Clin Nucl Med. 2018 Oct;43(10):710-714. doi: 10.1097/RLU.0000000000002240.
To evaluate the value of I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT-SPECT) to change management strategies of patients suspected of parkinsonism.
This was an institutional review board-approved, retrospective study. DAT-SPECT scans ordered by movement disorder specialist and neurologists from 2011-2014 were reviewed. Clinical data and radiological reports of 173 patients suspected of parkinsonism were reviewed. The DAT-SPECT scan results were correlated with clinical assessment and treatment changes.
A total of 173 patients (104 male and 69 female subjects; age, 64.4 ± 12.6 years) suspected of parkinsonism were included. Median duration of symptoms was 36 months (range, 1-480 months). Scans were most often requested when there was diagnostic uncertainty in clinical features (59.6%, 103/173) or to differentiate one other disease from parkinsonism such as Parkinson disease (PD) versus essential tremor (23.7%, 41/173), PD versus drug-induced parkinsonism (8.7%, 15/173), or PD versus psychogenic (6.4%, 11/173) or vascular (1.7%, 3/173) disorders. Patients were classified, according to the DAT-SPECT scanning results, as those with abnormal DAT-SPECT findings (59%, 102/173) and those with normal DAT-SPECT findings (41%, 71/173). In patients with normal DAT-SPECT findings, follow-up management data were available in 76.1% (54/71). The management changed in 39.4% (28/54) after DAT scan with starting a new appropriate medications or supportive therapy in 4.2% (3/28), withholding inappropriate dopaminergic treatment in 11.3% (8/28), or continuing observation in 23.9% (17/28). In patients with abnormal DAT-SPECT findings, follow-up management data were available in 78.4% (80/102). There was change in management of 37.3% (38/80), a new PD treatment was started in 89.5% (34/38). The dose of medication was adjusted in 5.3% (2/38), although the original treatment was not changed. Parkinson disease treatment was stopped in 2.6% (1/38) and discontinued in 2.6% (1/38) based on clinical decision of neurologists despite abnormal DAT-SPECT findings.
DAT-SPECT findings impacted treatment decisions in 44.7% of patients suspected of Parkinsonism.
评估 I-2β- 甲氧基-3β-(4- 碘苯基）-N-(3- 氟丙基）-nortropane（I-FP-CIT）多巴胺转运体单光子发射计算机断层扫描（DAT-SPECT）在改变疑似帕金森病患者的治疗策略中的价值。
这是一项经过机构审查委员会批准的回顾性研究。回顾了 2011-2014 年间运动障碍专家和神经科医生要求进行的 DAT-SPECT 扫描。回顾了 173 例疑似帕金森病患者的临床数据和影像学报告。将 DAT-SPECT 扫描结果与临床评估和治疗变化相关联。
共纳入 173 例（104 例男性和 69 例女性；年龄 64.4±12.6 岁）疑似帕金森病患者。中位症状持续时间为 36 个月（范围 1-480 个月）。当临床特征存在诊断不确定性（59.6%，103/173）或需要将一种其他疾病与帕金森病区分开来时，通常会要求进行扫描，例如帕金森病（PD）与特发性震颤（23.7%，41/173）、PD 与药物诱导的帕金森病（8.7%，15/173）、PD 与精神性（6.4%，11/173）或血管性（1.7%，3/173）疾病。根据 DAT-SPECT 扫描结果，患者被分为 DAT-SPECT 异常发现者（59%，102/173）和 DAT-SPECT 正常发现者（41%，71/173）。在 DAT-SPECT 正常发现者中，76.1%（54/71）有随访管理数据。DAT 扫描后，管理发生变化的占 39.4%（28/54），开始新的适当药物治疗或支持性治疗的占 4.2%（28/28），停用不适当的多巴胺能治疗的占 11.3%（8/28），或继续观察的占 23.9%（17/28）。在 DAT-SPECT 异常发现者中，78.4%（80/102）有随访管理数据。管理发生变化的占 37.3%（38/80），89.5%（34/38）开始新的 PD 治疗。尽管 DAT-SPECT 结果异常，但药物剂量调整占 5.3%（2/38），且原始治疗未改变。根据神经科医生的临床决策，停止 PD 治疗的占 2.6%（1/38），停止治疗的占 2.6%（1/38）。
DAT-SPECT 结果影响了 44.7%疑似帕金森病患者的治疗决策。
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