Topography of dopamine transporter availability in progressive supranuclear palsy: a voxelwise [123I]beta-CIT SPECT analysis.
BACKGROUND
Dopaminergic loss can be visualized by means of iodine I 123-labeled 2beta-carbomethoxy-3beta-(4-iodophenyl)tropane ([(123)I]beta-CIT) single-photon emission computed tomography (SPECT) in several neurodegenerative parkinsonian disorders. Most previous SPECT studies have adopted region-of-interest methods for analysis, which are subjective and operator dependent.


OBJECTIVE
To objectively localize the cerebral dopamine transporter status in the early stages of progressive supranuclear palsy (PSP).


METHODS
Prospective study.


METHODS
Parkinson disease outpatient clinic.


METHODS
Fourteen patients with PSP, 17 with Parkinson disease (PD), 15 with Parkinson-variant multiple-system atrophy (MSA-P), and 13 healthy control subjects, matched for age and disease duration.


METHODS
Statistical parametric mapping applied to [(123)I]beta-CIT SPECT.


METHODS
Differences in [(123)I]beta-CIT uptake.


RESULTS
All patients with the different parkinsonian disorders showed a significant decrease in striatal [(123)I]beta-CIT uptake without any overlap with the control group. In patients with MSA-P and PSP, an additional reduction in brainstem [(123)I]beta-CIT signal compared with controls and patients with PD was identified with statistical parametric mapping. Midbrain [(123)I]beta-CIT uptake discriminated atypical parkinsonian disorders from PD with an overall correct classification of 91.3%. On the other hand, [(123)I]beta-CIT SPECT failed to discriminate PSP and MSA-P.


CONCLUSIONS
By applying statistical parametric mapping to [(123)I]beta-CIT SPECT images of patients with PSP, a widespread decline of monoaminergic transporter availability including the striatum and brainstem was localized in PSP, discriminating patients with PSP from patients with PD, but not from those with MSA-P. Quantification of midbrain dopamine transporter signal may therefore enhance the utility of SPECT imaging in the differential diagnosis of patients with parkinsonism.
Seppi
Klaus
K
Department of Neurology, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. klaus.seppi@uibk.ac.at
Scherfler
Christoph
C
Donnemiller
Eveline
E
Virgolini
Irene
I
Schocke
Michael F H
MF
Goebel
Georg
G
Mair
Katherina J
KJ
Boesch
Sylvia
S
Brenneis
Christian
C
Wenning
Gregor K
GK
Poewe
Werner
W
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism; D003042:Cocaine / Q000031:analogs & derivatives* / Q000378:metabolism; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D013494:Supranuclear Palsy, Progressive / Q000000981:diagnostic imaging* / Q000378:metabolism*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D050483:Dopamine Plasma Membrane Transport Proteins; D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; C069723:2beta-carbomethoxy-3beta-(4-iodophenyl)tropane; D003042:Cocaine