Impact of DAT-SPECT on management of patients suspected of parkinsonism

Sahar Mirpour, Evrim B. Turkbey, Wael Marashdeh, Riham El Khouli, Rathan M. Subramaniam

Research output: Contribution to journalArticle

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Abstract

Objective To evaluate the value of 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT-SPECT) to change management strategies of patients suspected of parkinsonism. Method This was an institutional review board-approved, retrospective study. DAT-SPECT scans ordered by movement disorder specialist and neurologists from 2011-2014 were reviewed. Clinical data and radiological reports of 173 patients suspected of parkinsonism were reviewed. The DAT-SPECT scan results were correlated with clinical assessment and treatment changes. Results A total of 173 patients (104 male and 69 female subjects; age, 64.4 ± 12.6 years) suspected of parkinsonism were included. Median duration of symptoms was 36 months (range, 1-480 months). Scans were most often requested when there was diagnostic uncertainty in clinical features (59.6%, 103/173) or to differentiate one other disease from parkinsonism such as Parkinson disease (PD) versus essential tremor (23.7%, 41/173), PD versus drug-induced parkinsonism (8.7%, 15/173), or PD versus psychogenic (6.4%, 11/173) or vascular (1.7%, 3/173) disorders. Patients were classified, according to the DAT-SPECT scanning results, as those with abnormal DAT-SPECT findings (59%, 102/173) and those with normal DAT-SPECT findings (41%, 71/173). In patients with normal DAT-SPECT findings, follow-up management data were available in 76.1% (54/71). The management changed in 39.4% (28/54) after DAT scan with starting a new appropriate medications or supportive therapy in 4.2% (3/28), withholding inappropriate dopaminergic treatment in 11.3% (8/28), or continuing observation in 23.9% (17/28). In patients with abnormal DAT-SPECT findings, follow-up management data were available in 78.4% (80/102). There was change in management of 37.3% (38/80), a new PD treatment was started in 89.5% (34/38). The dose of medication was adjusted in 5.3% (2/38), although the original treatment was not changed. Parkinson disease treatment was stopped in 2.6% (1/38) and discontinued in 2.6% (1/38) based on clinical decision of neurologists despite abnormal DAT-SPECT findings. Conclusions DAT-SPECT findings impacted treatment decisions in 44.7% of patients suspected of Parkinsonism.

Original languageEnglish (US)
Pages (from-to)710-714
Number of pages5
JournalClinical Nuclear Medicine
Volume43
Issue number10
DOIs
StatePublished - Oct 1 2018

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Dopamine Plasma Membrane Transport Proteins
Parkinsonian Disorders
Single-Photon Emission-Computed Tomography
Parkinson Disease
Therapeutics
Nortropanes
Essential Tremor
Research Ethics Committees
Movement Disorders
Uncertainty
Blood Vessels
Retrospective Studies
Observation

Keywords

  • I-FP-CIT
  • DAT-SPECT
  • parkinsonism

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Impact of DAT-SPECT on management of patients suspected of parkinsonism. / Mirpour, Sahar; Turkbey, Evrim B.; Marashdeh, Wael; El Khouli, Riham; Subramaniam, Rathan M.

In: Clinical Nuclear Medicine, Vol. 43, No. 10, 01.10.2018, p. 710-714.

Research output: Contribution to journalArticle

Mirpour, Sahar ; Turkbey, Evrim B. ; Marashdeh, Wael ; El Khouli, Riham ; Subramaniam, Rathan M. / Impact of DAT-SPECT on management of patients suspected of parkinsonism. In: Clinical Nuclear Medicine. 2018 ; Vol. 43, No. 10. pp. 710-714.
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abstract = "Objective To evaluate the value of 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT-SPECT) to change management strategies of patients suspected of parkinsonism. Method This was an institutional review board-approved, retrospective study. DAT-SPECT scans ordered by movement disorder specialist and neurologists from 2011-2014 were reviewed. Clinical data and radiological reports of 173 patients suspected of parkinsonism were reviewed. The DAT-SPECT scan results were correlated with clinical assessment and treatment changes. Results A total of 173 patients (104 male and 69 female subjects; age, 64.4 ± 12.6 years) suspected of parkinsonism were included. Median duration of symptoms was 36 months (range, 1-480 months). Scans were most often requested when there was diagnostic uncertainty in clinical features (59.6{\%}, 103/173) or to differentiate one other disease from parkinsonism such as Parkinson disease (PD) versus essential tremor (23.7{\%}, 41/173), PD versus drug-induced parkinsonism (8.7{\%}, 15/173), or PD versus psychogenic (6.4{\%}, 11/173) or vascular (1.7{\%}, 3/173) disorders. Patients were classified, according to the DAT-SPECT scanning results, as those with abnormal DAT-SPECT findings (59{\%}, 102/173) and those with normal DAT-SPECT findings (41{\%}, 71/173). In patients with normal DAT-SPECT findings, follow-up management data were available in 76.1{\%} (54/71). The management changed in 39.4{\%} (28/54) after DAT scan with starting a new appropriate medications or supportive therapy in 4.2{\%} (3/28), withholding inappropriate dopaminergic treatment in 11.3{\%} (8/28), or continuing observation in 23.9{\%} (17/28). In patients with abnormal DAT-SPECT findings, follow-up management data were available in 78.4{\%} (80/102). There was change in management of 37.3{\%} (38/80), a new PD treatment was started in 89.5{\%} (34/38). The dose of medication was adjusted in 5.3{\%} (2/38), although the original treatment was not changed. Parkinson disease treatment was stopped in 2.6{\%} (1/38) and discontinued in 2.6{\%} (1/38) based on clinical decision of neurologists despite abnormal DAT-SPECT findings. Conclusions DAT-SPECT findings impacted treatment decisions in 44.7{\%} of patients suspected of Parkinsonism.",
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N2 - Objective To evaluate the value of 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT-SPECT) to change management strategies of patients suspected of parkinsonism. Method This was an institutional review board-approved, retrospective study. DAT-SPECT scans ordered by movement disorder specialist and neurologists from 2011-2014 were reviewed. Clinical data and radiological reports of 173 patients suspected of parkinsonism were reviewed. The DAT-SPECT scan results were correlated with clinical assessment and treatment changes. Results A total of 173 patients (104 male and 69 female subjects; age, 64.4 ± 12.6 years) suspected of parkinsonism were included. Median duration of symptoms was 36 months (range, 1-480 months). Scans were most often requested when there was diagnostic uncertainty in clinical features (59.6%, 103/173) or to differentiate one other disease from parkinsonism such as Parkinson disease (PD) versus essential tremor (23.7%, 41/173), PD versus drug-induced parkinsonism (8.7%, 15/173), or PD versus psychogenic (6.4%, 11/173) or vascular (1.7%, 3/173) disorders. Patients were classified, according to the DAT-SPECT scanning results, as those with abnormal DAT-SPECT findings (59%, 102/173) and those with normal DAT-SPECT findings (41%, 71/173). In patients with normal DAT-SPECT findings, follow-up management data were available in 76.1% (54/71). The management changed in 39.4% (28/54) after DAT scan with starting a new appropriate medications or supportive therapy in 4.2% (3/28), withholding inappropriate dopaminergic treatment in 11.3% (8/28), or continuing observation in 23.9% (17/28). In patients with abnormal DAT-SPECT findings, follow-up management data were available in 78.4% (80/102). There was change in management of 37.3% (38/80), a new PD treatment was started in 89.5% (34/38). The dose of medication was adjusted in 5.3% (2/38), although the original treatment was not changed. Parkinson disease treatment was stopped in 2.6% (1/38) and discontinued in 2.6% (1/38) based on clinical decision of neurologists despite abnormal DAT-SPECT findings. Conclusions DAT-SPECT findings impacted treatment decisions in 44.7% of patients suspected of Parkinsonism.

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