Reliability of visual assessment by non-expert nuclear medicine physicians and appropriateness of indications of [123I]FP-CIT SPECT imaging by neurologists in patients with early drug-naive Parkinson\u2019s disease

Rob M. A. de Bie,Constant V. M. Verschuur,Sven R. Suwijn,Marleen A. Slim,Jan Booij

doi:10.1186/s13550-019-0537-2

Abstract

PurposeTo determine the reliability of visual assessment of [123I]FP-CIT SPECT imaging by non-experts in dopamine transporter (DAT) SPECT imaging in patients with early drug-naive Parkinson’s disease (PD). Also, we explored the indications of DAT SPECT imaging in clinical practice by neurologists.MethodsWe collected [123I]FP-CIT SPECT scans of the Levodopa in EArly Parkinson’s disease (LEAP) trial participants that were made prior to recruitment, as part of routine clinical work-up. All scans were reassessed by an expert in DAT imaging. A survey on the use of DAT SPECT imaging was sent to all referring neurologists.ResultsThe concordance of the initial local assessment and the expert reassessment was 98.7%. The survey showed that neurologists requested DAT SPECT imaging in only 73.6% of patients to differentiate between a neurodegenerative disease and non-neurodegenerative parkinsonism.ConclusionsVisual assessment of [123I]FP-CIT SPECT imaging by community nuclear medicine physicians in patients with early PD is reliable. Neurologists who request DAT SPECT scans are not always aware that the high accuracy is limited only to the differentiation between neurodegenerative and non-neurodegenerative parkinsonism. A significant portion of neurologists who request DAT SPECT scans is not always aware that the high accuracy is limited to the differentiation between neurodegenerative and non-neurodegenerative parkinsonism as DAT SPECT cannot reliably distinguish the various Parkinsonian syndromes.

Highlights

Parkinsonism is characterized by bradykinesia accompanied by either rigidity and rest tremor, or both
The survey showed that neurologists requested dopamine transporter (DAT) Dopamine transporter single photon emission computed tomography (SPECT) imaging in only 73.6% of patients to differentiate between a neurodegenerative disease and non-neurodegenerative parkinsonism
A significant portion of neurologists who request DAT SPECT scans is not always aware that the high accuracy is limited to the differentiation between neurodegenerative and non-neurodegenerative parkinsonism as DAT SPECT cannot reliably distinguish the various Parkinsonian syndromes

Summary

Introduction

Parkinsonism is characterized by bradykinesia accompanied by either rigidity and rest tremor, or both. Parkinsonism can be classified into two clinically relevant categories: parkinsonism with nigrostriatal degeneration and parkinsonism or mimics with an intact nigrostriatal system. The most frequent cause of parkinsonism with nigrostriatal cell loss is Parkinson’s disease (PD). Less common forms of neurodegenerative parkinsonism, called atypical Parkinsonian syndromes (APS), include multiple system atrophy, progressive supranuclear palsy, dementia with Lewy bodies, and corticobasal degeneration. Non-neurodegenerative forms of parkinsonism are disorders that are clinically established forms of parkinsonism/parkinsonism mimics but molecular imaging or autopsy shows no signs of (2019) 9:63 nigrostriatal cell loss. Parkinsonism or mimics with an intact nigrostriatal system can be caused by for example medication, functional neurological symptoms, and essential tremor [1]

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