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Ishimaru T, Nunomura S, Wakita M, Ura S. [A case of Holmes tremor in which 123I-IMP SPECT and MRI findings suggest damage to the cerebellothalamic tract and the dentato-rubro-olivary pathway]. Rinsho Shinkeigaku 2024; 64:280-285. [PMID: 38522912 DOI: 10.5692/clinicalneurol.cn-001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
A 75-year-old woman was referred to our department in October 2022 with ataxia and involuntary movements of the right upper and lower limbs. She had experienced a left pontine hemorrhage in March 2021, which was managed conservatively. However, she had residual right-sided hemiplegia. In addition, she had cerebellar ataxia and a 2 Hz resting tremor of the right upper and lower limbs, which was enhanced while maintaining posture and contemplation. Based on her history, and the findings of MRI and nuclear medicine imaging, we diagnosed the patient with Holmes tremor due to pontine hemorrhage. Holmes tremor is a rare movement disorder secondary to brainstem and thalamic lesions, characterized by a unilateral low-frequency tremor. In this case, 123I-IMP SPECT and MRI shows damage to the cerebellothalamic tract and dentaro-rubro-olivary pathway.
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Affiliation(s)
- Tomoki Ishimaru
- Department of Neurology, Asahikawa Red Cross Hospital
- Department of Neurology, Obihiro-Kosei General Hospital
| | | | | | - Shigehisa Ura
- Department of Neurology, Asahikawa Red Cross Hospital
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Boccalini C, Nicastro N, Peretti DE, Caminiti SP, Perani D, Garibotto V. Sex differences in dementia with Lewy bodies: an imaging study of neurotransmission pathways. Eur J Nucl Med Mol Imaging 2023; 50:2036-2046. [PMID: 36826477 PMCID: PMC10199852 DOI: 10.1007/s00259-023-06132-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/29/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Dementia with Lewy bodies (DLB) is characterized by a wide clinical and biological heterogeneity, with sex differences reported in both clinical and pathologically confirmed DLB cohorts. No research evidence is available on sex differences regarding molecular neurotransmission. This study aimed to assess whether sex can influence neurotransmitter systems in patients with probable DLB (pDLB). METHODS We included 123 pDLB patients (male/female: 77/46) and 78 control subjects (male/female: 34/44) for comparison, who underwent 123I-FP-CIT SPECT imaging. We assessed sex differences in the dopaminergic activity of the nigrostriatal and mesolimbic systems using regional-based and voxel-wise analyses of 123I-FP-CIT binding. We tested whether sex-specific binding alterations would also pertain to the serotoninergic and noradrenergic systems by applying spatial correlation analyses. We applied molecular connectivity analyses to assess potential sex differences in the dopaminergic pathways. RESULTS We found comparable 123I-FP-CIT binding decreases in the striatum for pDLB males and females compared to controls. However, pDLB females showed lower binding in the extrastriatal projections of the nigrostriatal and mesolimbic dopaminergic systems compared to pDLB males. According to the spatial correlation analysis, sex-specific molecular alterations were also associated with serotonergic and noradrenergic systems. Nigrostriatal and mesolimbic systems' connectivity was impaired in both groups, with males showing local alterations and females presenting long-distance disconnections between subcortical and cortical regions. CONCLUSIONS Sex-specific differences in 123I-FP-CIT binding were found in our cohort, namely, a trend for lower 123I-FP-CIT binding in females, significant in the presence of a pDLB diagnosis. pDLB females showed also different patterns of connectivity compared to males, mostly involving extrastriatal regions. The results suggest the presence of a sex-related regional vulnerability to alpha-synuclein pathology, possibly complicated also by the higher prevalence of Alzheimer's disease co-pathology in females, as previously reported in pDLB populations.
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Affiliation(s)
- Cecilia Boccalini
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Nicastro
- Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Debora Elisa Peretti
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland.
- CIBM Center for Biomedical Imaging, Geneva, Switzerland.
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Flaus A, Philippe R, Thobois S, Janier M, Scheiber C. Semi-quantitative analysis of visually normal 123I-FP-CIT across three large databases revealed no difference between control and patients. EJNMMI Res 2023; 13:37. [PMID: 37117951 PMCID: PMC10147889 DOI: 10.1186/s13550-023-00983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/07/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND To show the equivalence between the specific binding ratios (SBR) of visually normal 123I-FP-CIT SPECT scans from patients to those from healthy volunteers (Hv) or patients without dopaminergic degeneration to allow their use as a reference database. METHODS The SBR values of visually normal SPECT scans from 3 groups were studied: (1) suspected Parkinsonism and no diagnostic follow-up (ScanOnlyDB: n = 764, NM/CT 670 CZT, GE Healthcare), (2) no degenerative dopaminergic pathology after a 5-year follow-up (NoDG5YearsDB: n = 237, Symbia T2, Siemens Medical Solutions), and 3) Hv (HvDB: n = 118, commercial GE database). A general linear model (GLM) was constructed with caudate, putamen, and striatum SBR as the dependent variables, and age and gender as the independent variables. Following post-reconstruction harmonization of the data, DB were combined in pairs, ScanOnlyDB&NoDG5yearsDG and ScanOnlyDB&HvDB before performing GLM analysis. Additionally, ScanOnlyDB GLM estimates were compared to those published from Siemens commercial DB (SiemensDB) and ENC-DAT. RESULTS The dispersion parameters, R2 and the SBR coefficients of variation, did not differ between databases. For all volumes of interest and all databases, SBR decreased significantly with age (e.g., decrease per decade for the striatum: - 4.94% for ScanOnlyDB, - 4.65% for NoDG5YearsDB, - 5.69% for HvDB). There was a significant covariance between SBR and gender for ScanOnlyDB (P < 10-5) and NoDG5YearsDB (P < 10-2). The age-gender interaction was significant only for ScanOnlyDB (P < 10-2), and the p-value decreased to 10-6 after combining ScanOnlyDB with NoDG5YearsDB. ScanOnlyDB GLM estimates were not significantly different from those from SiemensDB or ENC-DAT except for age-gender interaction. CONCLUSION SBR values distribution from visually normal scans were not different from the existing reference database, enabling this method to create a reference database by expert nuclear physicians. In addition, it showed a rarely described age-gender interaction related to its size. The proposed post-reconstruction harmonization method can also facilitate the use of semi-quantitative analysis.
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Affiliation(s)
- Anthime Flaus
- Department of Nuclear Medicine, Hospices Civils de Lyon, Bron, Rhône, France
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France
| | - Remi Philippe
- Institut des Sciences, Cognitives Marc Jeannerod, UMR 5229, CNRS, CRNL, Université Claude Bernard, Lyon 1, Lyon, France
| | - Stephane Thobois
- Institut des Sciences, Cognitives Marc Jeannerod, UMR 5229, CNRS, CRNL, Université Claude Bernard, Lyon 1, Lyon, France
- Movement Disorder Clinic, Department of Neurology C, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, Rhône, France
| | - Marc Janier
- Department of Nuclear Medicine, Hospices Civils de Lyon, Bron, Rhône, France
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France
| | - Christian Scheiber
- Department of Nuclear Medicine, Hospices Civils de Lyon, Bron, Rhône, France.
- Institut des Sciences, Cognitives Marc Jeannerod, UMR 5229, CNRS, CRNL, Université Claude Bernard, Lyon 1, Lyon, France.
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Hutchison RM, Evans KC, Fox T, Yang M, Barakos J, Bedell BJ, Cedarbaum JM, Brys M, Siderowf A, Lang AE. Evaluating dopamine transporter imaging as an enrichment biomarker in a phase 2 Parkinson's disease trial. BMC Neurol 2021; 21:459. [PMID: 34814867 PMCID: PMC8609885 DOI: 10.1186/s12883-021-02470-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dopamine transporter single-photon emission computed tomography (DaT-SPECT) can quantify the functional integrity of the dopaminergic nerve terminals and has been suggested as an imaging modality to verify the clinical diagnosis of Parkinson's disease (PD). Depending on the stage of progression, approximately 5-15% of participants clinically diagnosed with idiopathic PD have been observed in previous studies to have normal DaT-SPECT patterns. However, the utility of DaT-SPECT in enhancing early PD participant selection in a global, multicenter clinical trial of a potentially disease-modifying therapy is not well understood. METHODS The SPARK clinical trial was a phase 2 trial of cinpanemab, a monoclonal antibody against alpha-synuclein, in participants with early PD. DaT-SPECT was performed at screening to select participants with DaT-SPECT patterns consistent with degenerative parkinsonism. Acquisition was harmonised across 82 sites. Images were reconstructed and qualitatively read at a central laboratory by blinded neuroradiologists for inclusion prior to automated quantitative analysis. RESULTS In total, 482 unique participants were screened between January 2018 and May 2019; 3.8% (15/398) of imaged participants were excluded owing to negative DaT-SPECT findings (i.e., scans without evidence of dopaminergic deficit [SWEDD]). CONCLUSION A smaller proportion of SPARK participants were excluded owing to SWEDD status upon DaT-SPECT screening than has been reported in prior studies. Further research is needed to understand the reasons for the low SWEDD rate in this study and whether these results are generalisable to future studies. If supported, the radiation risks, imaging costs, and operational burden of DaT-SPECT for enrichment may be mitigated by clinical assessment and other study design aspects. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03318523 . Date submitted: October 19, 2017. First Posted: October 24, 2017.
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Affiliation(s)
| | | | | | - Minhua Yang
- Biogen, 300 Binney Street, Cambridge, MA, 02142, USA
| | | | | | | | | | | | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto, ON, Canada
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Sala A, Caminiti SP, Presotto L, Pilotto A, Liguori C, Chiaravalloti A, Garibotto V, Frisoni GB, D'Amelio M, Paghera B, Schillaci O, Mercuri N, Padovani A, Perani D. In vivo human molecular neuroimaging of dopaminergic vulnerability along the Alzheimer's disease phases. Alzheimers Res Ther 2021; 13:187. [PMID: 34772450 PMCID: PMC8588696 DOI: 10.1186/s13195-021-00925-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preclinical and pathology evidence suggests an involvement of brain dopamine (DA) circuitry in Alzheimer's disease (AD). We in vivo investigated if, when, and in which target regions [123I]FP-CIT-SPECT regional binding and molecular connectivity are damaged along the AD course. METHODS We retrospectively selected 16 amyloid-positive subjects with mild cognitive impairment due to AD (AD-MCI), 22 amyloid-positive patients with probable AD dementia (AD-D), and 74 healthy controls, all with available [123I]FP-CIT-SPECT imaging. We tested whether nigrostriatal vs. mesocorticolimbic dopaminergic targets present binding potential loss, via MANCOVA, and alterations in molecular connectivity, via partial correlation analysis. Results were deemed significant at p < 0.05, after Bonferroni correction for multiple comparisons. RESULTS We found significant reductions of [123I]FP-CIT binding in both AD-MCI and AD-D compared to controls. Binding reductions were prominent in the major targets of the ventrotegmental-mesocorticolimbic pathway, namely the ventral striatum and the hippocampus, in both clinical groups, and in the cingulate gyrus, in patients with dementia only. Within the nigrostriatal projections, only the dorsal caudate nucleus showed reduced [123I]FP-CIT binding, in both groups. Molecular connectivity assessment revealed a widespread loss of inter-connections among subcortical and cortical targets of the mesocorticolimbic network only (poor overlap with the control group as expressed by a Dice coefficient ≤ 0.25) and no alterations of the nigrostriatal network (high overlap with controls, Dice coefficient = 1). CONCLUSION Local- and system-level alterations of the mesocorticolimbic dopaminergic circuitry characterize AD, already in prodromal disease phases. These results might foster new therapeutic strategies for AD. The clinical correlates of these findings deserve to be carefully considered within the emergence of both neuropsychiatric symptoms and cognitive deficits.
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Affiliation(s)
- Arianna Sala
- Vita-Salute San Raffaele University, Via Olgettina 60, Milan, 20132, Italy
- In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Via Olgettina 60, Milan, 20132, Italy
- In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Luca Presotto
- Nuclear Medicine Unit, San Raffaele Hospital, 20132, Milan, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121, Brescia, Italy
- Parkinson's Disease Rehabilitation Centre, FERB ONLUS - S. Isidoro Hospital, 24069, Trescore Balneario, Italy
| | - Claudio Liguori
- Division of Neurology, Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy
- IRCCS Neuromed, 86077, Pozzilli, Italy
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, University Hospitals of Geneva, and NIMTLab, Faculty of Medicine, Geneva University, 1205, Geneva, Switzerland
| | - Giovanni Battista Frisoni
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, University Hospitals of Geneva, and NIMTLab, Faculty of Medicine, Geneva University, 1205, Geneva, Switzerland
- Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, 1205, Geneva, Switzerland
| | - Marcello D'Amelio
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00179, Rome, Italy
- Unit of Molecular Neurosciences, Department of Medicine, University Campus-Biomedico, 00128, Rome, Italy
| | - Barbara Paghera
- Nuclear Medicine Unit, Spedali Civili Brescia, 25123, Brescia, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy
- IRCCS Neuromed, 86077, Pozzilli, Italy
| | - Nicola Mercuri
- Division of Neurology, Department of Systems Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, 00179, Rome, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121, Brescia, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Via Olgettina 60, Milan, 20132, Italy.
- In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, San Raffaele Scientific Institute, 20132, Milan, Italy.
- Nuclear Medicine Unit, San Raffaele Hospital, 20132, Milan, Italy.
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Könik A, Zeraatkar N, Kalluri KS, Auer B, Fromme TJ, He Y, May M, Furenlid LR, Kuo PH, King MA. Improved Performance of a Multipinhole SPECT for DAT Imaging by Increasing Number of Pinholes at the Expense of Increased Multiplexing. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2021; 5:817-825. [PMID: 34746540 DOI: 10.1109/trpms.2020.3035626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
SPECT imaging of dopamine transporters (DAT) in the brain is a widely utilized study to improve the diagnosis of Parkinsonian syndromes, where conventional (parallel-hole and fan-beam) collimators on dual-head scanners are commonly employed. We have designed a multi-pinhole (MPH) collimator to improve the performance of DAT imaging. The MPH collimator focuses on the striatum and hence offers a better trade-off for sensitivity and spatial resolution than the conventional collimators within this clinically most relevant region for DAT imaging. Our original MPH design consisted of 9 pinholes with a background-to-striatal (Bkg/Str) projection multiplexing of 1% only. In this simulation study, we investigated whether further improvements in the performance of MPH imaging could be obtained by increasing the number of pinholes, hence by enhancing the sensitivity and sampling, despite the ambiguity in reconstructing images due to increased multiplexing. We performed analytic simulations of the MPH configurations with 9, 13, and 16 pinholes (aperture diameters: 4-6mm) using a digital phantom modeling DAT imaging. Our quantitative analyses indicated that using 13 (Bkg/Str: 12%) and 16 (Bkg/Str: 22%) pinholes provided better performance than the original 9-pinhole configuration for the acquisition with 2 or 4 angular views, but a similar performance with 8 and 16 views.
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Affiliation(s)
- Arda Könik
- Department of Imaging, Dana Farber Cancer Institute, Boston, MA, 02215, USA
| | - Navid Zeraatkar
- Department of Radiology, Univ. of Mass. Medical School, Worcester, MA, 01605, USA
| | - Kesava S Kalluri
- Department of Radiology, Univ. of Mass. Medical School, Worcester, MA, 01605, USA
| | - Benjamin Auer
- Department of Radiology, Univ. of Mass. Medical School, Worcester, MA, 01605, USA
| | | | - Yulun He
- MD Anderson Cancer Center, Houston, TX
| | - Micaehla May
- Department of Radiology, University of Arizona, Tucson, AZ, 85724 USA
| | - Lars R Furenlid
- Department of Radiology, University of Arizona, Tucson, AZ, 85724 USA
| | - Phillip H Kuo
- Department of Radiology, University of Arizona, Tucson, AZ, 85724 USA
| | - Michael A King
- Department of Radiology, Univ. of Mass. Medical School, Worcester, MA, 01605, USA
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Nicastro N, Stripeikyte G, Assal F, Garibotto V, Blanke O. Premotor and fronto-striatal mechanisms associated with presence hallucinations in dementia with Lewy bodies. NEUROIMAGE: CLINICAL 2021; 32:102791. [PMID: 34461436 PMCID: PMC8403753 DOI: 10.1016/j.nicl.2021.102791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION presence hallucinations (PH) are frequent in dementia with Lewy bodies (DLB), but their cortico-subcortical origin is unknown. Recent studies have defined key frontal and temporal areas contributing to the occurrence of PH (PH-network) and tested their relevance in subjects with Parkinson's disease (PD). With the present study, we aimed at disentangling the metabolic and dopaminergic correlates of pH as well as their relation to a recently defined PH brain network in DLB. METHODS for the present study, we included 34 DLB subjects (10 with PH (PH + ); 24 without PH (PH-)), who underwent 18F-FDG PET and 123I-FP-CIT SPECT imaging. We performed 18F-FDG PET group comparisons, as well as interregional correlation analyses using 18F-FDG PH-network regions as a seed. RESULTS PH + versus PH- had reduced 18F-FDG uptake in precentral, superior frontal and parietal gyri, involving ventral premotor cortex (vPMC) of the PH-network that showed strongly reduced functional connectivity with bilateral cortical regions. 18F-FDG vPMC uptake was negatively correlated with caudate 123I-FP-CIT uptake in PH+ (p = 0.028) and interregional correlation analysis seeding from the vPMC showed widespread fronto-parietal 18F-FDG decreases in PH + . DISCUSSION these findings uncover the pivotal role of vPMC (involved in a PH-network) and its cortico-striatal connections in association with PH in DLB, improving our understanding of psychosis in neurodegeneration.
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Affiliation(s)
- Nicolas Nicastro
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Switzerland.
| | - Giedre Stripeikyte
- Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Brain Mind Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Frédéric Assal
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Switzerland
| | - Valentina Garibotto
- Faculty of Medicine, University of Geneva, Switzerland; Division of Nuclear Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olaf Blanke
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland; Center for Neuroprosthetics, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Brain Mind Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
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Schmitz-Steinkrüger H, Lange C, Apostolova I, Mathies FL, Frings L, Klutmann S, Hellwig S, Meyer PT, Buchert R. Impact of age and sex correction on the diagnostic performance of dopamine transporter SPECT. Eur J Nucl Med Mol Imaging 2020; 48:1445-1459. [PMID: 33130960 PMCID: PMC8113204 DOI: 10.1007/s00259-020-05085-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
Purpose The specific binding ratio (SBR) of 123I-FP-CIT (FP-CIT) in the putamen decreases with age by about 5% per decade and most likely is about 10% higher in females. However, the clinical utility of age and sex correction of the SBR is still a matter of debate. This study tested the impact of age and sex correction on the diagnostic performance of the putamen SBR in three independent patient samples. Methods Research sample: 207 healthy controls (HC) and 438 Parkinson’s disease (PD) patients. Clinical sample A: 183 patients with neurodegenerative parkinsonian syndrome (PS) and 183 patients with non-neurodegenerative PS from one site. Clinical sample B: 84 patients with neurodegenerative PS and 38 patients with non-neurodegenerative PS from another site. Correction for age and sex of the putamen SBR was based on linear regression in the HC or non-neurodegenerative PS, separately in each sample. The area under the ROC curve (AUC) was used as performance measure. Results The putamen SBR was higher in females compared to males (PPMI: 14%, p < 0.0005; clinical sample A: 7%, p < 0.0005; clinical sample B: 6%, p = 0.361). Age-related decline of the putamen SBR ranged between 3.3 and 10.4% (p ≤ 0.019). In subjects ≥ 50 years, age and sex explained < 10% of SBR between-subjects variance. Correction of the putamen SBR for age and sex resulted in slightly decreased AUC in the PPMI sample (0.9955 versus 0.9969, p = 0.025) and in clinical sample A (0.9448 versus 0.9519, p = 0.057). There was a small, non-significant AUC increase in clinical sample B (0.9828 versus 0.9743, p = 0.232). Conclusion These findings do not support age and sex correction of the putaminal FP-CIT SBR in the diagnostic workup of parkinsonian syndromes. This most likely is explained by the fact that the proportion of between-subjects variance caused by age and sex is considerably below the symptom threshold of about 50% reduction in neurodegenerative PS. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-020-05085-2.
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Affiliation(s)
- Helen Schmitz-Steinkrüger
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Catharina Lange
- Department of Nuclear Medicine, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ivayla Apostolova
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Franziska L Mathies
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lars Frings
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Klutmann
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Sabine Hellwig
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Buchert
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Nicastro N, Fleury V, Broc N, Burkhard PR, Garibotto V. Extrastriatal 123I-FP-CIT SPECT impairment in degenerative parkinsonisms. Parkinsonism Relat Disord 2020; 78:38-43. [DOI: 10.1016/j.parkreldis.2020.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
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10
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Fahmi R, Platsch G, Sadr AB, Gouttard S, Thobois S, Zuehlsdorff S, Scheiber C. Single-site 123I-FP-CIT reference values from individuals with non-degenerative parkinsonism-comparison with values from healthy volunteers. Eur J Hybrid Imaging 2020; 4:5. [PMID: 34191214 PMCID: PMC8218096 DOI: 10.1186/s41824-020-0074-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/29/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Iodine 123-radiolabeled 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) SPECT can be performed to distinguish degenerative forms of movement disorders/parkinsonism/tremor from other entities such as idiopathic tremor or drug-induced parkinsonism. For equivocal cases, semi-quantification and comparison to reference values are a necessary addition to visual interpretation of 123I-FP-CIT scans. To overcome the challenges of multi-center recruitment and scanning of healthy volunteers, we generated 123I-FP-CIT reference values from individuals with various neurological conditions but without dopaminergic degeneration, scanned at a single center on the same SPECT-CT system following the same protocol, and compared them to references from a multi-center database built using healthy volunteers’ data. Methods From a cohort of 1884 patients, we identified 237 subjects (120 men, 117 women, age range 16–88 years) through a two-stage selection process. Every patient had a final clinical diagnosis after a mean follow-up of 4.8 ± 1.3 years. Images were reconstructed using (1) Flash3D with scatter and CT-based attenuation corrections (AC) and (2) filtered back projection with Chang AC. Volume-of-interest analysis was performed using a commercial software to calculate specific binding ratios (SBRs), caudate-to-putamen ratios, and asymmetry values on different striatal regions. Generated reference values were assessed according to age and gender and compared with those from the ENC-DAT study, and their robustness was tested against a cohort of patients with different diagnoses. Results Age had a significant negative linear effect on all SBRs. Overall, the reduction rate per decade in SBR was between 3.80 and 5.70%. Women had greater SBRs than men, but this gender difference was only statistically significant for the Flash3D database. Linear regression was used to correct for age-dependency of SBRs and to allow comparisons to age-matched reference values and “normality” limits. Generated regression parameters and their 95% confidence intervals (CIs) were comparable to corresponding European Normal Control Database of DaTscan (ENC-DAT) results. For example, 95% CI mean slope for the striatum in women is − 0.015 ([− 0.019, − 0.011]) for the Flash3D database versus − 0.015 ([− 0.021, − 0.009]) for ENC-DAT. Caudate-to-putamen ratios and asymmetries were not influenced by age or gender. Conclusion The generated 123I-FP-CIT references values have similar age-related distribution, with no increase in variance due to comorbidities when compared to values from a multi-center study with healthy volunteers. This makes it possible for sites to build their 123I-FP-CIT references from scans acquired during routine clinical practice.
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Affiliation(s)
- Rachid Fahmi
- Siemens Medical Solutions USA, Inc., Molecular Imaging, Knoxville, TN, USA
| | | | | | | | - Stephane Thobois
- Movement Disorder Clinic, Pierre Wertheimer Neurologic Hospital, Hospices Civils de Lyon, 69500, Bron, France.,Faculté de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France.,Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, CNRS, Bron, France
| | - Sven Zuehlsdorff
- Siemens Medical Solutions USA, Inc., Molecular Imaging, Knoxville, TN, USA
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11
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Frings L, Henninger F, Treppner M, Köber G, Boeker M, Hellwig S, Buchert R, Meyer PT. [123I]FP-CIT SPECT in Clinically Uncertain Parkinsonism Predicts Survival: A Data-Driven Analysis. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1457-1465. [PMID: 33044193 DOI: 10.3233/jpd-202214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Dopamine transporter SPECT is an established method to investigate nigrostriatal integrity in case of clinically uncertain parkinsonism. OBJECTIVE The present study explores whether a data-driven analysis of [123I]FP-CIT SPECT is able to stratify patients according to mortality after SPECT. METHODS Patients from our clinical registry were included if they had received [123I]FP-CIT SPECT between 10/2008 and 06/2016 for diagnosis of parkinsonism and if their vital status could be determined in 07/2017. Specific binding ratios (SBR) of the whole striatum, its asymmetry (asymmetry index, AI; absolute value), and the rostrocaudal gradient of striatal binding (C/pP: caudate SBR divided by posterior putamen SBR) were used as input for hierarchical clustering of patients. We tested differences in survival between these groups (adjusted for age) with a Cox proportional hazards model. RESULTS Data from 518 patients were analyzed. Median follow-up duration was 3.3 years [95% C.I. 3.1 to 3.7]. Three subgroups identified by hierarchical clustering were characterized by relatively low striatal SBR, high AI, and low C/pP (group 1), low striatal SBR, high AI, and high C/pP (group 2), and high striatal SBR, low AI, and low C/pP (group 3). Mortality was significantly higher in group 1 compared to each of the other two groups (p = 0.029 and p = 0.003, respectively). CONCLUSION Data-driven analysis of [123I]FP-CIT SPECT identified a subgroup of patients with significantly increased mortality during follow-up. This suggests that [123I]-FP-CIT SPECT might not only serve as a diagnostic tool to verify nigrostriatal degeneration but also provide valuable prognostic information.
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Affiliation(s)
- Lars Frings
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franziska Henninger
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Treppner
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Göran Köber
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sabine Hellwig
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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12
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Classification of degenerative parkinsonism subtypes by support-vector-machine analysis and striatal 123I-FP-CIT indices. J Neurol 2019; 266:1771-1781. [PMID: 31037416 PMCID: PMC6586917 DOI: 10.1007/s00415-019-09330-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/10/2019] [Accepted: 04/21/2019] [Indexed: 12/30/2022]
Abstract
Objectives To provide an automated classification method for degenerative parkinsonian syndromes (PS) based on semiquantitative 123I-FP-CIT SPECT striatal indices and support-vector-machine (SVM) analysis. Methods 123I-FP-CIT SPECT was performed at a single-center level on 370 individuals with PS, including 280 patients with Parkinson’s disease (PD), 21 with multiple system atrophy-parkinsonian type (MSA-P), 41 with progressive supranuclear palsy (PSP) and 28 with corticobasal syndrome (CBS) (mean age 70.3 years, 47% female, mean disease duration at scan 1.4 year), as well as 208 age- and gender-matched control subjects. Striatal volumes-of-interest (VOIs) uptake, VOIs asymmetry indices (AIs) and caudate/putamen (C/P) ratio were used as input for SVM individual classification using fivefold cross-validation. Results Univariate analyses showed significantly lower VOIs uptake, higher striatal AI and C/P ratio for each PS in comparison to controls (all p < 0.001). Among PS, higher degree of striatal impairment was observed in MSA-P and PSP, while CBS showed moderate uptake reduction and higher AI. Binary SVM classification showed 92.9% accuracy in distinguishing PS from controls. Classification based on each binary combination of PS ranged 62.9–83.7% accuracy with the most satisfactory results when separating CBS from the other PS. Sensitivity and specificity values were high and balanced ranging from 60 to 80% for all analyses with > 70% accuracy. Overall, striatal AI and C/P ratio on the more affected side had the highest weighting factors. Conclusion Semiquantitative 123I-FP-CIT SPECT striatal evaluation combined with SVM represents a promising approach to disentangle PD from non-degenerative conditions and from atypical PS at the early stage.
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13
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Nicastro N, Eger AF, Assal F, Garibotto V. Feeling of presence in dementia with Lewy bodies is related to reduced left frontoparietal metabolism. Brain Imaging Behav 2018; 14:1199-1207. [PMID: 30511120 PMCID: PMC7381475 DOI: 10.1007/s11682-018-9997-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Feeling of presence (FOP) refers to the vivid sensation of a person’s presence near oneself and is common in Dementia with Lewy Bodies (DLB). Based on previous observations on epileptic subjects, we hypothesized that DLB subjects with FOP would harbour 18F-fluorodeoxyglucose PET hypometabolism in left parietal areas. 25 subjects (mean age 71.9 ± 6.7, disease duration at scan 1.7 ± 1.5 years) were included in the study, of whom nine (36%) experienced FOP. No significant between-group difference was observed regarding dopamine transporters striatal uptake (p = 0.64), daily dopaminergic treatment dosage (p = 0.88) and visual hallucinations (p = 0.83). Statistical parametric mapping showed that subjects with FOP had a significantly reduced glucose metabolism in several left frontoparietal areas (p < 0.001), including superior parietal lobule and precuneus. Interregional correlation analysis of these areas showed specific connectivity with right insula and putamen in the FOP subgroup and right orbitofrontal and superior frontal in subjects without FOP. This provides further evidence about the role of a left frontoparietal network and suggest a possible contribution of impaired orbitofrontal reality filtering associated with FOP.
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Affiliation(s)
- Nicolas Nicastro
- Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK. .,Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
| | - Antoine F Eger
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Frederic Assal
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Valentina Garibotto
- Department of Nuclear Medicine, Geneva University Hospitals, Geneva, Switzerland.,NiMTLab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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14
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Combined 123I-FP-CIT SPECT semiquantitative and visual assessment in parkinsonian syndromes and dementia with Lewy bodies – response to Kawada et al. J Neurol Sci 2018; 392:126-127. [DOI: 10.1016/j.jns.2018.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 11/18/2022]
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15
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Dopaminergic imaging separates normal pressure hydrocephalus from its mimics. J Neurol 2018; 265:2434-2441. [DOI: 10.1007/s00415-018-9029-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/30/2018] [Accepted: 08/19/2018] [Indexed: 10/28/2022]
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16
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Abstract
PURPOSE [123I]FP-CIT (DaTSCAN®) single-photon emission computed tomography (SPECT) imaging is widely used to study neurodegenerative parkinsonism, by measuring presynaptic dopamine transporter (DAT) in striatal regions. Beyond DAT, [123I]FP-CIT may be considered for other monoaminergic systems, in particular the serotonin transporter (SERT). Independent component analysis (ICA) implemented in source-based morphometry (SBM) could represent an alternative method to explore monoaminergic pathways, studying the relationship among voxels and grouping them into "neurotransmission" networks. PROCEDURES One hundred forty-three subjects [84 with Parkinson's disease (PD) and 59 control individuals (CG)] underwent DATSCAN® imaging. The [123I]FP-CIT binding was evaluated by multivariate SBM approach, as well as by a whole-brain voxel-wise univariate (statistical parametric mapping, SPM) approach. RESULTS As compared to the univariate whole-brain approach (SPM) (only demonstrating striatal [123I]FP-CIT binding reduction in PD group), SBM identified six sources of non-artefactual origin, including basal ganglia and cortical regions as well as brainstem. Among them, three sources (basal ganglia and cortical regions) presented loading scores (as index of [123I]FP-CIT binding) significantly different between PD and CG. Notably, even if not significantly different between PD and CG, the remaining three non-artefactual sources were characterized by a predominant frontal, brainstem, and occipito-temporal involvement. CONCLUSION The concept of source blind separation by the application of ICA (as implemented in SBM) represents a feasible approach to be considered in [123I]FP-CIT (DaTSCAN®) SPECT imaging. Taking advantage of this multivariate analysis, specific patterns of variance can be identified (involving either striatal than extrastriatal regions) that could be useful in differentiating neurodegenerative parkinsonisms.
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17
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Nicastro N, Manuel AL, Garibotto V, Burkhard PR, Schnider A. Consolidation of a Learned Skill Correlates with Dopamine SPECT Uptake in Early Parkinson's Disease. J Clin Neurol 2018; 14:505-512. [PMID: 30198222 PMCID: PMC6172506 DOI: 10.3988/jcn.2018.14.4.505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Basal ganglia play a pivotal role in procedural memory. However, the correlation between skill learning and striatal ¹²³I-ioflupane uptake in Parkinson's disease (PD) has not been reported previously. Our objective was to determine whether visuomotor skill learning is associated with striatal ¹²³I-ioflupane uptake in early PD. METHODS We designed a case-control study to assess learning and consolidation of a visuomotor learning task (mirrored drawing of star-shaped figures) performed on two consecutive days by early-PD patients (disease duration <2 years) and age-matched healthy subjects. Outcomes were the error rate and time per trial, as well as performance indices to assess the relative improvement on the first day (learning) and the retention on the second day (consolidation). For PD patients, we evaluated the correlation of skill learning with semiquantitative ¹²³I-ioflupane uptake. RESULTS We included 9 PD patients and 10 control subjects with the same baseline characteristics (age, male/female ratio, educational level, Mini Mental State Examination score, and Hospital Anxiety and Depression Scale score, all p>0.18) other than the score on part III of the Movement Disorders Society Unified Parkinson's Disease Rating Scale, which was higher in the PD patients (mean±SD: 15.0±10.4 vs. 1.3±1.1, p<0.001). The learning indices were the same in the two groups (p>0.5), whereas PD patients showed a lower consolidation index for the time per trial (p=0.009). Moreover, this performance was correlated with uptake in the right caudate nucleus (Spearman's rho=0.82, p=0.007) and the right striatum (Spearman's rho=0.67, p=0.049), including when multiple linear regression adjusting for the levodopa equivalent daily dose was performed (p=0.005 for the caudate nucleus and p=0.024 for the striatum). CONCLUSIONS This study provides evidence of a correlation between procedural memory impairment and striatal dopaminergic dysfunction in early PD.
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Affiliation(s)
- Nicolas Nicastro
- Division of Neurorehabilitation, Geneva University Hospitals, Geneva, Switzerland.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
| | - Aurélie L Manuel
- Laboratory of Cognitive Neurorehabilitation, Geneva University Hospitals, Geneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzlerland
| | - Pierre R Burkhard
- Faculty of Medicine, Geneva University, Geneva, Switzlerland.,Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Armin Schnider
- Division of Neurorehabilitation, Geneva University Hospitals, Geneva, Switzerland.,Laboratory of Cognitive Neurorehabilitation, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzlerland
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18
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Semiquantitative analysis using standardized uptake value in 123I-FP-CIT SPECT/CT. Clin Imaging 2018; 52:57-61. [PMID: 29909364 DOI: 10.1016/j.clinimag.2018.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/02/2018] [Accepted: 06/10/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate potential of a semiquantitative method using standardized uptake value (SUV) in 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) single photon emission computed tomography/computed tomography (SPECT/CT) compared with specific binding ratio (SBR). MATERIALS AND METHODS First, we performed a phantom study to validate the accuracy of measuring SUV. 52 patients (25 male, 27 female; mean age of 75.1-year-old; 40 and 12 patients with neurodegenerative diseases with or without presynaptic dopaminergic deficits, respectively) were enrolled in a retrospective study. We measured SBR, maximum SUV, peak SUV, mean SUV, and striatum-to-background ratio of SUV (SUVratio) for striatum with lower 123I-FP-CIT uptake using commercial software. We calculated Pearson's correlation coefficient between SBR and SUV. We also calculated the sensitivity, specificity, and accuracy of each parameter for differential diagnosis. RESULTS The phantom study revealed errors of <10% between theoretical and actual SUVs. Although there were significant correlations between SBR and all SUV-based parameters, SUVratio showed the most strong correlation with SBR (r = 0.877, p < 0.001). However, diagnostic capability of SUVratio (cutoff = 2.35) yielded to that of SBR (cutoff = 3.90) for diagnosing neurodegenerative diseases with presynaptic dopaminergic deficits (sensitivity of 85.0% vs 92.5%, specificity of 100% vs 91.7%, and accuracy of 88.5% vs 92.3%, respectively). CONCLUSION SBR is a promising parameter to aid differential diagnosis of neurodegenerative diseases with or without presynaptic dopaminergic deficit. Although technically acceptable, SUV may not be superior to SBR when clinically applied in 123I-FP-CIT SPECT/CT.
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Neuroimaging in Parkinson's disease: focus on substantia nigra and nigro-striatal projection. Curr Opin Neurol 2018; 30:416-426. [PMID: 28537985 DOI: 10.1097/wco.0000000000000463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW The diagnosis of Parkinson disease is based on clinical features; however, unmet need is an imaging signature for Parkinson disease and the early differential diagnosis with atypical parkinsonisms. A summary of the molecular imaging and MRI recent evidences for Parkinson disease diagnosis will be presented in this review. RECENT FINDINGS The nigro-striatal dysfunction explored by dopamine transporter imaging is not a mandatory diagnostic criterion for Parkinson disease, recent evidence supported its utility as in-vivo proof of degenerative parkinsonisms, and there might be compensatory mechanisms leading to an early overestimation. The visualization of abnormalities in substantia nigra by MRI has been recently described as sensitive and specific tool for Parkinson disease diagnosis, even in preclinical conditions, whereas it is not useful for distinguishing between Parkinson disease and atypical parkinsonisms. The relationship between the nigral anatomical changes, evaluated as structural alterations or neuromelanin signal decrease and the dopaminergic nigro-striatal function needs to be further clarified. SUMMARY With the hopeful advent of potential neuroprotective drugs for PD, it is crucial to have imaging measures that are able to detect at risk subjects. Moreover it is desirable to increase the knowledge about which measure better predicts the probability and the time of clinical conversion to PD.
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20
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Nicastro N, Burkhard PR, Garibotto V. Scan without evidence of dopaminergic deficit (SWEDD) in degenerative parkinsonism and dementia with Lewy bodies: A prospective study. J Neurol Sci 2018; 385:17-21. [DOI: 10.1016/j.jns.2017.11.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/26/2017] [Accepted: 11/30/2017] [Indexed: 11/15/2022]
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21
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123I-FP-CIT SPECT Accurately Distinguishes Parkinsonian From Cerebellar Variant of Multiple System Atrophy. Clin Nucl Med 2018; 43:e33-e36. [DOI: 10.1097/rlu.0000000000001899] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Ueda J, Yoshimura H, Shimizu K, Hino M, Kohara N. Response to the letter to the editor of Nicolas Nicastro et al. Neurol Sci 2018; 39:189-190. [DOI: 10.1007/s10072-017-3113-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
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23
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Nicastro N, Garibotto V, Burkhard PR. The added value of combined visual and semi-quantitative assessment for 123I-FP-CIT SPECT and reply to Ueda et al. Neurol Sci 2017; 38:1883-1884. [DOI: 10.1007/s10072-017-3010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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24
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Gajos A, Budrewicz S, Koszewicz M, Bieńkiewicz M, Dąbrowski J, Kuśmierek J, Sławek J, Bogucki A. Is nigrostriatal dopaminergic deficit necessary for Holmes tremor to develop? The DaTSCAN and IBZM SPECT study. J Neural Transm (Vienna) 2017; 124:1389-1393. [PMID: 28836067 PMCID: PMC5653710 DOI: 10.1007/s00702-017-1780-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/14/2017] [Indexed: 12/28/2022]
Abstract
Holmes’s tremor (HT) is assumed to be the result of coexistence of nigrostriatal dopaminergic system impairment and the lesion of cerebello-thalamic pathways. It was suggested that dopaminergic deficiency is responsible for rest tremor, and lack of compensatory cerebellar function leads to spill of tremor into voluntary movements. Cases of HT with and without abnormalities of the presynaptic part of dopaminergic nigrostriatal were published and these findings raised the question of possibility of the postsynaptic lesion. Three patients with HT diagnosed according to criteria of Consensus Statement on Tremor were studied. In all of them SPECT imaging with ligands of presynaptic (I 123-FP CIT—DaTSCAN) and postsynaptic (I 123-iodobenzamide—IBZM) nigrostriatal dopaminergic neurons was performed. Indices of uptake in caudate and putamen normalized to nonspecific uptake in occipital cortex and indices of asymmetry for each whole striatum as well as for putamen and caudate separately were calculated. SPECT studies did not reveal asymmetry of DaTSCAN and IBZM binding in striatum in all studied subjects. The current clinical diagnostic criteria of HT are presumably insufficiently specific and when using them we identify patients both with and without the involvement of dopaminergic system. These two groups may represent tremor disorders of similar phenomenology but of different pathomechanism.
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Affiliation(s)
- Agata Gajos
- Department of Extrapyramidal Diseases, Central University Hospital, Medical University of Łódź, Pomorska 251 Str, 92-213, Łódź, Poland
| | | | | | - Małgorzata Bieńkiewicz
- Department of Quality Control and Radiological Protection, Medical University of Łódź, Łódź, Poland
| | - Janusz Dąbrowski
- Department of Nuclear Medicine, Medical University of Łódź, Łódź, Poland
| | - Jacek Kuśmierek
- Department of Nuclear Medicine, Medical University of Łódź, Łódź, Poland
| | - Jarosław Sławek
- Department of Neurological and Psychiatric Nursing, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Bogucki
- Department of Extrapyramidal Diseases, Central University Hospital, Medical University of Łódź, Pomorska 251 Str, 92-213, Łódź, Poland.
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Added Value of Combined Semi-Quantitative and Visual [123I]FP-CIT SPECT Analyses for the Diagnosis of Dementia With Lewy Bodies. Clin Nucl Med 2017; 42:e96-e102. [DOI: 10.1097/rlu.0000000000001477] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Isaacson SH, Fisher S, Gupta F, Hermanowicz N, Kremens DE, Lew MF, Marek K, Pahwa R, Russell DS, Seibyl J. Clinical utility of DaTscan™ imaging in the evaluation of patients with parkinsonism: a US perspective. Expert Rev Neurother 2016; 17:219-225. [DOI: 10.1080/14737175.2017.1256205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, FL, USA
| | - Stanley Fisher
- Saint Luke’s Marion Bloch Neuroscience Institute, Kansas City, MO, USA
| | - Fiona Gupta
- Hackensack University Medical Center, Movement Disorders Center, Hackensack, NJ, USA
| | - Neal Hermanowicz
- Irvine Health Movement Disorders Program, University of California, Irvine, CA, USA
| | - Daniel E. Kremens
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Mark F. Lew
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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Wile DJ, Sossi V, Stoessl AJ. Reply to letter to the editor: Is there anything more to learn from SWEDD? Mov Disord 2016; 31:1426-8. [PMID: 27519281 DOI: 10.1002/mds.26709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Daryl J Wile
- Pacific Parkinson's Research Centre, University of British Columbia, British Columbia, Vancouver, Canada.
| | - Vesna Sossi
- Pacific Parkinson's Research Centre, University of British Columbia, British Columbia, Vancouver, Canada.,Department of Physics and Astronomy, University of British Columbia, British Columbia, Vancouver, Canada
| | - A Jon Stoessl
- Pacific Parkinson's Research Centre, University of British Columbia, British Columbia, Vancouver, Canada
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Nicastro N, Garibotto V, Badoud S, Burkhard PR. Scan without evidence of dopaminergic deficit: A 10-year retrospective study. Parkinsonism Relat Disord 2016; 31:53-58. [PMID: 27421952 DOI: 10.1016/j.parkreldis.2016.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/28/2016] [Accepted: 07/05/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION 123I-ioflupane SPECT is a powerful method to assess nigrostriatal dopamine system integrity. Several independent studies have shown that 1-15% of patients with suspected degenerative parkinsonism, mainly PD, have scans without evidence of dopaminergic deficit (SWEDD). It has been proposed that most SWEDD patients either present with a non-degenerative condition mimicking PD, such as atypical tremor or dystonia, or demonstrate an abnormal scan when repeated later. We here hypothesized that scan interpretation methods may also play a crucial yet underestimated role in this issue. METHODS We previously established age-dependent reference values of striatal uptake by analyzing scans from a cohort of patients with non-degenerative conditions. We then studied a large population with well-established degenerative parkinsonism (N = 410, 80% with PD), using identical imaging protocol, to evaluate the prevalence of patients with normal scans based on routine visual assessment. Each scan was eventually reassessed using the same automated method as for controls and a detailed 3D analysis. RESULTS Ten potential SWEDD cases (2.4%) were identified. However, both reassessment methods independently showed that these scans were all outside reference limits and/or visually abnormal when reexamined carefully, except for one case (0.2%) with corticobasal syndrome. CONCLUSION SPECT misinterpretation emerges as an important contributor to the SWEDD population, suggesting that suspected SWEDD cases should prompt not only a serious diagnosis challenge but, equally important, a detailed scan reassessment. True SWEDD cases seem extremely rare in degenerative parkinsonism. We propose that the very concept of SWEDD is more confusing than helpful and should be definitely abandoned.
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Affiliation(s)
- Nicolas Nicastro
- Department of Neurology, Geneva University Hospitals, Switzerland
| | - Valentina Garibotto
- Department of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Switzerland; Faculty of Medicine, University of Geneva, Switzerland
| | - Simon Badoud
- Department of Neurology, Geneva University Hospitals, Switzerland; Physiology Unit, Department of Medicine, University of Fribourg, Switzerland
| | - Pierre R Burkhard
- Department of Neurology, Geneva University Hospitals, Switzerland; Faculty of Medicine, University of Geneva, Switzerland.
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Badoud S, Van De Ville D, Nicastro N, Garibotto V, Burkhard PR, Haller S. Discriminating among degenerative parkinsonisms using advanced (123)I-ioflupane SPECT analyses. Neuroimage Clin 2016; 12:234-40. [PMID: 27489771 PMCID: PMC4950578 DOI: 10.1016/j.nicl.2016.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/23/2016] [Accepted: 07/04/2016] [Indexed: 11/26/2022]
Abstract
(123)I-ioflupane single photon emission computed tomography (SPECT) is a sensitive and well established imaging tool in Parkinson's disease (PD) and atypical parkinsonian syndromes (APS), yet a discrimination between PD and APS has been considered inconsistent at least based on visual inspection or simple region of interest analyses. We here reappraise this issue by applying advanced image analysis techniques to separate PD from the various APS. This study included 392 consecutive patients with degenerative parkinsonism undergoing (123)I-ioflupane SPECT at our institution over the last decade: 306 PD, 24 multiple system atrophy (MSA), 32 progressive supranuclear palsy (PSP) and 30 corticobasal degeneration (CBD) patients. Data analysis included voxel-wise univariate statistical parametric mapping and multivariate pattern recognition using linear discriminant classifiers. MSA and PSP showed less ioflupane uptake in the head of caudate nucleus relative to PD and CBD, yet there was no difference between MSA and PSP. CBD had higher uptake in both putamen relative to PD, MSA and PSP. Classification was significant for PD versus APS (AUC 0.69, p < 0.05) and between APS subtypes (MSA vs CBD AUC 0.80, p < 0.05; MSA vs PSP AUC 0.69 p < 0.05; CBD vs PSP AUC 0.69 p < 0.05). Both striatal and extra-striatal regions contain classification information, yet the combination of both regions does not significantly improve classification accuracy. PD, MSA, PSP and CBD have distinct patterns of dopaminergic depletion on (123)I-ioflupane SPECT. The high specificity of 84-90% for PD versus APS indicates that the classifier is particularly useful for confirming APS cases.
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Affiliation(s)
- Simon Badoud
- Neurology Division, Department of Clinical Neurosciences (NEUCLI), Geneva University Hospitals, Switzerland
- Neurophysiology Unit, Department of Medicine, University of Fribourg (CH), Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
| | - Dimitri Van De Ville
- Department of Imaging and Medical Informatics, University Hospitals of Geneva, Faculty of Medicine, University of Geneva, Switzerland
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Switzerland
| | - Nicolas Nicastro
- Neurology Division, Department of Clinical Neurosciences (NEUCLI), Geneva University Hospitals, Switzerland
| | - Valentina Garibotto
- Faculty of Medicine, University of Geneva, Switzerland
- Nuclear Medicine and Molecular Imaging Division, Department of Imaging and Medical Informatics, University Hospitals of Geneva, Switzerland
| | - Pierre R. Burkhard
- Neurology Division, Department of Clinical Neurosciences (NEUCLI), Geneva University Hospitals, Switzerland
- Faculty of Medicine, University of Geneva, Switzerland
| | - Sven Haller
- Faculty of Medicine, University of Geneva, Switzerland
- Affidea Centre de Diagnostic Radiologique de Carouge CDRC, Geneva, Switzerland
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Department of Neuroradiology, University Hospital Freiburg, Germany
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Garibotto V, Nicastro N, Burkhard PR. No more SWEDDs. Mov Disord 2016; 31:1426. [PMID: 27297571 DOI: 10.1002/mds.26705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/11/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Nicastro
- Department of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre R Burkhard
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
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