Neurohospitalist 9, 144–150 (2019). CAS Therapeutic interventions for vascular Parkinsonism: a systematic review and meta-analysis. The only study to report a sample size calculation was the RCT by Kupsch et al.7. There is also a lack of studies applying blinded assessment. The time since onset of symptoms to DaTscan imaging was reported in 11 studies: the means ranged from 2.4 to 6.7 years (median 3.8 years). Crotty, G. F., O’Corragain, O., Bogue, C., Crotty, J. Accuracy of clinical diagnosis of Parkinson disease: a systematic review and meta-analysis. J. Neural Transm. As the country’s largest grassroots Parkinson’s organization, we rely on the community to help us in our cause. performed the literature search. This is to be expected as often DaT SPECT is ordered to confirm a diagnosis but the change in management comes in response to gaining confidence in the original diagnosis. All authors have approved the final version. Results were compared, and discrepancies between the two reviewers were resolved in a meeting. and transmitted securely. It turns out that the clinical features of PD are unique to PD and often very easy to see via a neurologic exam in a doctor’s office. Any medical information provided is solely for the purpose of providing information and is not intended as medical advice. The tracer attaches itself to a molecule found on dopamine neurons in the striatum called the dopamine transporter (or DAT). 2015 Jan 30;1(1):CD010633. How is that possible?”, “I don’t believe my diagnosis. 8600 Rockville Pike PO Box 61420 Neurology 82, 1791–1797 (2014). Clinical impact of 123I-ioflupane SPECT (DaTscan) in a Movement Disorder Center. The method of image analysis used to interpret the SPECT results were explicitly reported in 14 studies with 6 studies reporting visual assessment, 2 quantitative/semi-quantitative, 6 both and missing in the remaining 6 studies. An x-ray produces images using radiation outside your body to create images of dense interior structures. In patients with a diagnosis of Parkinson’s disease, or parkinsonism (referring more generally to a condition that causes symptoms that affect movement the way Parkinson's can), this area of the brain will show “dark.” This indicates the loss of dopamine-containing nerve cells within the brain, a hallmark of the disease. The process of diagnosis for someone dealing with symptoms of Parkinson’s disease can sometimes leave the patient and even their healthcare provider frustrated due to the slow pace of assessment and multiple tests required to confidently confirm the presence of the disease. Semin Clin Neuropsychiatry. A DaTscan is an imaging drug, also called Ioflupane I 123 or phenyltropane, that acts as a radioactive tracer for dopamine transporters within the brain. The site is secure. It explains how the Committee for Medicinal Products for Human Use (CHMP) assessed the medicine to reach its opinion in favour of granting a marketing authorisation and its recommendations on the conditions of use for DaTSCAN. 2018 Mar 15;131:431-439. doi: 10.1016/j.neuropharm.2018.01.015. Matthews, C. G. & Haaland, K. Y. To classify for inclusion, studies had to: Report the clinical utility analysis of imaging with DaTscan. DaTscan belongs to a group of drugs called diagnostic radiopharmaceuticals. The searches retrieved 3916 unique records and 20 studies were included in quantitative synthesis6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25. Details of the studies and patient characteristics are listed in Table 1. DaTscan is used to detect brain signs of Parkinson's disease in people with symptoms such as tremors, loss of balance or coordination, shuffling walk, or other . We attempted to account for this variation by using random-effects modelling, sub-group, and leave-one-out sensitivity analysis. Twenty studies met the inclusion criteria. O'Brien JT, Colloby S, Fenwick J, Williams ED, Firbank M, Burn D, Aarsland D, McKeith IG. The scan can be misread, leading to an incorrect diagnosis. DaTscan is injected into the patient’s bloodstream and eventually circulates to the brain. The DaTscan will then be injected into your bloodstream. This result provides more confidence to our analyses as retrospective studies have a higher propensity for bias, missing data and a tendency to overestimate the effect. This will naturally be broken down by your body without any persistent effects. Unlike other imaging tests, DaTscan with SPECT imaging assesses the function of the brain, rather than its anatomy or structure. hZ�n�ͧ�c��ݮ��� �@`C�#�zc�`#�%"4)P+���$��kvy�)Jp�n�>]���Oa"��B�'&&Nc����e��1�)r�ئXx" S�����*F�r�z�)G��8����,I�J�^R�J��:�>iS��aj|��V��[ 9�. The authors of the IDEAS study, meanwhile, identified a 30% threshold as being consistent with previous studies of coverage, with evidence examining the association between diagnostic imaging and changes in management27. Essential tremor (ET), drug-induced Parkinsonism (DIP) and other forms of non-DDA may present clinical features—bradykinesia, atypical tremor, rigidity, postural instability/gait impairment-resembling PS or PD without evidence of dopaminergic deficit3. There was significant heterogeneity for each outcome (p < 0.01 for all). The diagnostic accuracy of DaTscan images has been explored previously5 reporting over 90% sensitivity and specificity to differentiate between ND PS and non-DDA diseases. Several hours after the tracer has been injected, special imaging equipment scans the head to detect the presence of DaTscan. The drug is administered during the SPECT scan. It may help distinguish the diagnosis of essential tremor from Parkinson's syndromes, like Parkinson's disease or Parkinson's disease dementia. Neurodegener. All results were summarised in forest plots. A random-effect model (with restricted maximum-likelihood estimation) was used as it allows for more realistic assumptions of the true between studies heterogeneity35. Miguel-Puga, A., Villafuerte, G., Salas-Pacheco, J. Unsafe allergic effects may rarely happen. It is important to note, that a person who displays some of these features on exam may be unaware of them, while a trained neurologist can easily identify them. Z.H. Expert Rev Neurother. Here is a normal scan on the left, which would indicate a healthy dopamine system, next to an abnormal scan on the right, which would indicate an unhealthy dopamine system. Huma Sheikh, MD, is a board-certified neurologist, specializing in migraine and stroke, and affiliated with Mount Sinai of New York. The National Oncologic PET Registry (NOPR): design and analysis plan. SPECT brain scans using Ioflupane I 123 injections (DaTScan®) are the first and only FDA-approved aid in differentiating a relatively benign condition, essential tremor, from Parkinsonian syndromes (PS). Nucl. Provided by the Springer Nature SharedIt content-sharing initiative, European Journal of Nuclear Medicine and Molecular Imaging (2023), npj Parkinson's Disease (npj Parkinsons Dis.) �� �%XM�To�D�7��5D�`��lqQ�""jH�&Qŀ�ҵ�~�� � �� �VFxI���ð�)�E#&0/�Q#��kؐ�Q�3�>EB8��j�f���Ym�c � A recent systematic review and meta-analysis showed that patients with vascular parkinsonism have indeed a low response rate to levodopa30. In American Academy of Neurology (AAN) 70th Annual Meeting. Eur. 2017 Mar;17(3):219-225. doi: 10.1080/14737175.2017.1256205. However, our subgroup analysis based on study type did not show any influence on the results (0.62, 95% CI: 0.49–0.74 vs. 0.54, 95% CI: 0.47–0.62). HHS Vulnerability Disclosure, Help Graebner, A. K. et al. Currently, DaTscan that is in clinical use is not quantitative, which means that the test is not designed to determine how impaired the dopamine system is – just whether it is or not. Complementary PET studies of striatal neuronal function in the differential diagnosis between multiple system atrophy and Parkinson’s disease. Sampling variability (standard errors) of all proportions was assessed and their 95% confidence intervals were reported. It can be used to help clarify a PD diagnosis, but it is not a test you would undergo multiple times during the course of your disease. Current research continues to investigate the use of DaTscan and SPECT scans as secondary screening methods for people at risk for developing Parkinson’s disease and as a method of monitoring disease progression and striatal dopaminergic dysfunction in patients being treated for Parkinson’s disease. sharing sensitive information, make sure you’re on a federal Epub 2023 Feb 27. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Google Scholar. Additionally, separate meta-analyses were carried out by pre-scan diagnosis in studies that reported these separately (PD vs. J. Neurol. Study 1 reported on [123I]FP-CIT, DaTscan (I 123 Ioflupane) SPECT in patients with early suspected parkinsonism, comparing baseline scan results to the consensus clinical diagnosis established three years later1 Study 2 was a trial of DaTscan SPECT in patients with established diagnoses of parkinsonian syndrome (PS) or essential tremor (ET). All authors participated in the analysis, checking accuracy, interpretation and drafting the manuscript. 18). Research also suggests an overall increase in confidence in the diagnosis among doctors, which also impacted clinical management for about 58% of their patients. The converse is also true – a person may be very concerned that his/her symptoms are consistent with PD, while a trained neurologist can easily reassure the person that that is not the case. Schrag, A. et al. Clinical assessment was based on the UK Parkinson Disease Brain Bank criteria in 5 studies, Hoehn & Yahr stage (H&Y) in 4 studies and Movement Disorder Society-Parkinson Disease criteria (MDS-PD) in 2 studies, the method of clinical assessment was not reported in the rest. ALS vs. Parkinson's: What Are the Differences? Based on our 3 case reports and a review of the literature, the utility of this imaging method in the differential diagnosis of AD and DLB is highlighted. DaTscan is a test that can help in the diagnosis of PD, although in most situations a clinical exam done by a neurologist offers the same information. Google Scholar. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. A copy of the amended QUADAS-2 checklist is provided in Supplementary data (Sect. cMRI of the 3 cases (T 2 , coronal plane, including hippocampal area). Many of the quality of life measures or other patient-reported outcomes used in these studies are validated for patients with PD and may not be appropriate to assess non-dopamine deficiency aetiologies of Parkinsonism. https://doi.org/10.1038/s41531-021-00185-8, DOI: https://doi.org/10.1038/s41531-021-00185-8. People with PD will typically have a smaller signal in a part of the brain called the striatum, where the ends of the dopamine neurons are meant to be. 2018 Dec;32(12):1351-1361. doi: 10.1177/0269881118796814. For cases with either very slow or rapid progression, image results with DaTscan may lead to a change in diagnosis and management. Neurodegener. Several studies have shown that the use of DaTscan has similar accuracy to a solely clinical diagnosis in cases of early Parkinson’s disease. There are situations in which DaTscan can be very helpful in securing a diagnosis – when neurologic exam findings are not clear-cut. Bega, D., Gonzalez-Latapi, P., Zadikoff, C., Spies, W. & Simuni, T. Is there a role for DAT-SPECT imaging in a specialty movement disorders practice? Most commonly, a neurologist will look for specific physical examination findings that are classic to Parkinson’s disease, like resting tremor or rigidity. {ѐ3�W�vi> ��d�׳_��}��ω;X. In addition, study design varied between studies contributing to a high degree of heterogeneity for the pooled effect. The analysis of longitudinal data on diagnostic confidence obtained from the National Parkinson’s Foundation Quality Improvement Initiative reported that diagnostic certainty increases with time. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. With the exception of one study6, the rate of change in management was higher than a change in diagnosis. The most common side effects associated with the use of DaTscan include the following: The potential side effects from DaTscan tend to be minimal and are relieved shortly after the test concludes. To obtain This drug was approved by the FDA in 2011. SPECT Imaging With DaTscan. Table 2 lists the change in management and diagnosis extracted from each study. Please enable it to take advantage of the complete set of features! 53, 37–41 (2018). Slider with three articles shown per slide. The latter was also a factor contributing to higher change in management. Despite the DaTscan being available to help diagnose Parkinson’s, in most clinical situations, a DaTscan will not add information to what can be gleaned from the clinical exam. J. Neurol. 43, 710–714 (2018). Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. A PRISMA flow diagram is available in Supplementary Fig. Carriers of a common variant in the dopamine transporter gene have greater dementia risk, cognitive decline, and faster ventricular expansion. Unable to load your collection due to an error, Unable to load your delegates due to an error. 3–16. Can I bring someone with me? One study actually demonstrated that the accuracy of diagnosis in early PD was the same whether the diagnosis was reached using clinical exam or using DaTscan. • The risks of overdose relate predominantly to increased radiation exposure, with the long-term risks for neoplasia. npj Parkinsons Dis. PD tremors occur at rest and are accompanied by slowness and stiffness of the limb, whereas ET tremors occur with action and are not accompanied by slowness and stiffness of the limb. Careers. Used clinical examination with or without structural imaging to establish the pre-SPECT diagnosis. ©2023 American Parkinson Disease Association. The DaTscan injection and accompanying SPECT scan will usually take place in the nuclear medicine, or radiology, department of a hospital or in an outpatient clinic. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. Change in management was defined as any changes that the study authors recorded as changes in treatment or further investigations, such as drug changes (start of a new drug, discontinue existing medication or change in dose), referral for counselling or physical therapy following the disclosure of DaT imaging results. Therefore, Parkinson-plus syndromes, discussed in a prior blog, such as Progressive supranuclear palsy (PSP), Corticobasal ganglionic degeneration (CBGD) and Multiple system atrophy (MSA) all typically demonstrate abnormal DaTscans. In inconclusive cases like these, the healthcare provider may recommend the use of an imaging drug, called DaTscan, and a single-positron emission computed tomography (SPECT) scan to capture images of the brain. However, some people with PD do not have a rest tremor, which can make the diagnosis trickier. 2004 Apr;19(3):151-80. doi: 10.1002/hup.579. 2007;22(9):1229-38. doi:10.1002/mds.21505. A clinical evaluation from an experienced neurologist can be as accurate as a DaTscan for early Parkinson disease diagnosis. The above reflects the limitations of retrospective data collection and analysis. Epub 2012 Jul 22. However, DaTscan and SPECT specifically visualize to what capacity dopamine is being utilized in the brain. Dis. J. Nucl. and C.B. No other variables were associated with a change in management or change in diagnosis (Supplementary Figs. A detailed breakdown of the risk of bias assessment results is presented in Supplementary Table 1. However, specific dopaminergic stimulants that act on the central nervous system may interfere with DaTscan and should be stopped. Med. Med. DerSimonian, R. & Laird, N. Meta-analysis in clinical trials. In these cases, DaT SPECT will be used to confirm the diagnosis and result in less change in management. Careers. There is also a risk related to the radiation exposure in the SPECT scan, however, it too is minimal. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. American Parkinson Disease Association is exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. DATSCAN is indicated as an adjunct to other diagnostic evaluations for striatal dopamine transporter visualization using single photon emission computed tomography (SPECT) brain imaging in adult patients with: Important Safety Information About DaTscan™ (ioflupane I 123 injection). A meta-analysis of change in diagnosis and management rates reported from each study was performed using a random-effects model and logit transformation. with a DaTscan image is unknown. 2018 Nov;93(11):1690-1691. doi: 10.1016/j.mayocp.2018.09.012. Unauthorized use of these marks is strictly prohibited. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 1998;351:1032–1033. 15, 81–86 (2015). Epub 2015 Nov 3. Reconstructed pixel size should be between 3.5 and 4.5 mm with slices 1 pixel thick. Grundman, M. et al. All studies included a reference standard (clinical diagnosis) albeit with a variety of methods reported. Alzheimer Dis. Assoc. This systematic review was registered on PROSPERO under the reference CRD42020161315. Imaging of dopamine transporter with FP-CIT SPECT is one possibility to increase sensitivity. Control. D.B., P.K. The FDA indication for DaTscan is for distinguishing between PD and essential tremor (ET). 2021 Jun 21;13:672956. doi: 10.3389/fnagi.2021.672956. Article Dis. DaTscans are not currently used as preliminary tests to screen for Parkinson’s disease, and can only be used after classic motor symptoms are already present. Alzheimers Dement. Four of the included studies were prospective, including 1 randomised controlled trial (RCT), with the other 16 studies featuring a retrospective design. J. Clin. Past medical history included bipolar disorder (on lithium, haloperidol, valproate). The impact of dopamine agonists and antagonists on DaTscan imaging results has not been established. 17). To report SUSPECTED ADVERSE REACTIONS, contact GE HealthCare at 800 654 0118 (option 2, then option 1) or the FDA at 800 FDA 1088 or www.fda.gov/medwatch. This threshold was also supported by previous work assessing the clinical utility of amyloid PET28. An Update on DAT Scanning for Parkinson’s Disease Diagnosis. The risk of bias assessment was used independently of the quantitative meta-analysis. Nevertheless, some elements of the standard in-office neurologic exam are very characteristic, such as. There are many drugs and health problems that can do this. This is to show how a body system is functioning. The authors also reported that shorter disease duration, absence of tremor or motor fluctuation, poor cognition, comorbidities, and absence of levodopa treatment were associated with lower diagnostic confidence at baseline34. Nucl. has acted as a consultant, speaker and grant recipient for GE Healthcare and is an employee of Konica-Minolta. An official website of the United States government. At least one hour before administering the DaTscan, the healthcare provider will give you a medication that will decrease the amount of radioactive iodine from the DaTscan that will go to your thyroid gland. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 262, 909–915 (2015). In total, the studies included 3185 patients. 2015 Dec 15;359(1-2):161-71. doi: 10.1016/j.jns.2015.11.004. The heterogeneity of the studies included in our meta-analysis could be considered as a limitation. In neurogenerative disorders, it is often difficult to capture the long-term effect of diagnostic tests in clinical outcomes. In addition, the definition of ‘change in diagnosis’6 also included cases where the pre-scan diagnoses were less definitive and firmly established post-scan. �=2������7�?�m�iҺ����ե�W�������v;i�����ﻗ�k�W֯/Ϸ�!wЛ�O�����˻�|}y�{�[=ǿ/.?��*]8�0SY��������7ח_v�W�w�߰�����? Change in diagnosis was defined as any change in the patient’s assigned or suspected diagnosis following disclosure of the results of the imaging scan. The combination of an elderly population with potentially cognitive impairment and no benefit from levodopa reduce treatment options in these patients and therefore, determine an overall low rate of change in management. Currently, the threshold for the proportion of cases that constitute a ‘clinically important’ change in management varies depending on multiple factors, including but not limited to, underlying conditions and available treatment management options.
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