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Sensitivity and Specificity of ^99mTc-TRODAT-1 SPECT Imaging in Differentiating Patients with Idiopathic Parkinson’s Disease from Healthy Subjects

¹ Movement Disorders Unit, the First Department of Neurology, Chang Gung Memorial Hospital and Medical College, Taipei, Taiwan
² Nuclear Medicine Department, Chang Gung Memorial Hospital and Medical College, Taipei, Taiwan
³ Biostatistics Center and Department of Public Health, Chang Gung University, Taipei, Taiwan
⁴ Taipei Medical University, Taipei, Taiwan
⁵ Institute of Nuclear Energy Research of Taiwan, Taoyuan, Taiwan

The imaging of dopamine transporter (DAT) with ^99mTc-TRODAT-1 ([2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo[3,2,1]oct-2-yl]methyl](2-mercaptoethyl)amino]ethyl]amino]ethanethiolato(3-)-N2,N2',S2,S2']oxo-[1R-(exo-exo)]-^99mTc-technetium) and SPECT has been recently proposed to be a valuable and feasible means of assessment of the integrity of dopamine neurons. The purpose of this study was to further investigate the clinical correlations and the age-specific sensitivity and specificity of this new approach in the diagnosis of patients with idiopathic Parkinson’s disease (PD) that manifests in patients >50 y of age. Methods: SPECT imaging with ^99mTc-TRODAT-1 was conducted in 78 consecutive PD patients and in 40 age-matched healthy subjects. The images were obtained 4 h after the intravenous injection of the tracer. The ratios of specific striatal binding to nonspecific occipital binding were calculated. S/O represents the ratio for whole striatal binding, whereas P/O and C/O represent the putamen and caudate nucleus, respectively. Statistical analyses of the sensitivity and specificity of these ratios in different age-specific subgroups were performed. The correlations between these ratios and clinical assessments were also analyzed. The age-related declines in the striatal binding in both patients and controls were given particular focus. Results: The S/O, C/O, and P/O ratios decreased significantly both contralaterally and ipsilaterally to the dominant symptomatic side in the PD group (P < 0.0001). The mean reduction of binding was found in the order of putamen (contralateral side, -81%; ipsilateral side, -67%) and caudate nucleus (contralateral side, -46%; ipsilateral side, -40%). The sensitivity and specificity of both P/O and S/O ratios were 100% in discriminating PD patients from healthy subjects in the age-specific groups. The binding ratios correlated negatively with the Unified Parkinson’s Rating Scale and Hoehn and Yahr (H–Y) staging. Of particular interest, the binding of the striatum contralateral to the asymptomatic side in H–Y stage I patients also decreased significantly. The age-related decline of these ratios was significant in the control group. Conclusion: We have demonstrated that ^99mTc-TRODAT-1 SPECT has a high sensitivity and specificity for measuring the decrement of DAT in PD patients. In addition to its wide availability, we suggest that this new approach may serve as a diagnostic marker for PD.

Key Words: ^99mTc-TRODAT-1 • SPECT • dopamine transporter • Parkinson’s disease

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