60 years of age.

Methods

Twenty-nine healthy older adults and twenty-three with MCI due to Alzheimer’s disease were included as controls, i.e. individuals with no evidence of Lewy body disease. Their ages ranged from 60 to 92 years (mean 76; SD 7.9). SBRs and Z scores were calculated using BRASS (Hermes Medical) and DaTQUANT (GE Healthcare). SBRs were plotted against age and linear mixed effect models applied. We tested the effect of removing age correction in BRASS using an independent dataset of 71 older adults with dementia or mild cognitive impairment.

Results

The slopes of the linear fits between SBR and age per year were − 0.007 (p = 0.30) with BRASS and − 0.004 (p = 0.35) with DaTQUANT. The slopes are smaller than reported in the literature and show no statistically significant difference from zero. Switching age correction off in BRASS in the test subjects reduced Z scores by approximately 1 standard deviation at 80 years of age.

Conclusion

We found no statistically significant age-related decline in SBR in adults over 60 years of age without Lewy body disease. Commercial software packages that apply a fixed rate of age correction may be overcorrecting for age in older adults, which could contribute to misdiagnosis.

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Acknowledgements

The authors would like to thank Miss Helen Kain, Research Support Secretary (Newcastle University Institute of Neuroscience) and our colleagues in the Nuclear Medicine department at the Newcastle Royal Victoria Infirmary. We thank the Alzheimer’s Society for supporting the Fellowship of the lead author and the NIHR and Alzheimer’s Research UK for supporting the clinical research studies used in this project. We are grateful to Liz Clarke (GE Healthcare) and Helena McMeekin (Hermes Medical) for providing information on DaTQUANT and BRASS, respectively.

Funding

The lead author is receiving full-time support from the Alzheimer’s Society via a Clinical Training Fellowship. The clinical studies used in this project were funded by Alzheimer’s Research UK and the Newcastle National Institute for Health Research (NIHR) Biomedical Research Centre, hosted by Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University.

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Authors and Affiliations

  1. Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK

    Gemma Roberts, James J. Lloyd, Paul C. Donaghy, Joseph P. M. Kane, Rory Durcan, Sarah Lawley, John-Paul Taylor, John T. O’Brien & Alan J. Thomas

  2. Nuclear Medicine Department, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Hospitals Trust, Newcastle upon Tyne, NE1 4LP, UK

    Gemma Roberts, James J. Lloyd, George S. Petrides & Kim Howe

  3. Centre for Public Health, Institute of Clinical Sciences, Queen’s University Belfast, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK

    Joseph P. M. Kane

  4. Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne NHS Foundation Hospitals Trust, Newcastle upon Tyne, NE7 7DN, UK

    Andrew J. Sims

  5. Institute of Cellular Medicine, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK

    Andrew J. Sims

  6. Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK

    John T. O’Brien

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  1. Gemma Roberts
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Correspondence to Gemma Roberts.

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Conflict of interest

123I-FP-CIT radiopharmaceutical and the DaTQUANT software package were provided by GE Healthcare. We have no other conflicts of interest relevant to this study.

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Roberts, G., Lloyd, J.J., Petrides, G.S. et al. 123I-FP-CIT striatal binding ratios do not decrease significantly with age in older adults. Ann Nucl Med 33, 434–443 (2019). https://doi.org/10.1007/s12149-019-01352-x

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  • DOI: https://doi.org/10.1007/s12149-019-01352-x

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