title: Implementation of the European multicentre database of healthy controls for [(123)I]FP-CIT SPECT increases diagnostic accuracy in patients with clinically uncertain parkinsonian syndromes.
abstract: OBJECTIVE
  Even though [(123)I]FP-CIT SPECT provides high accuracy in detecting nigrostriatal cell loss in neurodegenerative parkinsonian syndromes (PS), some patients with an inconclusive diagnosis remain. We investigated whether the diagnostic accuracy in patients with clinically uncertain PS with previously inconclusive findings can be improved by the use of iterative reconstruction algorithms and an improved semiquantitative evaluation which additionally implemented a correction algorithm for patient age and gamma camera dependency (EARL-BRASS; Hermes Medical Solutions, Sweden).
  
  
  METHODS
  We identified 101 patients with inconclusive findings who underwent an [(123)I]FP-CIT SPECT between 2003 and 2010 as part of the diagnostic process of suspected PS at the University of Munich, and re-evaluated these scans using iterative reconstruction algorithms and the new corrected EARL-BRASS. Clinical follow-up was obtained in 62 out of the 101 patients and constituted the gold standard for the re-evaluation to assess the possible improvement in diagnostic accuracy.
  
  
  RESULTS
  Clinical follow-up confirmed the diagnosis of PS in 11 of the 62 patients. In patients in whom both visual and semiquantitative analysis showed concordant findings (48 patients), a high negative predictive value (93 %), positive predictive value (100 %) and accuracy (94 %) were found, and thus a correct diagnosis was obtained in 45 of the 48 patients. Among the 14 patients with discordant findings, the additional semiquantitative analysis correctly identified all five of nine patients patients without PS by nonpathological semiquantitative findings in visually pathological or inconclusive scans. In contrast, four of the remaining five patients with decreased semiquantitative values but visually normal scans did not show a PS during follow-up.
  
  
  CONCLUSIONS
  The age-corrected and camera-corrected mode of evaluation using EARL-BRASS provided a notable improvement in the diagnostic accuracy of [(123)I]FP-CIT SPECT in PS patients with previously inconclusive findings. The gain in accuracy might be achieved by better discrimination between physiological low striatal [(123)I]FP-CIT binding due to age-related loss of the dopamine transporter or pathological loss of binding.
authors.affiliation: Department of Nuclear Medicine, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany. nathalie.albert@med.uni-muenchen.de.
authors.forename: Nathalie L
authors.initials: NL
authors.lastname: Albert
authors.affiliation: Department of Nuclear Medicine, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Unterrainer
authors.affiliation: Hermes Medical Solutions, Stockholm, Sweden.
authors.forename: Markus
authors.initials: M
authors.lastname: Diemling
authors.affiliation: Department of Nuclear Medicine, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany.
authors.forename: Guoming
authors.initials: G
authors.lastname: Xiong
authors.affiliation: Department of Nuclear Medicine, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.affiliation: Department of Nuclear Medicine, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Koch
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Andrea
authors.initials: A
authors.lastname: Varrone
authors.affiliation: Institute of Nuclear Medicine, UCLH NHS Foundation Trust and University College, London, UK.
authors.forename: John C
authors.initials: JC
authors.lastname: Dickson
authors.affiliation: Department of Medical Physics, University Hospitals Southampton NHS Trust, Southampton, UK.
authors.forename: Livia
authors.initials: L
authors.lastname: Tossici-Bolt
authors.affiliation: Department of Nuclear Medicine and Euromedic Szeged, University of Szeged, Szeged, Hungary.
authors.forename: Terez
authors.initials: T
authors.lastname: Sera
authors.affiliation: Department of Neurology, Medical University of Vienna, Vienna, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Asenbaum
authors.affiliation: Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Booij
authors.affiliation: Department of Nuclear Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
authors.forename: L Özlem Atay
authors.initials: LÖ
authors.lastname: Kapucu
authors.affiliation: ABX-CRO, Dresden, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kluge
authors.affiliation: Neurobiology Research Unit, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Ziebell
authors.affiliation: Nuclear Medicine Department, Centre Antoine Lacassagne, University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Darcourt
authors.affiliation: Clinical Neurology Unit, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Nobili
authors.affiliation: Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy.|Department of Nuclear medicine, Karolinska Hospital, Stockholm, Sweden.
authors.forename: Marco
authors.initials: M
authors.lastname: Pagani
authors.affiliation: Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Osama
authors.initials: O
authors.lastname: Sabri
authors.affiliation: Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany.|Molecular Neuroimaging IFB Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany.
authors.forename: Swen
authors.initials: S
authors.lastname: Hesse
authors.affiliation: Nuclear Medicine Division, Mont-Godinne Medical Center, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: Thierry Vander
authors.initials: TV
authors.lastname: Borght
authors.affiliation: Nuclear Medicine, University Hospital and K.U. Leuven, Leuven, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Van Laere
authors.affiliation: Department of Nuclear Medicine, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Tatsch
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, University of Tuebingen, Tuebingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: la Fougère
mesh_terms: D016022:Case-Control Studies; D016208:Databases, Factual; D005060:Europe; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes; D035501:Uncertainty
chemical_list: D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane
keywords: Diagnostic accuracy; EARL-BRASS; Parkinsonian syndromes; [123I]FP-CIT SPECT