title: The diagnostic accuracy of dopamine transporter SPECT imaging to detect nigrostriatal cell loss in patients with Parkinson's disease or clinically uncertain parkinsonism: a systematic review.
abstract: In specialized movement disorder centers, Parkinson's disease (PD) is wrongly diagnosed in 6 to 25% of cases. To improve the accuracy of the clinical diagnosis, it is necessary to have a reliable and practical reference standard. Dopamine transporter single-photon emission computed tomography (DAT SPECT) imaging might have the potential (high diagnostic accuracy and practical to use) to act as reference standard in detecting nigrostriatal cell loss in patients with (early stage) parkinsonism. We performed a systematic review to evaluate if DAT SPECT imaging can be used as such. Relevant studies were searched in the MEDLINE and EMBASE databases. Studies were selected when they met the following criteria: (1) all patients were adults with a clinical diagnosis of PD or clinically uncertain parkinsonism and (2) the study reported original data. In addition, studies needed to fulfill one of the two following criteria: (1) patients underwent at least one DAT SPECT and had a neuropathological confirmed diagnosis and (2) patients underwent at least two DAT SPECT scans, performed at least 2 years apart. The search identified 1,649 articles. Eight studies fulfilled our selection criteria and were included in this review. There was only one study including patients with diagnostic uncertainty. Sensitivity and specificity of DAT SPECT imaging to detect nigrostriatal cell loss were 98%. The other studies included patients with a diagnosis of PD in whom there was no uncertainty. In these studies, sensitivity was 100%. Our systematic review indicates that DAT SPECT imaging seems to be accurate to detect nigrostriatal cell loss in patients with parkinsonism.
authors: Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors: Sven R
authors: SR
authors: Suwijn
authors: Department of Neurology, Medical Center Haaglanden, Lijnbaan 32, PO Box 432, 2501 CK The Hague, The Netherlands.
authors: Caroline Jm
authors: CJ
authors: van Boheemen
authors: Department of Clinical Research Unit, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors: Rob J
authors: RJ
authors: de Haan
authors: Department of Neurology, Atrium Medical Center Parkstad, Henri Dunantstraat 5, PO Box 4446, 6401 CX Heerlen, The Netherlands.
authors: Gerrit
authors: G
authors: Tissingh
authors: Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors: Jan
authors: J
authors: Booij
authors: Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors: Rob Ma
authors: RM
authors: de Bie
keywords: Clinical diagnosis; Diagnostic accuracy; Dopamine transporter; Nigrostriatal cell loss; Parkinsonism; Parkinson’s disease; Single-photon emission computed tomography