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Dopamine transporter single-photon emission computerized tomography supports diagnosis of akinetic crisis of parkinsonism and of neuroleptic malignant syndrome.

Martino G, Capasso M, Nasuti M, Bonanni L, Onofrj M, Thomas A - Medicine (Baltimore) (2015)

Bottom Line: One was diagnosed as having NMS because of exposure to risperidone.During AC or NMS, BP values in caudate and putamen were reduced by 95% to 80%, to noise level with a nearly complete loss of striatum dopamine transporter-binding, corresponding to the "burst striatum" pattern.No binding effects of apomorphine were observed.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Radiology and Radiotherapy, Nuclear Medicine University G. d'Annunzio of Chieti-Pescara (GM, MN); Neurology Clinic, State Hospital (MC, LB, MO, AT); and Department of Neuroscience and Imaging and Aging Research Center, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy (LB, MO, AT).

ABSTRACT
Akinetic crisis (AC) is akin to neuroleptic malignant syndrome (NMS) and is the most severe and possibly lethal complication of parkinsonism. Diagnosis is today based only on clinical assessments yet is often marred by concomitant precipitating factors. Our purpose is to evidence that AC and NMS can be reliably evidenced by FP/CIT single-photon emission computerized tomography (SPECT) performed during the crisis. Prospective cohort evaluation in 6 patients. In 5 patients, affected by Parkinson disease or Lewy body dementia, the crisis was categorized as AC. One was diagnosed as having NMS because of exposure to risperidone. In all FP/CIT, SPECT was performed in the acute phase. SPECT was repeated 3 to 6 months after the acute event in 5 patients. Visual assessments and semiquantitative evaluations of binding potentials (BPs) were used. To exclude the interference of emergency treatments, FP/CIT BP was also evaluated in 4 patients currently treated with apomorphine. During AC or NMS, BP values in caudate and putamen were reduced by 95% to 80%, to noise level with a nearly complete loss of striatum dopamine transporter-binding, corresponding to the "burst striatum" pattern. The follow-up re-evaluation in surviving patients showed a recovery of values to the range expected for Parkinsonisms of same disease duration. No binding effects of apomorphine were observed. By showing the outstanding binding reduction, presynaptic dopamine transporter ligand can provide instrumental evidence of AC in Parkinsonism and NMS.

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Related in: MedlinePlus

FP/CIT SPECT acquisition in two patients (PtB, PtD) chronically treated with apomorphine. Baseline SPECTs were acquired 6 years before, second acquisitions were obtained during chronic treatment. Notice that BP decay is in the range (Table 3) expected for the time lapsed from first acquisition, and the BP values are multiples of values (4–5 times) observed during AC (Figures 1 and 2). AC = akinetic crisis, BP = binding potential, SPECT = single-photon emission computerized tomography.
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Figure 4: FP/CIT SPECT acquisition in two patients (PtB, PtD) chronically treated with apomorphine. Baseline SPECTs were acquired 6 years before, second acquisitions were obtained during chronic treatment. Notice that BP decay is in the range (Table 3) expected for the time lapsed from first acquisition, and the BP values are multiples of values (4–5 times) observed during AC (Figures 1 and 2). AC = akinetic crisis, BP = binding potential, SPECT = single-photon emission computerized tomography.

Mentions: Brain SPECTs were acquired according to standard procedures.24–26 166.5 Bq of 123-I-FP-CIT (DatSCAN Amerham Health, Amsterdam) was injected intravenously 60 min after administration of oral potassium iodide (Lugol solution) to block thyroid uptake of free radioactive iodide. Patients underwent imaging 4 hours after the injection, by means of a dedicated double head gamma camera equipped with ultrahigh-resolution collimators, matrix size 128 × 128, 120 frames, 40 s/frame, angular 3 degree, zoom 1.5. Slices (5.89-mm thick) were transversal, coronal, and sagittal canthomeatal-orientated Chang's26 correction with a coefficient of 0.11 cm. Two SPECT evaluation methods were used: semiquantitative analyses of cumulative dopamine transporter bindings23 by regions of interest (ROI) density evaluation (Table 2), a visual classification comparing color scale intensity of basal ganglia versus background/occipital areas and semiquantitative BasGanV2-assisted evaluation27–29 by an automated volume if interest (VOI) measurement (Figure 4), assessing total binding density in basal ganglia.


Dopamine transporter single-photon emission computerized tomography supports diagnosis of akinetic crisis of parkinsonism and of neuroleptic malignant syndrome.

Martino G, Capasso M, Nasuti M, Bonanni L, Onofrj M, Thomas A - Medicine (Baltimore) (2015)

FP/CIT SPECT acquisition in two patients (PtB, PtD) chronically treated with apomorphine. Baseline SPECTs were acquired 6 years before, second acquisitions were obtained during chronic treatment. Notice that BP decay is in the range (Table 3) expected for the time lapsed from first acquisition, and the BP values are multiples of values (4–5 times) observed during AC (Figures 1 and 2). AC = akinetic crisis, BP = binding potential, SPECT = single-photon emission computerized tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554017&req=5

Figure 4: FP/CIT SPECT acquisition in two patients (PtB, PtD) chronically treated with apomorphine. Baseline SPECTs were acquired 6 years before, second acquisitions were obtained during chronic treatment. Notice that BP decay is in the range (Table 3) expected for the time lapsed from first acquisition, and the BP values are multiples of values (4–5 times) observed during AC (Figures 1 and 2). AC = akinetic crisis, BP = binding potential, SPECT = single-photon emission computerized tomography.
Mentions: Brain SPECTs were acquired according to standard procedures.24–26 166.5 Bq of 123-I-FP-CIT (DatSCAN Amerham Health, Amsterdam) was injected intravenously 60 min after administration of oral potassium iodide (Lugol solution) to block thyroid uptake of free radioactive iodide. Patients underwent imaging 4 hours after the injection, by means of a dedicated double head gamma camera equipped with ultrahigh-resolution collimators, matrix size 128 × 128, 120 frames, 40 s/frame, angular 3 degree, zoom 1.5. Slices (5.89-mm thick) were transversal, coronal, and sagittal canthomeatal-orientated Chang's26 correction with a coefficient of 0.11 cm. Two SPECT evaluation methods were used: semiquantitative analyses of cumulative dopamine transporter bindings23 by regions of interest (ROI) density evaluation (Table 2), a visual classification comparing color scale intensity of basal ganglia versus background/occipital areas and semiquantitative BasGanV2-assisted evaluation27–29 by an automated volume if interest (VOI) measurement (Figure 4), assessing total binding density in basal ganglia.

Bottom Line: One was diagnosed as having NMS because of exposure to risperidone.During AC or NMS, BP values in caudate and putamen were reduced by 95% to 80%, to noise level with a nearly complete loss of striatum dopamine transporter-binding, corresponding to the "burst striatum" pattern.No binding effects of apomorphine were observed.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Radiology and Radiotherapy, Nuclear Medicine University G. d'Annunzio of Chieti-Pescara (GM, MN); Neurology Clinic, State Hospital (MC, LB, MO, AT); and Department of Neuroscience and Imaging and Aging Research Center, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy (LB, MO, AT).

ABSTRACT
Akinetic crisis (AC) is akin to neuroleptic malignant syndrome (NMS) and is the most severe and possibly lethal complication of parkinsonism. Diagnosis is today based only on clinical assessments yet is often marred by concomitant precipitating factors. Our purpose is to evidence that AC and NMS can be reliably evidenced by FP/CIT single-photon emission computerized tomography (SPECT) performed during the crisis. Prospective cohort evaluation in 6 patients. In 5 patients, affected by Parkinson disease or Lewy body dementia, the crisis was categorized as AC. One was diagnosed as having NMS because of exposure to risperidone. In all FP/CIT, SPECT was performed in the acute phase. SPECT was repeated 3 to 6 months after the acute event in 5 patients. Visual assessments and semiquantitative evaluations of binding potentials (BPs) were used. To exclude the interference of emergency treatments, FP/CIT BP was also evaluated in 4 patients currently treated with apomorphine. During AC or NMS, BP values in caudate and putamen were reduced by 95% to 80%, to noise level with a nearly complete loss of striatum dopamine transporter-binding, corresponding to the "burst striatum" pattern. The follow-up re-evaluation in surviving patients showed a recovery of values to the range expected for Parkinsonisms of same disease duration. No binding effects of apomorphine were observed. By showing the outstanding binding reduction, presynaptic dopamine transporter ligand can provide instrumental evidence of AC in Parkinsonism and NMS.

Show MeSH
Related in: MedlinePlus