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| LETTER TO EDITOR |
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| Year : 2016 | Volume
: 31
| Issue : 3 | Page : 249-250 |
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Dopamine transporter single-photon emission computed tomography brain scan: A reliable way to distinguish between degenerative and drug-induced parkinsonism
Shakya Bhattacharjee1, Paramananda Vijaya Shankar2, Mohammed Elkider3
1 MRCP, Neurology, Plymouth Hospital NHS Trust, Devon, UK
2 DM, Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
3 MRCP, Neurology, Cork University Hospital, Cork, Ireland
| Date of Web Publication | 7-Jun-2016 |
Correspondence Address:
Shakya Bhattacharjee
Flat 96, 21, Plymbridge Lane, Plymouth, PL68AX
UK
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-3919.183620
How to cite this article:
Bhattacharjee S, Shankar PV, Elkider M. Dopamine transporter single-photon emission computed tomography brain scan: A reliable way to distinguish between degenerative and drug-induced parkinsonism
. Indian J Nucl Med 2016;31:249-50 |
How to cite this URL:
Bhattacharjee S, Shankar PV, Elkider M. Dopamine transporter single-photon emission computed tomography brain scan: A reliable way to distinguish between degenerative and drug-induced parkinsonism
. Indian J Nucl Med [serial online] 2016 [cited 2023 Mar 31];31:249-50. Available from: https://www.ijnm.in/text.asp?2016/31/3/249/183620 |
Sir,
A 54-year-old man on valproate because of bipolar affective disorders developed extra-pyramidal symptoms suggestive of drug-induced parkinsonism. His symptoms persisted despite stopping valproate. He had a dopamine transporter (DaT) scan and single-photon emission computed tomography (SPECT) scan. The DaT scan showed abnormality (Grade 1) [Table 1] in the right putaminal tracer uptake suggestive of degenerative parkinsonism instead of drug-induced parkinsonism [Figure 1]a and [Figure 1]b.[1],[2] | Figure 1: (a) Normal dopamine transporter single-photon emission computed tomography scan appearance, normal dopamine transporter scan appearance with head of the caudate nucleus appearing like a full stop (large arrow), and the putamen appearing like tail (small arrow). (b) Abnormal dopamine transporter scan in our patient: The left side is normal with normal putaminal tail (large arrow). The right side has abnormal tracer uptake - absence of putaminal tail, but the normal appearance of the caudate nucleus was like a full stop (small open arrow) (Type 1 abnormal uptake as per Benamer et al.)[2]
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 | Table 1: Type of dopamine scan tracer (123I-Ioflupane) uptake in the human basal ganglia
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DaT is the presynaptic transmembrane protein of the dopaminergic synapses. It transports dopamine back to the presynaptic neurons from the synaptic cleft.123 I-ioflupane is a molecular imaging agent used in DaT imaging to demonstrate the location and concentration of DaTs in the synapses. Tc99m-TRODAT and F-18 FDOPA positron emission tomography scan can also assess the DaT activity and the integrity of the presynaptic nigrostriatal function.[3]
DaT SPECT brain scan is helpful to distinguish between pre- (degenerative) and post-synaptic (such as drug-induced or vascular parkinsonism) parkinsonism.[4] DaT imaging is usually normal in postsynaptic parkinsonism, but abnormal in the presynaptic variety.[1] The degenerative presynaptic parkinsonism includes sub-types such as idiopathic Parkinson's disease, progressive supranuclear palsy, multiple system atrophy, Lewy body dementia, and corticobasal degeneration. Though this SPECT scan can distinguish between pre- and post-synaptic parkinsonism, it cannot distinguish among the sub-types of degenerative parkinsonism mentioned above.[1],[4]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Bajaj N, Hauser RA, Grachev ID. Clinical utility of dopamine transporter single photon emission CT (DaT-SPECT) with (123I) ioflupane in diagnosis of parkinsonian syndromes. J Neurol Neurosurg Psychiatry 2013;84:1288-95.  |
| 2. | Benamer TS, Patterson J, Grosset DG, Booij J, de Bruin K, van Royen E, et al. Accurate differentiation of parkinsonism and essential tremor using visual assessment of [123I]-FP-CIT SPECT imaging: The [123I]-FP-CIT study group. Mov Disord 2000;15:503-10. |
| 3. | Berti V, Pupi A, Mosconi L. PET/CT in diagnosis of movement disorders. Ann N Y Acad Sci 2011;1228:93-108. |
| 4. | Djang DS, Janssen MJ, Bohnen N, Booij J, Henderson TA, Herholz K, et al. SNM practice guideline for dopamine transporter imaging with 123I-ioflupane SPECT 1.0. J Nucl Med 2012;53:154-63. |
[Figure 1]
[Table 1]
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