Ioflupane [I-123] 370MBq/5ml solution for injection vials

IntroductionDopaminergic scintigraphic imaging is a cornerstone to support the diagnosis in dementia with Lewy bodies. To clarify the current state of knowledge on this imaging modality and its impact on clinical diagnosis, we performed an updated systematic review of the literature.MethodsThis systematic review was carried out according to PRISMA guidelines. A comprehensive computer literature search of PubMed/MEDLINE, EMBASE, and Cochrane Library databases for studies published through June 2022 was performed using the following search algorithm: (a) "Lewy body" [TI] OR "Lewy bodies" [TI] and (b) ("DaTscan" OR "ioflupane" OR "123ip" OR "123?ip" OR "123 ip" OR "123i-FP-CIT" OR "FPCIT" OR "FP-CIT" OR "beta?CIT" OR "beta CIT" OR "CIT?SPECT" OR "CIT SPECT" OR "Dat?scan*" OR "dat scan*" OR "dat?spect*" OR "SPECT"). Risk of bias and applicability concerns of the studies were evaluated using the QUADAS-2 tool.ResultsWe performed a qualitative analysis of 59 studies. Of the 59 studies, 19 (32%) addressed the diagnostic performance of dopamine transporter imaging, 15 (25%) assessed the identification of dementia with Lewy bodies in the spectrum of Lewy body disease and 18 (31%) investigated the role of functional dopaminergic imaging in distinguishing dementia with Lewy bodies from other dementias. Dopamine transporter loss was correlated with clinical outcomes in 19 studies (32%) and with other functional imaging modalities in 15 studies (25%). Heterogeneous technical aspects were found among the studies through the use of various radioligands, the more prevalent being the [123I]N‑ω‑fluoropropyl‑2β‑carbomethoxy‑3β‑(4‑iodophenyl) nortropane (123I-FP-CIT) in 54 studies (91.5%). Image analysis used visual analysis (9 studies, 15%), semi-quantitative analysis (29 studies, 49%), or a combination of both (16 studies, 27%).ConclusionOur systematic review confirms the major role of dopaminergic scintigraphic imaging in the assessment of dementia with Lewy bodies. Early diagnosis could be facilitated by identifying the prodromes of dementia with Lewy bodies using dopaminergic scintigraphic imaging coupled with emphasis on clinical neuropsychiatric symptoms. Most published studies use a semi-quantitative analytical assessment of tracer uptake, while there are no studies using quantitative analytical methods to measure dopamine transporter loss. The superiority of a purely quantitative approach to assess dopaminergic transmission more accurately needs to be further clarified.

Abstract licence: CC BY

Abstract Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder caused by an unstable expansion of CAG trinucleotide repeats that lead to progressive degeneration of postsynaptic striatal medium-spiny GABAergic neurons. We report a case of abnormal [123I] Ioflupane single-photon emission computed tomography/computed tomography (DaTSCAN) and a subsequent genetic test confirming HD. A 68-year-old man presented with progressive memory difficulties, auditory hallucinations, nightmares, suicidal thoughts, low mood, and involuntary limb movements. DaTSCAN showed borderline reduced putaminal binding ratios bilaterally, more prominent on the left side, and a low putamen-to-caudate ratio suggesting degenerative parkinsonism. Genetic testing revealed one pathogenic expansion (40/17 CAG repeats), confirming HD. Postsynaptic dopaminergic involvement has previously been documented in postmortem studies. However, an emerging in vivo research also suggests presynaptic dopaminergic involvement. While genetic testing remains the gold standard for diagnosis of HD, DaTSCAN may play a role in assessing dopamine transporter activity and tracking the progression of neurodegeneration in HD.

Abstract licence: CC BY 4.0