Objective: To assess changes in clinical diagnosis and/or treatment of 200 consecutive patients with clinically uncertain Parkinsonian syndromes who underwent DaTscan imaging with ioflupane for striatal dopamine transporter degeneration.

Background: Clinically, the differentiation of parkinsonism can be challenging. It is not uncommon for patients to be initially treated, but later to have diagnosis revised and treatment changed. Striatal dopamine transporter is a marker of presynaptic dopaminergic neuroterminals. Datscan imaging can identify loss of striatal dopamine transporters, indicative of dopaminergic degeneration. Striatal dopamine transporter imaging can help distinguish between Parkinsonian disorders with (PD, SND, PSP, etc) and without (drug-induced, ET, vascular, etc) dopaminergic degeneration.

Methods: Retrospective ongoing analysis of 100 consecutive patients whose clinical diagnosis was unclear and in whom a movement disorder specialist ordered DATscan imaging to clarify diagnosis by determining whether dopaminergic degeneration was present. All patients had assessment of % likely abnormal scan prior to imaging based on clinical examination and prior treatment response. After DaTscan imaging, changes to clinical diagnosis and treatment were assessed.

Results: 51% of patients had an uncertain provisional diagnosis confirmed, 6% of patients had clarification between two provisional diagnoses, and 42% of imaged patients had a provional diagnosis changed. We identified several clinical scenarios where Datscan imaging seem most useful: drug-induced; prominent action tremor; lower extremity predominant; early subtle signs with nonmotor symptoms; and clinically stable and/or without fluctuations after 5 years. Changes in treatment followed clarification of clinical diagnosis and whether striataonigral dopaminergic degeneration was identified on Datscan. Overall, 21% had a medication stopped, 34% had a medication begun, and 26% had a medication changed.

Conclusions: In several clinical scenarios in which diagnosis of Parkinsonian syndromes is unclear, visualization of striatal dopamine transporters using DaTscan can differentiate between disorders with and without nigrostriatal dopaminergic degeneration, clarifying diagnosis and impacting treatment.

An interim analysis of the initial 100 patients was presented at MDS in San Diego 2015.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-datscan-on-clinical-decision-making-diagnosis-and-management-of-clinically-uncertain-parkinsonian-syndromes/