Rad-path correlation of DaT SPECT imaging with MRI and post-mortem tissue findings in the evaluation of tremor disorders

Learning Objectives 1. Brief discussion of DaT scan. 2. Pathophysiology of Parkinson’s disease and clinical presentation. 3. Role of DaT scan as a biomarker in the diagnosis of Parkinson’s disease. 4. Multimodality imaging patterns in symptomatic patients (DaT scan, MRI). a. Parkinsonian syndromes b. Non parkinsonian tremor disorders c. Potential imaging pitfalls 5. Pathologic correlation with imaging findings.

Pinpointing the etiology of tremor disorders is often not straightforward. DaT SPECT can help stratify between Parkinson’s disease (PD) and Non Parkinson’s (NP) etiologies and aid treatment decisions and management. I123 Ioflupane (DaTscan) is a FDA approved (Jan 2011) radiopharmaceutical that has been used in the diagnosis of suspected PD. It binds with high affinity to the presynaptic dopaminergic neurons in the striatum allowing visualization of the dopaminergic system with SPECT imaging. Uptake correlates with the number of dopamine transporters in the pre-synaptic neuron. In PD, DaT scan helps in identifying disease related changes in the striatum and can be used for longitudinal follow-up. MRI provides structural information and may offer light on the etiology behind the symptoms, based on known patterns of disease processes. This exhibit will highlight the role of both DaT SPECT imaging and MRI, including discussion of imaging patterns and correlation of findings, in the evaluation of both PD and NP tremor disorders. Pictorial pathologic correlation with imaging findings will be provided for these processes to further enhance the educational value of this presentation.