title: [(123)]FP-CIT SPECT scans initially rated as normal became abnormal over time in patients with probable dementia with Lewy bodies.
abstract: OBJECTIVE
  Decreased striatal dopamine transporter (DAT) binding on SPECT imaging is a strong biomarker for the diagnosis of dementia with Lewy bodies (DLB). There is still a lot of uncertainty about patients meeting the clinical criteria for probable DLB who have a normal DAT SPECT scan (DLB/S-). The aim of this study was to describe the clinical and imaging follow-up in these patients, and compare them to DLB patients with abnormal baseline scans (DLB/S+).
  
  
  METHODS
  DLB patients who underwent DAT imaging ([(123)I]FP-CIT SPECT) were selected from the Amsterdam Dementia Cohort. All [(123)I]FP-CIT SPECT scans were evaluated independently by two nuclear medicine physicians and in patients with normal scans follow-up imaging was obtained. We matched DLB/S-- patients for age and disease duration to DLB/S+ patients and compared their clinical characteristics.
  
  
  RESULTS
  Of 67 [(123)I]FP-CIT SPECT scans, 7 (10.4 %) were rated as normal. In five DLB/S- patients, a second [(123)I]FP-CIT SPECT was performed (after on average 1.5 years) and these scans were all abnormal. No significant differences in clinical characteristics were found at baseline. DLB/S- patients could be expected to have a better MMSE score after 1 year.
  
  
  CONCLUSIONS
  This study was the first to investigate DLB patients with the initial [(123)I]FP-CIT SPECT scan rated as normal and subsequent scans during disease progression rated as abnormal. We hypothesize that DLB/S- scans could represent a relatively rare DLB subtype with possibly a different severity or spread of alpha-synuclein pathology ("neocortical predominant subtype"). In clinical practice, if an alternative diagnosis is not imminent in a DLB/S- patient, repeating [(123)I]FP-CIT SPECT should be considered.
authors.affiliation: VU Medical Center Alzheimer Center, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands. j.vanderzande@vumc.nl.
authors.forename: J J
authors.initials: JJ
authors.lastname: van der Zande
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Booij
authors.affiliation: VU Medical Center Alzheimer Center, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Scheltens
authors.affiliation: Department of Nuclear Medicine, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: P G H M
authors.initials: PG
authors.lastname: Raijmakers
authors.affiliation: VU Medical Center Alzheimer Center, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
authors.forename: A W
authors.initials: AW
authors.lastname: Lemstra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020961:Lewy Body Disease / Q000000981:diagnostic imaging* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes / Q000378:metabolism*
chemical_list: D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane
keywords: Dementia with Lewy bodies; Dopamine transporter; Neuroimaging; [123I]FP-CIT SPECT
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