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Two-year follow-up in 150 consecutive cases with normal dopamine transporter imaging

Marshall, Vicky L.a; Patterson, Jimb; Hadley, Donald M.c; Grosset, Katherine A.a; Grosset, Donald G.a

Nuclear Medicine Communications: December 2006 - Volume 27 - Issue 12 - p 933-937
doi: 10.1097/01.mnm.0000243374.11260.5b
Original Articles

Background and aims Functional pre-synaptic dopamine brain imaging is generally abnormal when parkinsonism is degenerative (such as in idiopathic Parkinson's disease) and normal in patients with non-degenerative movement disorder (such as essential tremor). However, some patients diagnosed as early Parkinson's disease have normal presynaptic dopamine imaging. Follow-up of patients with normal imaging should help determine whether such patients truly have degenerative parkinsonism (and therefore represent false negative imaging results), or emerge as cases of non-degenerative parkinsonism (and therefore represent initial clinical over-diagnosis of Parkinson's disease).

Methods and results One hundred and fifty cases with normal 123I-FP-CIT SPECT undertaken during routine care over a 3-year period were reviewed 2.4 years (interquartile range, 2.2–3.1 years) after SPECT. Diagnosis after follow-up was non-degenerative parkinsonism or tremor in 146 (97%), who did not progress clinically, and degenerative parkinsonism in four (3%), in whom clinicial progression was noted. Anti-Parkinson therapy was used in 36, and withdrawn in 27 with no deterioration in 25. Patients strictly fulfilling Brain Bank criteria (part 1) were more likely to undergo a trial of anti-Parkinson therapy (P<0.05) but were no more likely to maintain or respond to anti-Parkinson therapy than those not fulfilling criteria.

Conclusion The clinical profile and therapy response during follow-up of patients with normal presynaptic dopamine imaging supports the diagnosis of a non-degenerative movement disorder in nearly all cases.

Departments of aNeurology

bClinical Physics

cNeuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK

Correspondence to: Dr Vicky Marshall, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, G51 4TF, UK.

Tel: +0044 141 201 1100; fax: +0044 141 201 2510;


Received 16 May 2006 Accepted 22 July 2006

© 2006 Lippincott Williams & Wilkins, Inc.