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One-Day Protocol for Imaging of the Nigrostriatal Dopaminergic Pathway in Parkinson's Disease by [¹²³I]FPCIT SPECT

Graduate School of Neurosciences, Departments of Nuclear Medicine and Neurology, Academic Medical Center, University of Amsterdam, Amsterdam
Amersham Cygne and Eindhoven University of Technology, Eindhoven, The Netherlands

Correspondence: For correspondence or reprints contact: Jan Booij, MD, Department of Nuclear Medicine, F2N, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

ABSTRACT

Parkinson's disease is characterized by degeneration of dopaminergic neurons, resulting in loss of dopamine transporters in the striatum. Recently, the tracer ¹²³I-N--fluoropropyl-2ß-carbomethoxy-3ß-(4-iodophenyl)nortropane (FPCIT) was developed for imaging dopamine transporters with SPECT. The purpose of this study was to develop an [¹²³I]FPCIT SPECT protocol for routine clinical studies. Methods: We examined the time course of [¹²³I]FPCIT binding to dopamine transporters in 10 healthy volunteers and 19 patients with Parkinson's disease. Results: We found that the time of peak specific striatal [¹²³I]FPCIT binding was highly varied among subjects, but specific binding peaked in all controls and patients within 3 h postinjection. Between 3 and 6 h, the ratio of specific-to-nonspecific striatal [¹²³I]FPCIT binding was stable in both groups, although, as expected, it was significantly lower in patients. In the patients, [¹²³I]FPCIT binding in the putamen was lower than in the caudate nucleus, and contralateral striatal binding was significantly lower than ipsilateral striatal binding. The subgroup of patients with hemi-Parkinson's disease showed loss of striatal dopamine transporters, even on the ipsilateral side. Conclusion: For routine clinical [¹²³I]FPCIT SPECT studies, we recommend imaging at a single time point, between 3 and 6 h postinjection, and using a tissue ratio as the outcome measure. The [¹²³I]FPCIT SPECT technique is sensitive enough to distinguish control subjects from patients with Parkinson's disease, even at an early stage of the disease.

Key Words: dopamine transporter imaging • SPECT • Parkinson's disease • [¹²³I]FPCIT

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