Objective: To determine usefulness of DaT-SPECT imaging in the management of normal pressure hydrocephalus (NPH).

Background: Dopamine transporter single-photon emission computed tomography (DaT-SPECT) imaging is useful in detecting dopaminergic dysfunction in both idiopathic Parkinson’s disease and Parkinson-plus syndromes and are used in diagnosing conditions such as essential tremors and drug-induced parkinsonism [1,2]. Little data is available on DaT-SPECT in normal pressure hydrocephalus (NPH) and its  implications in management and prognosis.

Method: A retrospective chart review was performed on 31 patients with clinical and radiological diagnosis of NPH to determine the course and prognosis of patients with positive or negative DaT-Scans on initial presentation. A chi-square test was performed to assess differences among individuals with clinical and radiological evidence of NPH with or without response to ventriculoperitoneal shunt (VPS) placement, and presence or absence of dopaminergic dysfunction on DaT-Scan.

Results: Of the 31 patients (mean age 79 + 6.1 years) with clinical and radiological evidence of NPH, 17 had undergone DaT-Scans. Ten patients had positive DaT-Scans, 8 of which had VPS placed with 6 showing sustained treatment response (continued benefit >1 year). Five of those individuals are not on dopaminergic therapy. Seven patients with negative DaT-Scans had a VPS, 4 of them with sustained treatment response, of which 3 are not on dopaminergic therapy. Chi-square testing showed no difference in treatment response among DaT-positive and DaT-negative patients (p > 0.05).

Conclusion: Despite the use of  DaT-Scans in diagnosing Parkinson’s disease, positive DaT scans do not rule out treatment-responsive normal pressure hydrocephalus. Dopaminergic dysfunction can co-exist with NPH in a significant number of patients, and thus DaT-Scans have limited utility in ruling out NPH.

References: Kagi G, Bhatia K, Tolosa E. The role of DAT-SPECT in movement disorder. J Neurol Neurosurg Psychiatryi, 81(1):5-12.

Perlmutter J, Eidelberg D. To scan or not to scan, DaT is the question. Neurology, 78(10):688-9.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dat-scans-have-limited-utility-in-predicting-treatment-response-to-ventriculoperitoneal-shunts-in-normal-pressure-hydrocephalus/