Objective: We investigate the usefulness Dopamine transporter (DAT)-SPECT with an automated striatal analysis software in differential diagnosis of neurodegenerative parkinsonism.

Background: DAT-SPECT imaging is sensitive to detect presynaptic dopaminergic neuronal loss in neurodegenerative parkinsonism. However, DAT-SPECT imaging is thought to have a limited value in differentiation between Parkinson’s disease (PD) and atypical parkinsonism such as progressive supranuclear palsy (PSP) and multiple system atrophy-parkinson type (MSA-P) (1). We demonstrated semiquantitative analyses of DAT-SPECT imaging in PD, PSP and MSA-P with a new striatal analysis software for SPECT.

Methods: 103 patients [14 essential tremor (ET) as normal controls, 71 PD, 8 PSP and 10 MSA-P] were enrolled. All of the patients were clinically diagnosed before undergoing DAT-SPECT imaging. DAT-SPECT imaging using (¹²³I) ioflupane were performed in our hospital. In the present study, SCENIUM^® (Siemens), a new automated striatal analysis software for SPECT was used to calculate the Distribution Volume Ratio (DVR) of striatum. Additionally, striatal asymmetry (%) was calculated. ANOVA was used to compare mean DVR and striatal asymmetry. The discrimination performance of striatal asymmetry was verified by plotting receiver operating characteristic (ROC) curves.

Results: There were no significant differences in the age and disease duration between the four groups. Mean striatal DVR were significantly lower in PD, PSP and MSA-P than ET (as a normal control group) (p < 0.01). Mean striatal asymmetry (%) were significantly higher in PD and MSA-P than ET (p < 0.05, p < 0.01, respectively). Moreover, mean striatal asymmetry was significantly higher in MSA-P than PD and PSP (p < 0.01). The discrimination performance of striatal asymmetry between MSA-P and PD provided an optimal cutoff of 16.3%, a sensitivity of 87.3% and a specificity of 77.8% with an area under the curve (AUC) of 0.858 as well as between MSA-P and PSP, an optimal cutoff of 16.3%, a sensitivity of 100% and a specificity of 77.8% with an AUC of 0.917 in ROC analyses.

Conclusions: Semiquantitative analyses of DAT-SPECT imaging with an automated striatal analysis software can be useful not only for demonstrating striatal DAT loss, but also for differentiating neurodegenerative parkinsonism, particularly MSA from PD and PSP.

References: 1.  Bajaj N, Hauser RA, Grachev ID. Clinical utility of dopamine transporter single photon emission CT (DaT-SPECT) with (123I) ioflupane in diagnosis of parkinsonian syndromes. J Neurol Neurosurg Psychiatry. 2013;84(11):1288-95.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/semiquantitative-analyses-of-dat-spect-imaging-with-an-automated-striatal-analysis-software-in-differential-diagnosis-of-neurodegenerative-parkinsonism/