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Estimation of Dopamine D2 Receptor Binding Potential in the Striatum with Iodine-123-IBZM SPECT: Technical and Interobserver Variability

Department of Nuclear Medicine, Academic Medical Centre, Amsterdam
Cygne B.V., Technical University, Eindhoven, The Netherlands

Correspondence: For correspondence or reprints contact: N.P.L.G. Verhoeff, MD, PhD, Singel 24, NL 2912 SL Nieuwerkerk aan den IJssel (ZH), The Netherlands.

ABSTRACT

Factors contributing to the quantification of the striatal dopamine D2 receptor binding potential in vivo using ¹²³I-iodobenzamide (¹²³I-IBZM) and SPECT were analyzed in phantom studies, healthy volunteers and in patients with the parkinsonian syndrome. A cylindrical brain phantom based on a stereotactic brain atlas was constructed with independently fillable compartments representing two striata (ST), cerebellum (CB) and background. Clinical ¹²³I-IBZM SPECT studies were performed on 15 healthy volunteers and on 28 patients with parkinsonian syndrome. Interobserver variability of region of interest (ROI) selection and count ratios were estimated by two independent observers. ROIs for the striatum were either fixed, based on a stereotactic brain atlas, or drawn manually, based on 70% isocontour lines. Reference regions were either the cerebellum (isocontour ROIs) or the occipital cortex (occiptal cortex; fixed ROIs). The brain phantom measurements showed linearity with respect to radioactivity concentration, good reproduability and good contrast recovery. The interobserver study-showed that the striatum-to-occipital cortex ratio with fixed ROIs for the striatum, as an estimate for striatal D2 receptor binding potential, resulted in a means of separating patients with normal receptor activity from those with decreased striatal dopamine D2 receptor activity.

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