Assessment of Motor Dysfunction with Virtual Reality in Patients Undergoing [123I]FP-CIT SPECT/CT Brain Imaging.

Jeanne P Vu,Zabrina Reyes,Ghiam Yamin,Alex Shin,Pengtao Xie,Sebastian Obrzut,Alexander Young,Irene Litvan

doi:10.3390/tomography7020009

Abstract

[123I]FP-CIT SPECT has been valuable for distinguishing Parkinson disease (PD) from essential tremor. However, its performance for quantitative assessment of motor dysfunction has not been established. A virtual reality (VR) application was developed and compared with [123I]FP-CIT SPECT/CT for detection of severity of motor dysfunction. Forty-four patients (21 males, 23 females, age 64.5 ± 12.4) with abnormal [123I]FP-CIT SPECT/CT underwent assessment of bradykinesia, activities of daily living, and tremor with VR. Support vector machines (SVM) machine learning models were applied to VR and SPECT data. Receiver operating characteristic (ROC) analysis demonstrated greater area under the curve (AUC) for VR (0.8418, 95% CI 0.6071–0.9617) compared with brain SPECT (0.5357, 95% CI 0.3373–0.7357, p = 0.029) for detection of motor dysfunction. Logistic regression identified VR as an independent predictor of motor dysfunction (Odds Ratio 326.4, SE 2.17, p = 0.008). SVM for prediction of the Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III) demonstrated greater R-squared of 0.713 (p = 0.008) for VR, compared with 0.0764 (p = 0.361) for brain SPECT. This study demonstrates that VR can be safely used in patients prior to [123I]FP-CIT SPECT imaging and may improve prediction of motor dysfunction. This test has the potential to provide a simple, objective, quantitative analysis of motor symptoms in PD patients.

Highlights

Parkinson disease (PD) is a progressive disorder of the nervous system, resulting in the loss of dopaminergic neurons
Dopamine transporter imaging with [123I]FP-CIT (N-(3-Fluoropropyl)-2β-carbomethoxy-3β-(4-[123I]iodophenyl) nortropane) single photon emission computed tomography (SPECT) and [18F]FP-CIT(N-(3[18F]fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl)nortropane) positron emission tomography (PET) are in vivo molecular imaging techniques used to investigate loss of dopaminergic neurons in the striatum in patients suspected of having PD
Diagnosis can improve the assessment of patient prognosis, as more than half of nigrostriatal dopaminergic neurons are lost before the appearance of typical motor manifestations [3]. [123I]FP-CIT SPECT is indicated in cases when the etiology of tremor and motor dysfunction is difficult to establish clinically [4]

Summary

Introduction

Parkinson disease (PD) is a progressive disorder of the nervous system, resulting in the loss of dopaminergic neurons. Dopamine transporter imaging with [123I]FP-CIT (N-(3-Fluoropropyl)-2β-carbomethoxy-3β-(4-[123I]iodophenyl) nortropane) single photon emission computed tomography (SPECT) and [18F]FP-CIT(N-(3[18F]fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl)nortropane) positron emission tomography (PET) are in vivo molecular imaging techniques used to investigate loss of dopaminergic neurons in the striatum in patients suspected of having PD. [123I]FP-CIT SPECT is indicated in cases when the etiology of tremor and motor dysfunction is difficult to establish clinically [4]. This method can distinguish essential tremor from PD, a strong and consistent correlation between [123I]FP-CIT uptake in the striatum and disease severity, as assessed for example with the Movement Disorder SocietySponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III (motor component), has not been established [5]. A novel, quantitative, facile, low-cost test that would complement dopamine transporter imaging and could be administered prior to radiotracer injection may be valuable for the objective assessment of motor dysfunction in early PD

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