The diagnostic accuracy of dopamine transporter SPECT imaging to detect nigrostriatal cell loss in patients with Parkinson's disease or clinically uncertain parkinsonism: a systematic review.

Sven R Suwijn,Gerrit Tissingh,Rob Ma De Bie,Jan Booij,Rob J De Haan,Caroline Jm Van Boheemen

doi:10.1186/s13550-015-0087-1

Abstract

In specialized movement disorder centers, Parkinson’s disease (PD) is wrongly diagnosed in 6 to 25% of cases. To improve the accuracy of the clinical diagnosis, it is necessary to have a reliable and practical reference standard. Dopamine transporter single-photon emission computed tomography (DAT SPECT) imaging might have the potential (high diagnostic accuracy and practical to use) to act as reference standard in detecting nigrostriatal cell loss in patients with (early stage) parkinsonism. We performed a systematic review to evaluate if DAT SPECT imaging can be used as such. Relevant studies were searched in the MEDLINE and EMBASE databases. Studies were selected when they met the following criteria: (1) all patients were adults with a clinical diagnosis of PD or clinically uncertain parkinsonism and (2) the study reported original data. In addition, studies needed to fulfill one of the two following criteria: (1) patients underwent at least one DAT SPECT and had a neuropathological confirmed diagnosis and (2) patients underwent at least two DAT SPECT scans, performed at least 2 years apart. The search identified 1,649 articles. Eight studies fulfilled our selection criteria and were included in this review. There was only one study including patients with diagnostic uncertainty. Sensitivity and specificity of DAT SPECT imaging to detect nigrostriatal cell loss were 98%. The other studies included patients with a diagnosis of PD in whom there was no uncertainty. In these studies, sensitivity was 100%. Our systematic review indicates that DAT SPECT imaging seems to be accurate to detect nigrostriatal cell loss in patients with parkinsonism.Electronic supplementary materialThe online version of this article (doi:10.1186/s13550-015-0087-1) contains supplementary material, which is available to authorized users.

Highlights

Parkinsonism is a clinical syndrome characterized by bradykinesia and at least one of the following symptoms: rest tremor, muscular rigidity, and postural instability
Studies were selected according to the following inclusion criteria: (1) all patients were adults with a clinical diagnosis of Parkinson’s disease (PD) or clinically uncertain parkinsonism and (2) the study reported original data
Our study indicates that DAT SPECT imaging may be accurate in detecting the loss of nigrostriatal dopaminergic cells

Summary

Introduction

Parkinsonism is a clinical syndrome characterized by bradykinesia and at least one of the following symptoms: rest tremor, muscular rigidity, and postural instability. Parkinsonism is most commonly caused by idiopathic Parkinson’s disease (PD) [1,2]. There is no definite test to confirm the cause of parkinsonism in clinical practice, except for the vascular causes of parkinsonism. Diagnostic criteria have been developed in the past 20 years [3,4,5,6]. The diagnosis is straightforward when patients have a classic presentation, establishing the cause of parkinsonism can be challenging, especially in early stages [7,8]. In a communitybased study in Wales, only 53% of patients, treated with antiparkinson medication in primary care, met the Queen Square Brain Bank criteria for the clinical diagnosis of PD

Methods

Results

Conclusion