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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

View larger version (117K): [in a new window]   FIGURE 1. 99mTc-TRODAT-1 SPECT images of 4 subjects. (A) A 62-y-old female healthy volunteer. (B) A 63-y-old female patient (H–Y stage I) with left side tremor and bradykinesia. The binding of 99mTc-TRODAT-1 decreased significantly in the right striatum and was also slightly reduced in the left putamen. (C) A 62-y-old female patient (H–Y stage III) with bilateral bradykinesia, dominant in the left side. The uptake decreased significantly in the bilateral putamen and was also slightly reduced in the bilateral caudate nuclei. The reduction was more severe in the right striatum. (D) A 63-y-old male patient (H–Y stage V) with severe bilateral akinesia. The uptake decreased in all defined regions.

View larger version (18K): [in a new window]   FIGURE 2. 99mTc-TRODAT-1 binding ratios of the healthy subjects (A) and PD patients (B) in different age groups. The binding ratios of the healthy subjects were symmetric and decreased significantly with aging. The binding ratios of the PD patients were asymmetric. The significant decrease of binding ratios in the contralateral putamen is a specific finding in PD.

View larger version (20K): [in a new window]   FIGURE 3. The correlation of age and the C/O and P/O ratios in the controls (A) and PD patients (B). In the control group, the reduction of the binding ratios with normal aging was symmetric and even loss. The binding ratios also decreased with aging, except the contralateral P/O ratios in the PD patients with a similar duration and severity of disease (C-C/O, P = 0.0004; I-C/O, P = 0.016; C-P/O, P = 0.211; I-P/O, P = 0.045). The pattern of the age-related decline of binding ratios was quite different between the PD patients and the normal controls., regression line for C-C/O;, regression line for I-C/O; ····, regression line for C-P/O; ·····, regression line for I-P/O.

View larger version (26K): [in a new window]   FIGURE 4. The binding ratios of 99mTc-TRODAT-1 in the PD patients significantly negatively correlated with the UPDRS (A) and H–Y staging (B)., regression line for C-C/O;, regression line for I-C/O; ····, regression line for C-P/O; ·····, regression line for I-P/O.

View larger version (17K): [in a new window]   FIGURE 5. The ipsilateral P/O ratios of the controls and the PD patients. The binding ratios of 99mTc-TRODAT-1 in the elderly controls were equal to or even lower than those in some younger PD patients. The dotted circle = ipsilateral P/O ratios of the controls; the dotted oval = ipsilateral P/O ratios of the PD patients.

View larger version (16K): [in a new window]   FIGURE 6. The binding ratios in 28 age-matched controls and in 24 PD patients with unilateral symptoms: The ipsilateral S/O and P/O ratios, which represented the DAT concentration in the preclinical striatum, showed a more clear-cut reduction than the ratios in the healthy subjects. •, PD; , control.