The Association of Visually Guided Saccades and DAT-SPECT Findings in Parkinson’s Disease

2021 ◽  
Vol 84 (2) ◽  
pp. 110-118
Author(s):  
Makoto Kobayashi ◽  
Satoshi Kuwabara
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Target Location ◽  
Photon Emission ◽  
Motor Dysfunction ◽  
Emission Computed Tomography ◽  
Visually Guided ◽  
Specific Binding Ratio ◽  
Dat Spect ◽  
Nigrostriatal Degeneration

<b><i>Background:</i></b> In individuals with Parkinson’s disease (PD), visually guided saccades (VGSs) reportedly reflect general motor dysfunction and cognitive impairments. However, it has not been fully elucidated whether the VGS abnormalities result from nigrostriatal degeneration or other PD-related neural changes. <b><i>Methods:</i></b> We measured VGS latency and gain in 50 PD participants and 56 age-matched normal controls (NCs), and PD participants underwent dopamine transporter (DAT) single-photon emission computed tomography (SPECT) within 2 months of the measurement. VGSs were evoked by a white dot on a monitor, which was presented at the center and pseudo-randomly jumped off horizontally (10° or 20° eccentricity) or vertically (10° or 15°). First, we compared the parameters between PD participants and NCs for each target location. Second, in the participants who exhibited striatal DAT asymmetry on SPECT, VGSs contralaterally directed to the more severely affected striatum were compared with those ipsilaterally directed. Third, effects of the DAT-SPECT specific binding ratio (SBR) on VGSs were analyzed. <b><i>Results:</i></b> PD participants demonstrated prolonged latencies when the target was presented at the upward 15° eccentricity and decreased gains at all target locations. Contralateral VGSs relative to the side of the more severely affected striatum were more delayed and hypometric than ipsilateral. The SBR had a significant positive effect on VGS gain. <b><i>Conclusions:</i></b> In participants with PD, saccadic abnormalities were emphasized when VGSs were directed contralaterally to the more severely affected striatum. Moreover, the dopaminergic nigrostriatal degeneration on DAT-SPECT was mainly associated with VGS gain.

The utility of the combined use of 123I-FP-CIT SPECT and neuromelanin MRI in differentiating Parkinson's disease from other parkinsonian syndromes

2018 ◽  
Vol 60 (2) ◽  
pp. 230-238 ◽  
Author(s):  
Eiji Matsusue ◽  
Yoshio Fujihara ◽  
Kenichiro Tanaka ◽  
Yuki Aozasa ◽  
Manabu Shimoda ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Single Photon ◽  
Photon Emission ◽  
Contrast Ratio ◽  
Emission Computed Tomography ◽  
Specific Information ◽  
Specific Binding Ratio ◽  
Significant Difference ◽  
Dat Spect

Background Neuromelanin magnetic resonance imaging (NmMRI) and 123I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) provide specific information that distinguishes Parkinson's disease (PD) from non-degenerative parkinsonian syndrome (NDPS). Purpose To determine whether a multiparametric scoring system (MSS) could improve accuracy compared to each parameter of DAT-SPECT and NmMRI in differentiating PD from NDPS. Material and Methods A total of 49 patients, including 14 with NDPS, 30 with PD, and five with atypical parkinsonian disorder (APD) underwent both NmMRI and DAT-SPECT and were evaluated. The average (Ave) and the asymmetry index (AI) were calculated in the substantia nigra compacta area (SNc-area), SNc midbrain-tegmentum contrast ratio (SNc-CR), and specific binding ratio (SBR). Cut-off values were determined, using receiver operating characteristic (ROC) analysis, for the differentiation of PD from NDPS on the statistically significant parameters. All cases were scored as either 1 (PD) or 0 (NDPS) for each parameter according to its threshold. These individual scores were totaled for each case, yielding a combined score for each case to obtain a cut-off value for the MSS. Results The Ave-SNc-area, Ave-SNc-CR, and Ave-SBR in PD were significantly lower than those in NDPS. The AI-SNc-area and AI-SBR in PD were significantly higher than those in NDPS. Of the five parameters, the highest accuracy was 93% for the Ave-SNc-area. For the MSS, a cut-off value of 3 was the accuracy of 96%. Besides, no significant difference was observed between PD and APD on all parameters. Conclusion An MSS has comparable or better accuracy compared to each parameter of DAT-SPECT and NmMRI in distinguishing PD from NDPS.

Asymmetric Dopaminergic Dysfunction in Brain-First versus Body-First Parkinson’s Disease Subtypes

2021 ◽  
pp. 1-11
Author(s):  
Karoline Knudsen ◽  
Tatyana D. Fedorova ◽  
Jacob Horsager ◽  
Katrine B. Andersen ◽  
Casper Skjærbæk ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
De Novo ◽  
Specific Binding ◽  
Asymmetry Index ◽  
The Body ◽  
Specific Binding Ratio ◽  
Dat Spect ◽  
Vagal Innervation ◽  
Nigrostriatal Degeneration

Background: We have hypothesized that Parkinson’s disease (PD) comprises two subtypes. Brain-first, where pathogenic α-synuclein initially forms unilaterally in one hemisphere leading to asymmetric nigrostriatal degeneration, and body-first with initial enteric pathology, which spreads through overlapping vagal innervation leading to more symmetric brainstem involvement and hence more symmetric nigrostriatal degeneration. Isolated REM sleep behaviour disorder has been identified as a strong marker of the body-first type. Objective: To analyse striatal asymmetry in [18F]FDOPA PET and [123I]FP-CIT DaT SPECT data from iRBD patients, de novo PD patients with RBD (PD +RBD) and de novo PD patients without RBD (PD - RBD). These groups were defined as prodromal body-first, de novo body-first, and de novo brain-first, respectively. Methods: We included [18F]FDOPA PET scans from 21 iRBD patients, 11 de novo PD +RBD, 22 de novo PD - RBD, and 18 controls subjects. Also, [123I]FP-CIT DaT SPECT data from iRBD and de novo PD patients with unknown RBD status from the PPPMI dataset was analysed. Lowest putamen specific binding ratio and putamen asymmetry index (AI) was defined. Results: Nigrostriatal degeneration was significantly more symmetric in patients with RBD versus patients without RBD or with unknown RBD status in both FDOPA (p = 0.001) and DaT SPECT (p = 0.001) datasets. Conclusion: iRBD subjects and de novo PD +RBD patients present with significantly more symmetric nigrostriatal dopaminergic degeneration compared to de novo PD - RBD patients. The results support the hypothesis that body-first PD is characterized by more symmetric distribution most likely due to more symmetric propagation of pathogenic α-synuclein compared to brain-first PD.

scholarly journals Evaluating dopamine transporter imaging as an enrichment biomarker in a phase 2 Parkinson’s disease trial

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
R. Matthew Hutchison ◽  
Karleyton C. Evans ◽  
Tara Fox ◽  
Minhua Yang ◽  
Jerome Barakos ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Clinical Trial ◽  
Parkinson's Disease ◽  
Dopamine Transporter ◽  
Single Photon ◽  
Photon Emission ◽  
Alpha Synuclein ◽  
Emission Computed Tomography ◽  
Phase 2 ◽  
Dat Spect

Abstract Background Dopamine transporter single-photon emission computed tomography (DaT-SPECT) can quantify the functional integrity of the dopaminergic nerve terminals and has been suggested as an imaging modality to verify the clinical diagnosis of Parkinson’s disease (PD). Depending on the stage of progression, approximately 5–15% of participants clinically diagnosed with idiopathic PD have been observed in previous studies to have normal DaT-SPECT patterns. However, the utility of DaT-SPECT in enhancing early PD participant selection in a global, multicenter clinical trial of a potentially disease-modifying therapy is not well understood. Methods The SPARK clinical trial was a phase 2 trial of cinpanemab, a monoclonal antibody against alpha-synuclein, in participants with early PD. DaT-SPECT was performed at screening to select participants with DaT-SPECT patterns consistent with degenerative parkinsonism. Acquisition was harmonised across 82 sites. Images were reconstructed and qualitatively read at a central laboratory by blinded neuroradiologists for inclusion prior to automated quantitative analysis. Results In total, 482 unique participants were screened between January 2018 and May 2019; 3.8% (15/398) of imaged participants were excluded owing to negative DaT-SPECT findings (i.e., scans without evidence of dopaminergic deficit [SWEDD]). Conclusion A smaller proportion of SPARK participants were excluded owing to SWEDD status upon DaT-SPECT screening than has been reported in prior studies. Further research is needed to understand the reasons for the low SWEDD rate in this study and whether these results are generalisable to future studies. If supported, the radiation risks, imaging costs, and operational burden of DaT-SPECT for enrichment may be mitigated by clinical assessment and other study design aspects. Trial registration ClinicalTrials.gov identifier: NCT03318523. Date submitted: October 19, 2017. First Posted: October 24, 2017.

Combined Use of 123i-fp-cit Spect and 123i-mibg Scintigraphy for Differentiation of Progressive Supranuclear Palsy Subtypes and Parkinson's Disease

2020 ◽  
Author(s):  
Keita Sakurai ◽  
Shohei Inui ◽  
Yufuko Saito ◽  
Satoko Sakakibara ◽  
Rina Hashimoto ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Progressive Supranuclear Palsy ◽  
Single Photon ◽  
Photon Emission ◽  
Washout Rate ◽  
Emission Computed Tomography ◽  
Mibg Scintigraphy ◽  
Adaptive Boosting ◽  
Specific Binding Ratio

Abstract Background:This study was undertaken to investigate the utility of 123I-ioflupane (123I-FP-CIT) single photon emission computed tomography (SPECT), 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy and both of these to differentiate among progressive supranuclear palsy (PSP), including typical cases and other subtypes, and Parkinson’s disease (PD).Methods: Twenty-five patients with typical PSP (Richardson's syndrome; PSP-RS), 14 atypical ones (PSP-variants; PSP-V) and 42 PD who underwent both 23I-FP-CIT SPECT and 123I-MIBG scintigraphy within short intervals were enrolled. Specific binding ratio (SBR) of the striatum and midbrain and anteroposterior and asymmetry ratio of the striatal SBR on 123I-FP-CIT SPECT and heart-to-mediastinum (H/M) ratio and washout rate (WR) on 123I-MIBG scintigraphy were used as quantitative measures. The classifier performance based on adaptive boosting was evaluated using five-fold cross-validation for these measures.Results: Midbrain SBR and the striatal anteroposterior ratio were statistically lower in PSP-RS than PD. On the other hand, there were no significant differences in any other quantitative measures among PSP-RS, PSP-V and PD. Striatal and midbrain SBRs and anteroposterior ratio of PSP-V were approximately in-between those of PSP-RS and PD. PD showed the lowest early and delayed H/M ratios and highest WR of any group. The combination of 123I-FP-CIT and 123I-MIBG was useful in discriminating PSP-RS and PSP-V from PD, while 123I-FP-CIT was superior to 123I-MIBG in differentiating PSP-RS from PSP-V.Conclusion: The combination of 123I-FP-CIT SPECT and 123I-MIBG scintigraphy, rather than either alone, may be a useful differential diagnostic tool to differentiate patients with PSP-RS, PSP-V and PD.

scholarly journals Value of Clinical Signs in Identifying Patients with Scans without Evidence of Dopaminergic Deficit (SWEDD)

2020 ◽  
Vol 10 (4) ◽  
pp. 1561-1569 ◽  
Author(s):  
Sven R. Suwijn ◽  
Hamdia Samim ◽  
Carsten Eggers ◽  
Alberto J. Espay ◽  
Susan Fox ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Diagnosis ◽  
Clinical Features ◽  
Spect Imaging ◽  
Emission Computed Tomography ◽  
Test Accuracy ◽  
Dat Spect ◽  
Nigrostriatal Degeneration ◽  
Early Parkinson’S Disease

Background: In clinical trials that recruited patients with early Parkinson’s disease (PD), 4–15% of the participants with a clinical diagnosis of PD had normal dopamine transporter single photon emission computed tomography (DAT SPECT) scans, also called “scans without evidence of dopaminergic deficit” (SWEDD). Objective: To investigate in patients with a clinical diagnosis of PD, if specific clinical features are useful to distinguish patients with nigrostriatal degeneration from those that have no nigrostriatal degeneration. Methods: We performed a diagnostic test accuracy study. Patients that participated in the Levodopa in Early Parkinson’s disease trial, a clinical trial in patients with early PD, were asked to participate if they had not undergone DAT SPECT imaging earlier. The index tests were specific clinical features that were videotaped. A panel of six neurologists in training (NT), six general neurologists (GN), and six movement disorders experts (MDE) received a batch of ten videos consisting of all SWEDD subjects and a random sample of patients with abnormal DAT SPECT scans. The raters analyzed the videos for presence of specific signs and if they suspected the patient to have SWEDD. The reference test was visually assessed DAT SPECT imaging. Results: Of a total of 87 participants, three subjects were SWEDDs (3.4%). The overall intraclass correlation coefficient (ICC) of the Parkinsonian signs was poor to moderate with ICCs ranging from 0.14 to 0.67. NT correctly identified 50.0% of the SWEDD subjects, GN 33.3%, and MDE 66.7%. Conclusion: Our study suggests that the selected videotaped clinical features cannot reliably distinguish patients with a clinical diagnosis of PD and an abnormal DAT SPECT from patients with clinical PD and a SWEDD.

Dopaminergic Correlates of Orthostatic Hypotension in de novo Parkinson’s Disease

2020 ◽  
pp. 1-9
Author(s):  
Tadashi Umehara ◽  
Hisayoshi Oka ◽  
Atsuo Nakahara ◽  
Tomotaka Shiraishi ◽  
Takeo Sato ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Orthostatic Hypotension ◽  
De Novo ◽  
Single Photon ◽  
Anterior Part ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Dopamine Depletion ◽  
Dat Spect

Background: Orthostatic hypotension (OH) at an early stage of Parkinson’s disease (PD) predicts poor prognosis, which may suggest degeneration of dopaminergic neurons affects sympathetic function, causing OH. Objective: We tested the hypothesis that striatal dopaminergic depletion is associated with OH in PD. Methods: Out of 99 patients with newly diagnosed untreated PD, 81 patients were enrolled according to our selection criteria. All patients underwent head-up tilt-table testing and striatal 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT-SPECT). DaTQUANT software (GE Healthcare) was used as a semi-quantitative tool to analyze DAT-SPECT data. The association between hemodynamic changes and 123I-FP-CIT uptake was examined. Results: 123I-FP-CIT uptake in the putamen, especially the anterior part and left side, was related not only to motor severity but also to OH. Change in systolic blood pressure correlated negatively with 123I-FP-CIT uptake in bilateral anterior putamen (left: p <  0.01, right: p <  0.05) and left posterior putamen (p <  0.05). Patients with OH had more severe dopamine depletion in left anterior (p = 0.008) and posterior (p = 0.007) putamen at a similar motor severity than did patients without OH even though both groups have similar baseline characteristics. An analysis of asymmetry index showed patients with OH had symmetrically decreased dopamine levels in anterior putamen when compared to those without OH (p = 0.024). Conclusion: OH is closely related to striatal dopamine depletion in PD. This relation may help to account for the prognostic value of OH.

scholarly journals Impact of DaTscan Imaging on Clinical Decision Making in Clinically Uncertain Parkinson’s Disease

2021 ◽  
pp. 1-5
Author(s):  
Jonathan R. Isaacson ◽  
Salima Brillman ◽  
Nisha Chhabria ◽  
Stuart H. Isaacson
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Diagnosis ◽  
Clinical Decision Making ◽  
Photon Emission ◽  
Case Series ◽  
Emission Computed Tomography ◽  
Medication Therapy ◽  
Clinical Scenarios ◽  
The Impact

Background: The diagnosis of Parkinson’s disease (PD) is primarily clinical, but in cases of diagnostic uncertainty, evaluation of nigrostriatal dopaminergic degeneration (NSDD) by imaging of the dopamine transporter using DaTscan with single-photon emission computed tomography (SPECT) brain imaging may be helpful. Objective/Methods: In the current paper, we describe clinical scenarios for which DaTscan imaging was used in a prospective case series of 201 consecutive patients in whom a movement disorder specialist ordered DaTscan imaging to clarify NSDD. We describe the impact of DaTscan results on changing or confirming pre-DaTscan clinical diagnosis and on post-DaTscan treatment changes. Results/Conclusion: DaTscan imaging can be useful in several clinical scenarios to determine if NSDD is present. These include in patients with early subtle symptoms, suboptimal response to levodopa, prominent action tremor, drug-induced parkinsonism, and in patients with lower extremity or other less common parkinsonism clinical presentations. We also found DaTscan imaging to be useful to determine underlying NSDD in patients with PD diagnosis for 3-5 years but without apparent clinical progression or development of motor fluctuations. Overall, in 201 consecutive patients with clinically questionable NSDD, DaTscan was abnormal in 58.7% of patients, normal in 37.8%, and inconclusive in 3.5%. DaTscan imaging changed clinical diagnosis in 39.8% of patients and led to medication therapy changes in 70.1% of patients.

scholarly journals Diagnosis of Parkinson’s Disease. Part 1. The Potential of Functional Neuroimaging

Doctor Ru ◽  
2020 ◽  
Vol 19 (9) ◽  
pp. 6-12
Author(s):  
M.R. Sapronova ◽  
◽  
D.V. Dmitrenko ◽  
N.A. Schnaider ◽  
A.A. Molgachev ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Functional Neuroimaging ◽  
Single Photon ◽  
Photon Emission ◽  
Transcranial Sonography ◽  
Emission Computed Tomography ◽  
Resonance Spectroscopy ◽  
Positron Emission ◽  
Neuroimaging Techniques

Objective of the Review: To describe available functional neuroimaging techniques for use in patients with Parkinson’s disease (PD). Key Points: Parkinson’s disease is a neurodegenerative disorder which affects 2-3% of people older than 65 years. The main neuropathological hallmarks of PD are an accumulation of alpha-synuclein aggregates in the cellular cytoplasm and a loss of neurons in the pars compacta of the substantia nigra, leading to dopamine deficiency. Clinical symptoms of the disease appear when the underlying neural impairment is already advanced, which significantly reduces treatment options. Over the two last decades, functional neuroimaging techniques such as positron emission tomography, single-photon emission computed tomography, proton magnetic resonance spectroscopy, and transcranial sonography have increasingly been used for diagnosing PD during patients’ lifetime and understanding the neuropathological mechanisms and compensatory reactions underlying its symptoms, as well as for monitoring the progression of PD. Conclusion: Modern functional neuroimaging techniques not only facilitate differential diagnosis of PD, but also make it possible to detect the disease at its early/preclinical stage. Keywords: Parkinson’s disease, neuroimaging, positron emission tomography, single-photon emission computed tomography, proton magnetic resonance spectroscopy, transcranial sonography.

scholarly journals Clinical Differentiation of Essential Tremor and Parkinson's Disease

2013 ◽  
Vol 6 ◽  
pp. CCRep.S11903 ◽  
Author(s):  
Robert Fekete ◽  
Jin Li
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Essential Tremor ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Postural Tremor ◽  
Arm Swing ◽  
Rest Tremor ◽  
Dopaminergic Terminal

We present clinical features and tremor characterization in a patient with Parkinson's disease (PD) as well as in two cases of essential tremor (ET) with some parkinsonian features but no evidence of dopaminergic terminal loss on 123I-FP-CIT Single Photon Emission Computed Tomography (SPECT). Relatively slow frequency rest tremor and bilateral upper extremity bradykinesia without decrementing amplitude were observed in the ET cases, with unilaterally decreased arm swing in case 3. Alternating rest tremor and re-emergent tremor with 13 second latency was confirmed in the PD case. Re-emergent tremor had alternating characteristics, which to our knowledge has not been previously reported. The ET cases had synchronous postural tremor. Alternating re-emergent tremor in PD provides further evidence for re-emergent tremor as an analogue of rest tremor in PD. Two cases of ET with synchronous postural tremor and one to two year history of parkinsonian features had no evidence of dopaminergic terminal loss up to 40 years after the initial onset of ET. Tremor synchronicity characterization can assist in differential diagnosis between the two disorders.

Sign in / Sign up

Export Citation Format

Share Document