Improvement of diagnostic accuracy of Parkinson's disease on I-123-ioflupane single photon emission computed tomography (123I FP-CIT SPECT) using new Japanese normal database

Objective(s): I-123-ioflupane single photon emission computed tomography (FP-CIT-SPECT) has been used to assess dopamine transporter (DAT) loss in Parkinson's disease. The specific binding ratio (SBR), a quantitative parameter of DAT density in the striatum, may be affected by differences in age, sex, and SPECT system. The purpose of this study was to evaluate the utility of FP-CIT-SPECT using the Japanese normal database (NDB) in the diagnosis of Parkinson's disease. Methods: To standardize the quantitative outcome measures of DAT density obtained with different SPECT systems, striatal phantoms filled with striatal to background materials at ratios between 8:1 and 1:1 were measured using a gamma camera (ECAM) in our institute. Consecutive fifty patients (23 men and 27 women; age range, 40-86 years) with suspected PD undergoing FP-CIT SPECT brain imaging during the period from April to October 2016 were enrolled in this retrospective study. Their final diagnoses were PD in 28 patients and PD in 22 patients. SBRs of the patients were calculated using either new (Japanese database with different age and sex; NEWver) or old (non-Japanese database not specifying age and sex; OLDver) version software (AZE Virtual Place Hayabusa [DaTView], AZE, Ltd. Tokyo, Japan). The McNemar test was used to compare the diagnostic accuracy between old and new versions. Results: Based on the phantom study, the calibrated SBR could be calculated by Y=1.25×Measured SBR+0.78. The sensitivities for OLDver and NEWver were 100% and 93%, respectively (p=0.5), and the specificities were 55% and 100% (p=0.002). The diagnostic accuracy of NEWver (96%) was better than that of OLDver (80%, p<0.001).  Conclusion: FP-CIT-SPECT using the Japanese NDB improved the diagnostic accuracy of PD by improving specificity.