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Imaging of Dopamine Transporters with Iodine-123-FP-CIT SPECT in Healthy Controls and Patients with Parkinson's Disease

Graduate School of Neurosciences Amsterdam, Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam; Department of Neurology, Academisch Ziekenhuis Vrije Universiteit, Amsterdam; Amersdam Cygne and Eindhoven University of Technology, Eindhoven, The Netherlands

Correspondence: For correspondence or reprints contact: J. Booij, MD, Department of Nuclear Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

ABSTRACT

Several SPECT studies reported decreased striatal ¹²³I-/V-cu-fluoro-propyl- 2ß-carbomethoxy-3ß-(4-iodophenyl)nortropane ([¹²³I]FP-CIT) binding in patients with Parkinson's disease. For application in routine clinical studies, information on the reliability and reproduc ibility of the [¹²³I]FP-CIT SPECT technique is critical. This study reports on the reliability and reproducibility of [¹²³I]FP-CIT SPECT in healthy control subjects and patients with Parkinson's disease using two different analysis protocols: the conventional region of interest (ROI) protocol and a newly developed, fully automatic, operator-independent volume of interest (VOI) protocol. Methods: We per formed repeated [¹²³I]FP-CIT SPECT scans in 6 healthy control subjects and 10 patients with Parkinson's disease to measure scan-to-scan variations. Scintigraphic data were analyzed 3 hr after injection of the radiotracer. Results: In controls, the mean test/retest for the ratio of the striatal-to-nonspecific [¹²³I]FP-CIT uptake were (3.79 ± 0.67/3.82 ± 0.74) and (4.16 ± 0.70/4.08 ± 0.97) for the ROI and VOI technique, respectively. No significant differences were measured between test/retest studies. The mean test/retest variability for the ROI technique was low (7.25%) with excellent reliability (p = 0.99). In addition, the mean test/retest variability for the VOI technique was also low (7.47%) with very high reliability (p = 0.95). In Parkinson's disease patients, we found mean test/retest for the striatal-to-nonspecific [¹²³I]FP-CIT ratio of (1.78 ± 0.23/1.79 ± 0.25) and (1.83 ± 0.31/1.85 ± 0.35) using the ROI and VOI technique, respectively. Also in patients, these results did not differ significantly between test/retest studies. The mean test/retest variability for the ROI technique was low (7.90%) with excellent reliability (p = 1.00). In addition, the mean test/retest variability for the VOI technique was also low (7.36%) with high reliability (p = 0.96). Conclusion: Reliable and reproducible results were obtained with the ROI, as well as the VOI technique, for the analysis of striatal dopamine transporters with [¹²³I]FP-CIT SPECT in healthy controls and Parkinson's disease patients. The use of an operator-independent method will be a great advantage in routine clinical studies.

Key Words: SPECT • reproducibility • dopamine transporter imaging • iodine-123-FP-CIT • cocaine analogs

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