The diagnostic performance of functional dopaminergic scintigraphic imaging in the diagnosis of dementia with Lewy bodies: an updated systematic review

• Published in: European journal of nuclear medicine and molecular imaging 2023-06, Vol.50 (7), p.1988-2035
• Main Authors: Jreige, Mario, Kurian, George K., Perriraz, Jérémy, Potheegadoo, Jevita, Bernasconi, Fosco, Stampacchia, Sara, Blanke, Olaf, Alessandra, Griffa, Lejay, Noemie, Chiabotti, Paolo Salvioni, Rouaud, Olivier, Nicod Lalonde, Marie, Schaefer, Niklaus, Treglia, Giorgio, Allali, Gilles, Prior, John O.
• Format: Article
• Language: English
• Subjects: Cardiology; Dementia; Dementia disorders; Diagnosis; Dopamine; Dopamine Plasma Membrane Transport Proteins; Dopamine receptors; Dopamine transporter; Humans; Image analysis; Image processing; Imaging; Iodine Radioisotopes; Lewy bodies; Lewy body disease; Lewy Body Disease - diagnostic imaging; Literature reviews; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Neurology; Nuclear Medicine; Oncology; Orthopedics; Qualitative analysis; Quantitative analysis; Radioisotopes; Radiology; Review; Review Article; Search algorithms; Signs and symptoms; Single photon emission computed tomography; Systematic review; Tomography, Emission-Computed, Single-Photon - methods; Tropanes
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-023-06154-y

Introduction Dopaminergic scintigraphic imaging is a cornerstone to support the diagnosis in dementia with Lewy bodies. To clarify the current state of knowledge on this imaging modality and its impact on clinical diagnosis, we performed an updated systematic review of the literature. Methods This systematic review was carried out according to PRISMA guidelines. A comprehensive computer literature search of PubMed/MEDLINE, EMBASE, and Cochrane Library databases for studies published through June 2022 was performed using the following search algorithm: (a) "Lewy body" [TI] OR "Lewy bodies" [TI] and (b) ("DaTscan" OR "ioflupane" OR "123ip" OR "123?ip" OR "123 ip" OR "123i-FP-CIT" OR "FPCIT" OR "FP-CIT" OR "beta?CIT" OR "beta CIT" OR "CIT?SPECT" OR "CIT SPECT" OR "Dat?scan*" OR "dat scan*" OR "dat?spect*" OR "SPECT"). Risk of bias and applicability concerns of the studies were evaluated using the QUADAS-2 tool. Results We performed a qualitative analysis of 59 studies. Of the 59 studies, 19 (32%) addressed the diagnostic performance of dopamine transporter imaging, 15 (25%) assessed the identification of dementia with Lewy bodies in the spectrum of Lewy body disease and 18 (31%) investigated the role of functional dopaminergic imaging in distinguishing dementia with Lewy bodies from other dementias. Dopamine transporter loss was correlated with clinical outcomes in 19 studies (32%) and with other functional imaging modalities in 15 studies (25%). Heterogeneous technical aspects were found among the studies through the use of various radioligands, the more prevalent being the [123I]N‑ω‑fluoropropyl‑2β‑carbomethoxy‑3β‑(4‑iodophenyl) nortropane ( 123 I-FP-CIT) in 54 studies (91.5%). Image analysis used visual analysis (9 studies, 15%), semi-quantitative analysis (29 studies, 49%), or a combination of both (16 studies, 27%). Conclusion Our systematic review confirms the major role of dopaminergic scintigraphic imaging in the assessment of dementia with Lewy bodies. Early diagnosis could be facilitated by identifying the prodromes of dementia with Lewy bodies using dopaminergic scintigraphic imaging coupled with emphasis on clinical neuropsychiatric symptoms. Most published studies use a semi-quantitative analytical assessment of tracer uptake, while there are no studies using quantitative analytical methods to measure dopamine transporter loss. The superiority of a purely quantitative approach to assess dopaminergic transmission more accurately needs to be furthe