Objective: To explore the expanding indications of dopamine transporter imaging (DaT SPECT) beyond the already known indication in Parkinson Diseases (PD)

Background: DaT SPECT is a well-established method to rule out presynaptic dopaminergic deficit, hence to rule out degenerative Parkinsonism. However, recent research has shed light on its diagnostic value in rare acquired conditions, which might cause presynaptic dopaminergic deficit.

Method: We performed a review of literature in PubMed to evaluate the findings in DaT SPECT in different acquired conditions

Results: Recent studies in idiopathic normal pressure hydrocephalus (iNPH) have shown a correlation between parkinsonism and a lower dopamine density in putamen and caudate (1-3) with   a prevalence varying from 30% (4) to 90% (3). This striatal dopamine depletion is  more prominent in the caudate nucleus which differs from the pattern in PD (3). Gait, Parkinsonism and caudate dopamine binding improved after surgery, suggesting a reversible striatal dysfunction.(1).

Striatal dopaminergic loss in Holmes’ Tremor (HT) has been reported in different papers with reduced nigrostriatal radiotracer uptake (5-7). In contrast, Gajos et al reported normal nigrostriatal radiotracer uptake (8), or the dopaminergic deficiency was only detectable with quantitative measurements, highlighting the clinical and pathophysiological diversity of HT (9).

Toxoplasma gondii shows a tropism for the basal ganglia. The rare movement disorders are typically hyperkinetic. One case with parkinsonism and tremor showed an unilateral presynaptic dopaminergic deficit, caused by direct damage of the substantia nigra (10)

The hemodynamic impairment caused by a dural arteriovenous fistula (dAVF) can also lead to parkinsonism (11). A bilateral decreased uptake in DaT SPECT has been reported in some case reports (12). Successful treatment of the dAVF showed clinical improvement along with improvement of radiotracer uptake of the DaT SPECT (11, 12).

Manganism leads to a PSP like parkinsonism. The normal DaT SPECT (13, 14) or only slight reduction in the uptake in putamen (15, 16) suggest a postsynaptic impairment due to predominantly striatal and pallidal damage.

Conclusion: Dopamin transporter imaging is a sensitive tool to detect nigrostriatal degeneration. This can add important information regarding diagnosis and treatment options in above mentioned acquired diseases.

References: 1. Todisco M, Zangaglia R, Minafra B, Pisano P, Trifiro G, Bossert I, et al. Clinical Outcome and Striatal Dopaminergic Function After Shunt Surgery in Patients With Idiopathic Normal Pressure Hydrocephalus. Neurology. 2021;96(23):e2861-e73.
2. Broggi M, Redaelli V, Tringali G, Restelli F, Romito L, Schiavolin S, et al. Normal Pressure Hydrocephalus and Parkinsonism: Preliminary Data on Neurosurgical and Neurological Treatment. World Neurosurg. 2016;90:348-56.
3. Lee JY, Park SB, Lee M, Ju H, Im K, Kwon KY. Detailed visual assessment of striatal dopaminergic depletion in patients with idiopathic normal pressure hydrocephalus: unremarkable or not? BMC Neurol. 2020;20(1):277.
4. Allali G, Garibotto V, Mainta IC, Nicastro N, Assal F. Dopaminergic imaging separates normal pressure hydrocephalus from its mimics. J Neurol. 2018;265(10):2434-41.
5. Sung YF, Hsu YD, Huang WS. (99m)Tc-TRODAT-1 SPECT study in evaluation of Holmes tremor after thalamic hemorrhage. Ann Nucl Med. 2009;23(6):605-8.
6. Wei TS, Hsu CS, Lee YC, Chang ST. Degeneration of paramedian nuclei in the thalamus induces Holmes tremor in a case of artery of Percheron infarction. Medicine (Baltimore). 2017;96(46):e8633.
7. Seidel S, Kasprian G, Leutmezer F, Prayer D, Auff E. Disruption of nigrostriatal and cerebellothalamic pathways in dopamine responsive Holmes’ tremor. J Neurol Neurosurg Psychiatry. 2009;80(8):921-3.
8. Gajos A, Budrewicz S, Koszewicz M, Bienkiewicz M, Dabrowski J, Kusmierek J, et al. Is nigrostriatal dopaminergic deficit necessary for Holmes tremor to develop? The DaTSCAN and IBZM SPECT study. J Neural Transm (Vienna). 2017;124(11):1389-93.
9. Gajos A, Bogucki A, Schinwelski M, Soltan W, Rudzinska M, Budrewicz S, et al. The clinical and neuroimaging studies in Holmes tremor. Acta Neurol Scand. 2010;122(5):360-6.
10. Malaquias MJ, Magrinelli F, Quattrone A, Neo RJ, Latorre A, Mulroy E, et al. Presynaptic Hemiparkinsonism Following Cerebral Toxoplasmosis: Case Report and Literature Review. Mov Disord Clin Pract. 2023;10(2):285-99.
11. Kim HR, Lee JY, Kim YK, Park H, Kim HJ, Son YJ, et al. Dural Arteriovenous Fistula-Associated Reversible Parkinsonism with Presynaptic Dopaminergic Loss. J Mov Disord. 2015;8(3):141-3.
12. Kawasaki H, Okuda R, Yokoyama R, Yamamoto T. The Sudden Onset of Pure Parkinsonism Caused by Intracranial Dural Arteriovenous Fistulas. Intern Med. 2022;61(7):1059-61.
13. Selikhova M, Fedoryshyn L, Matviyenko Y, Komnatska I, Kyrylchuk M, Krolicki L, et al. Parkinsonism and dystonia caused by the illicit use of ephedrone–a longitudinal study. Mov Disord. 2008;23(15):2224-31.
14. Sikk K, Taba P, Haldre S, Bergquist J, Nyholm D, Askmark H, et al. Clinical, neuroimaging and neurophysiological features in addicts with manganese-ephedrone exposure. Acta Neurol Scand. 2010;121(4):237-43.
15. Huang CC, Weng YH, Lu CS, Chu NS, Yen TC. Dopamine transporter binding in chronic manganese intoxication. J Neurol. 2003;250(11):1335-9.
16. Kim Y. Neuroimaging in manganism. Neurotoxicology. 2006;27(3):369-72.

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