Volume 24, Issue 4 p. 500-508
Research Article

Parkinson's disease is overdiagnosed clinically at baseline in diagnostically uncertain cases: A 3-year European multicenter study with repeat [123I]FP-CIT SPECT

Vicky L. Marshall MD

Corresponding Author

Vicky L. Marshall MD

Department of Neurology, Southern General Hospital, Glasgow, Scotland, United Kingdom

Department of Neuroradiology, Southern General Hospital, Glasgow, Scotland, United Kingdom

Department of Clinical Physics, Southern General Hospital, Glasgow, Scotland, United Kingdom

Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UKSearch for more papers by this author
Cornelia B. Reininger MD

Cornelia B. Reininger MD

General Electric Healthcare, Clinical Research & Development, Munich, Germany

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Moritz Marquardt MSc

Moritz Marquardt MSc

General Electric Healthcare, Clinical Research & Development, Munich, Germany

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Jim Patterson PhD

Jim Patterson PhD

Department of Neurology, Southern General Hospital, Glasgow, Scotland, United Kingdom

Department of Neuroradiology, Southern General Hospital, Glasgow, Scotland, United Kingdom

Department of Clinical Physics, Southern General Hospital, Glasgow, Scotland, United Kingdom

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Donald M. Hadley PhD

Donald M. Hadley PhD

Department of Neurology, Southern General Hospital, Glasgow, Scotland, United Kingdom

Department of Neuroradiology, Southern General Hospital, Glasgow, Scotland, United Kingdom

Department of Clinical Physics, Southern General Hospital, Glasgow, Scotland, United Kingdom

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Wolfgang H. Oertel MD

Wolfgang H. Oertel MD

Medizinisches Zentrum für Nervenheilkunde/Klinik für Neurologie/Abteilung für Nuklearmedizin, Klinikum der Phillips-Universität Marburg, Marburg, Germany

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Hani T.S. Benamer PhD

Hani T.S. Benamer PhD

New Cross Hospital, Wolverhampton, United Kingdom

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Paul Kemp MD

Paul Kemp MD

Department of Nuclear Medicine, Southampton General Hospital, Southampton, United Kingdom

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David Burn MD

David Burn MD

Newcastle General Hospital, Newcastle upon Tyne, United Kingdom

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Eduardo Tolosa MD

Eduardo Tolosa MD

Hospital Clinic i Provincial, Servicio de Neurologia, Barcelona, Spain

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Jamie Kulisevsky MD

Jamie Kulisevsky MD

Servicio de Neurologia and CIBERNED, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

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Luis Cunha MD

Luis Cunha MD

Servico de Neurologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal

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Durval Costa MD

Durval Costa MD

HPP Medicina Molecular, SA, Porto, Portugal

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Jan Booij MD

Jan Booij MD

Department of Nuclear Medicine, Academic Medical Centre, Amsterdam, Netherlands

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Klaus Tatsch MD

Klaus Tatsch MD

Abteilung für Nuklearmedizin, Klinikum Großhadern, München, Germany

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K. Ray Chaudhuri MD

K. Ray Chaudhuri MD

King's College Hospital and University Hospital Lewisham, London, United Kingdom

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Gudrun Ulm MD

Gudrun Ulm MD

Paracelsius-Elena-Klinik, Kassel, Germany

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Oliver Pogarell MD

Oliver Pogarell MD

Abteilung für Klinische Neurophysiologie, Klinik für Psychiatrie der Ludwig-Maximilians-Universität München, München, Germany

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Helmut Höffken MD

Helmut Höffken MD

Medizinisches Zentrum für Nervenheilkunde/Klinik für Neurologie/Abteilung für Nuklearmedizin, Klinikum der Phillips-Universität Marburg, Marburg, Germany

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Anja Gerstner MD

Anja Gerstner MD

Medizinisches Zentrum für Nervenheilkunde/Klinik für Neurologie/Abteilung für Nuklearmedizin, Klinikum der Phillips-Universität Marburg, Marburg, Germany

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Donald G. Grosset MD

Donald G. Grosset MD

Department of Neurology, Southern General Hospital, Glasgow, Scotland, United Kingdom

Department of Neuroradiology, Southern General Hospital, Glasgow, Scotland, United Kingdom

Department of Clinical Physics, Southern General Hospital, Glasgow, Scotland, United Kingdom

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First published: 24 March 2009
Citations: 157

Potential conflict of interest: Financial support has been received by Klaus Tatsch, Jan Booij, Paul Kemp, Ray Chaudhuri, Wolfgang Oertel, Jim Patterson, Hani Benamer, Oliver Pogarell, Vicky Marshall, and Donald Grosset from GE Healthcare (manufacturers of [123I]FP-CIT).

Abstract

Overdiagnosis of Parkinson's disease (PD) is suggested by specialist review of community diagnosis, and in postmortem studies. In specialist centers 4 to 15% of patients entered into clinical trials as early PD do not have functional imaging support for a PD diagnosis. In a European multicenter, prospective, longitudinal study, we compared clinical diagnosis with functional SPECT imaging using [123I]FP-CIT (DaTSCAN™, GE Healthcare). Repeat observations were performed over 3 years in patients with tremor and/or parkinsonism in whom there was initial diagnostic uncertainty between degenerative parkinsonism and nondegenerative tremor disorders. Video-recording of clinical features was scored independently of functional imaging results by two blinded clinicians at 36 months (= gold standard clinical diagnosis). Three readers, unaware of the clinical diagnosis, classified the images as normal or abnormal by visual inspection. The main endpoint was the sensitivity and specificity of SPECT imaging at baseline compared with the gold standard. In 99 patients completing the three serial assessments, on-site clinical diagnosis overdiagnosed degenerative parkinsonism at baseline in diagnostically uncertain cases compared with the gold standard clinical diagnosis (at 36 months), the latter giving a sensitivity of 93% and specificity of 46%. The corresponding baseline [123I]FP-CIT SPECT results showed a mean sensitivity of 78% and a specificity of 97%. Inter-reader agreement for rating scans as normal or abnormal was high (Cohen's equation image = 0.94–0.97). © 2008 Movement Disorder Society