¹²³I-IBZM SPECT: Reconstruction Methodology and Results in Parkinsonism and Dystonia^[*]

Summary

In 58 patients with Parkinsonism or dystonia striatal dopamine D₂ receptors were investigated using ¹²³l-iodobenzamide (¹²³I-IBZM) single-photon emission computed tomography (SPECT). The influence of SPECT reconstruction methodology on semiquantification and the clinical value of ¹²³I-IBZM SPECT were evaluated. Delineation of the striatal uptake and striatum/frontal cortex (ST/FC) ratios were improved by the use of compensation procedures for scatter and attenuation as well as the choice of an adequate filter. Satisfactory results were achieved using a Metz prefilter with a comparatively high order number (i. e. high cut-off and low suppression of higher frequencies via roll-off). Regarding clinical diagnoses it was not possible to differentiate between advanced idiopathic Parkinson’s disease (IP) and Parkinsonism of other aetiology (OP) on the basis of ¹²³I-IBZM SPECT. But patients with IP and favourable response to L-Dopa showed significantly higher ST/FC ratios than those with fluctuating response. In patients with dystonia ST/FC ratios were significantly higher compared to patients with IP or OP.

Zusammenfassung

Bei 58 Patienten mit Parkinsonismus oder Dystonie wurden SPECT-Studien der Striatalen Dopamin-D₂-Rezeptoren mit ¹²³J-lodobenzamid (¹²³J-IBZM) durchgeführt. Der Einfluß der SPECT-Rekonstruktionsmethodik auf die Semiquantifizierung und die klinische Bedeutung der ¹²³J-IBZM-SPECT wurden untersucht. Die Abgrenzbarkeit der Striatalen Speicherung und die Striatum/ Frontalhirn-(ST/FC-)Quotienten wurden sowohl durch die Anwendung von Korrekturverfahren für Streustrahlung und Schwächung als auch durch die Auswahl eines geeigneten Filters verbessert. Zufriedenstellende Ergebnisse wurden bei der Verwendung eines Metz-Filters mit vergleichsweise hoher Ordnung (d. h. hohem cut-off und niedriger Unterdrückung hoher Frequenzen durch den roll-off) erreicht. Hinsichtlich der klinischen Diagnose war es nicht möglich, auf der Grundlage der ¹²³J-IBZM-SPECT zwischen fortgeschrittenem idiopathischen Morbus Parkinson (IP) und Parkinsonismus anderer Ätiologie (OP) zu unterscheiden. Patienten mit IP, die auf L-Dopa ansprachen, zeigen jedoch signifikant höhere ST/FC-Quotienten als diejenigen mit fluktuierendem Ansprechen. Bei Patienten mit Dystonie lagen die ST/FC-Quotienten signifikant höher als bei denjenigen mit IP oder OP.

Key words

¹²³I-IBZM - SPECT - Reconstruction - Parkinsonism - Dystonia

Schlüsselwörter

¹²³J-IBZM - SPECT - Rekonstruktion - Parkinsonismus - Dystonie

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