Category: Parkinson's Disease: Neuroimaging
Objective: This study investigated the impact of I123-FP-CIT single photon emission computed tomography (SPECT) for the diagnosis of patients with clinically uncertain parkinsonian syndrome (CUPS) on changes in diagnosis, medical management, and healthcare utilization.
Background: Parkinson’s disease (PD) is a Parkinsonian syndrome (PS) characterized by nigrostriatal dopaminergic degeneration (NSDD). It is typically diagnosed based on clinical features including bradykinesia with resting tremor and/or rigidity. Patients presenting with atypical or ambiguous symptoms, or without satisfactory response to levodopa, may lead to a clinically uncertain diagnosis. I123-FP-CIT SPECT is indicated for helping to differentiate between non-dopaminergic degenerative conditions like essential tremor and conditions associated with NSDD like PD.
Method: This was a retrospective single-center study of adult patients first identified with CUPS at a movement disorders clinic between 3/17–2/19. All patients were evaluated and treated by a single neurologist per routine clinical practice and 1-year follow-up was collected from clinical records. Patients who had a I123-FP-CIT SPECT to assist with a definitive diagnosis were identified from imaging referrals. Patients with CUPS and without SPECT were identified from referrals that did not have a scan due to patient fear or discomfort, and from clinical records of patients with CUPS that were not referred for a scan due to non-clinical reasons such as lack of insurance coverage.
Results: The population included 81 patients with I123-FP-CIT SPECT and 12 controls. [Table 1] No complications related to I123-FP-CIT were reported. The proportions of patients with a diagnosis change within 1 year was similar (29.6% I123-FP-CIT vs. 33.3% controls), but the first change was made significantly later in the control group (226.5±119.2 vs. 47.5±21.4 days). The total number of clinic visits was similar (4.0±1.2 I123-FP-CIT vs. 4.1±1.4 controls), but only 12.3% of I123-FP-CIT patients had clinically uncertain diagnoses beyond their first CUPS visit compared to 83.3% of controls.
Conclusion: I123-FP-CIT SPECT is a safe diagnostic tool that can assist physicians in making an accurate and timely diagnosis in patients with CUPS. This may allow for more appropriate treatment earlier in the clinical course.
To cite this abstract in AMA style:R. Falconer, T. Hunter, E. Szabo, C. Brand. Diagnostic Utility of I123-FP-CIT Single Photon Emission Computed Tomography for Patients with Clinically Uncertain Parkinsonian Syndrome [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/diagnostic-utility-of-i123-fp-cit-single-photon-emission-computed-tomography-for-patients-with-clinically-uncertain-parkinsonian-syndrome/. Accessed March 5, 2024.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnostic-utility-of-i123-fp-cit-single-photon-emission-computed-tomography-for-patients-with-clinically-uncertain-parkinsonian-syndrome/