Diagnostic accuracy of I-123-FP-CIT SPECT in possible dementia with Lewy bodies

Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK. j.t.o'
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 02/2009; 194(1):34-9. DOI: 10.1192/bjp.bp.108.052050
Source: PubMed


(123)I-FP-CIT SPECT (single photon emission computed tomography) can help in the differential diagnosis of probable dementia with Lewy bodies (Lewy body dementia) and Alzheimer's disease.
Our aim was to determine the accuracy of (123)I-FP-CIT SPECT in diagnosing people with possible dementia with Lewy bodies.
We undertook a 12-month follow-up of 325 individuals with probable or possible Lewy body or non-Lewy body dementia who had previously undergone (123)I-FP-CIT SPECT. A consensus panel, masked to SPECT findings, established diagnosis at 12 months in 264 people.
Of 44 people with possible dementia with Lewy bodies at baseline, at follow-up the diagnosis for 19 people was probable dementia with Lewy bodies (43%), in 7 people non-Lewy body dementia (16%) and for 18 individuals it remained possible dementia with Lewy bodies (41%). Of the 19 who at follow-up were diagnosed with probable dementia with Lewy bodies, 12 had abnormal scans at baseline (sensitivity 63%); all 7 individuals with a possible diagnosis who were diagnosed as having Alzheimer's disease at follow-up had normal scans (specificity 100%).
Our findings confirm the diagnostic accuracy of (123)I-FP-CIT SPECT in distinguishing Lewy body from non-Lewy body dementia and also suggest a clinically useful role in diagnostically uncertain cases, as an abnormal scan in a person with possible dementia with Lewy bodies is strongly suggestive of dementia with Lewy bodies.

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    • "Le fait qu'elle ait servi de justification principale a ` la prise en charge de l'examen par l'assurance maladie en France est assez critiquable, puisque la population de l'e ´ tude (DCL et MA probables pour l'essentiel) ne correspond pas a ` celle où l'examen a ré ellement un inté rê t. L'analyse dans le dé tail des donné es de l'article (McKeith et al., 2007), le suivi e ´ volutif des patients (O'Brien et al., 2009) et les corré lations pathologiques effectué es ulté rieurement dans une vingtaine de cas (Walker et al., 2007) montrent toutefois que le FP-CIT est anormal dans la plupart des DCL de pré sentation atypique (y compris celles sans syndrome parkinsonien). En outre, trois cas de dé mence mixte MA-DCL confirmé s a ` l'autopsie, dont deux avaient une pré sentation clinique non-DCL, avaient une scintigraphie au FP-CIT positive (Walker et al., 2007). "
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    ABSTRACT: Dementia with Lewy bodies (DLB) is the second cause of degenerative dementia in autopsy studies. In clinical pratice however, the prevalence of DLB is much lower with important intercenter variations. Among the reasons for this low sensitivity of DLB diagnosis are (1) the imprecision and subjectivity of the diagnostic criteria; (2) the underestimation of non-motor symptoms (REM-sleep behavior disorder, dysautonomia, anosmia); mostly (3) the nearly constant association of Lewy bodies with Alzheimer's disease pathology, which dominates the clinical phenotype. With the avenue of targeted therapies against the protein agregates, new clinical scales able to apprehend the coexistence of Lewy pathology in Alzheimer's disease are expected.
    Revue Neurologique 11/2013; 169(11):844–857. DOI:10.1016/j.neurol.2013.05.004 · 0.66 Impact Factor
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    • "Iodine-123-fluoropropyl-carbomethoxy-3-β-(4-iodophenyltropane) (Fazio et al., 2011; Neumeyer et al., 1991) (FP-CIT; 123 I-ioflupane/ DaTSCAN) has been used to differentiate between Parkinsonian syndrome and essential tremors (Benamer et al., 2000; Marek et al., 2001; Seibyl et al., 1995). In addition, its importance has increased more recently when its application range was extended to be used for the differentiation of dementia with Lewy bodies from Alzheimer's disease (Colloby et al., 2004; Colloby et al., 2008; O'Brien et al., 2009; Walker et al., 2007). After intravenous injection, 123 I-FP-CIT binds to the dopamine transporters in the striatum. "
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    ABSTRACT: In this work, a linear procedure to perform the intensity normalization of FP-CIT SPECT brain images is presented. This proposed methodology is based on the fact that the histogram of intensity values can be fitted accurately using a positive skewed α-stable distribution. Then, the predicted α-stable parameters and the location-scale property are used to linearly transform the intensity values in each voxel. This transformation is performed such that the new histograms in each image have a pre-specified α-stable distribution with desired location and dispersion values. The proposed methodology is compared with a similar approach assuming Gaussian distribution and the widely used specific-to-nonspecific ratio. In this work, we show that the linear normalization method using the α-stable distribution outperforms those existing methods.
    NeuroImage 10/2012; 65. DOI:10.1016/j.neuroimage.2012.10.005 · 6.36 Impact Factor
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    • "In particular, in a phase III multicentre study among a large cohort of subjects, McKeith and co-workers (McKeith et al., 2007) determined the effectiveness of FP-CIT SPECT to distinguish DLB from other dementias (principally AD), revealing a sensitivity and specificity of respectively 78% and 90% respectively. So far, there have been published many studies that investigated DLB by dopaminergic SPECT (Colloby et al., 2005; David et al., 2008; Lim et al., 2009; O'brien et al., 2009; Roselli et al., 2009; Walker et al., 2007). All these works consistently show the diagnostic value of dopaminergic SPECT as applied to DLB, through the evaluation of the striatal dopaminergic innervations reduction, also in the distinction from other dementias (Soret et al., 2006). "

    Neuroimaging - Methods, 02/2012; , ISBN: 978-953-51-0097-3
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