How useful is [123I]β-CIT SPECT in clinical practice?

• Published in: Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2005-09, Vol.76 (9), p.1211-1216
• Main Authors: Eerola, J, Tienari, P J, Kaakkola, S, Nikkinen, P, Launes, J
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Biological and medical sciences; carbomethoxy-3β-(4-iodophenyl)tropane; Cerebrospinal fluid. Meninges. Spinal cord; CIT; Cocaine - analogs & derivatives; DAT; dementia with Lewy bodies; Diagnosis, Differential; DLB; dopamine transporter; dopamine transporters; Essential Tremor - diagnostic imaging; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; MSA; multiple system atrophy; Nervous system; Nervous system (semeiology, syndromes); Neurology; Parkinson Disease - diagnostic imaging; Parkinson’s disease; progressive supranuclear palsy; PSP; Radionuclide investigations; Radiopharmaceuticals; receiver operating characteristic; region of interest; ROC; ROI; Sensitivity and Specificity; single photon emission computed tomography; SPECT; Tomography, Emission-Computed, Single-Photon; β-CIT
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2004.045237

Objective: To assess the accuracy and clinical usefulness of [123I]β-CIT (2β-carbomethoxy-3β-(4-iodophenyl)tropane) SPECT in the differential diagnosis of Parkinson’s disease. Subjects: 185 consecutive patients with symptoms of movement disorder were studied. The diagnoses were Parkinson’s disease (92), essential tremor (16), vascular parkinsonism (15), various Parkinson plus syndromes (P+) (12), dementia with Lewy bodies (DLB) (5), dystonia (5), drug induced movement disorder (12), and other diagnoses (8). A reference group (psychogenic parkinsonism) comprised 20 subjects with complaints suggesting extrapyramidal disease but with no unequivocal signs on clinical examination and no abnormalities on brain imaging. Results: β-CIT uptake was significantly lower in the whole striatum as well as separately in the putamen and in the caudate nucleus in Parkinson’s disease than in the reference group or in drug induced movement disorder, essential tremor, or dystonia. The uptake of β-CIT in the vascular parkinsonism group was heterogeneous and mean β-CIT uptake fell between the reference group and the Parkinson’s disease group. In the P+ and DLB groups the striatal uptake ratios overlapped those of the Parkinson’s disease group. Conclusions: [123I]β-CIT SPECT may not be as useful a tool in the clinical differential diagnosis of Parkinson’s disease as was previously believed, but it was 100% sensitive and specific for the diagnosis in younger patients (age 55 years) specificity was substantially lower (68.5%). This differential specificity reflected the different distribution of differential diagnostic disorders (P+, DLB, vascular parkinsonism) in the older and younger age groups.