49 years old female with history of bradykinesia, genralised rigidity and tremors since last four to five years and is on tablet Sinemet, Lagaflex, Amantrel.
Ref for DAT SCAN (Trodat) for the confirmation of parkinsons disease and assessment of the extent of the severity of the disease.
Bilateral basal ganglion and deep white matter tracts appears to be symmetrical in morphology and signal characteristics ( MRI brian images re reviewed with our radiologist colleague Dr Raje).
Left side–There is no appreciable tracer uptakes seen in caudate lobe and putamen. Right side--There is minimal to mild tracer uptakes in caudate lobe (as shown with arrows) and no appreciable tracer uptakes in putamen.
ABNORMAL DAT SCAN confirms the Parkinsons disease and severity of the disease process (minimal to mild functional dopamine transporter system in right caudate lobe and rest shows severe deficit in dopamine transporter system).
Parkinson's disease is a progressive neurodegenerative disorder characterized by a selective loss of dopamine in the striatum. Problems remain in the accurate diagnosis of Parkinson's disease (The diagnosis of movement disorders including Parkinson's disease (PD) and essential tremor is determined through clinical assessment. The difficulty with diagnosis of early PD has been highlighted in several recent clinical trials. Studies have suggested relatively high clinical diagnostic error rates for PD and essential tremor.
Functional Imaging of the Dopamine Transporter (DAT) defines integrity of the Dopaminergic System and has its main clinical application in patients with mild, incomplete, or uncertain Parkinsonism (DAT is used to detect the presence of Dopamine Transporters (DAT) in the brain.
a) Detection of loss of Functional Dopaminergic Neuron Terminals in the straiatum of patients with clinically Uncertain Parkinsonism.
b) Differentiation of Essential Tremors, Psychogenic Parkinsonism or Neuroleptic induced Parkinsonism from Presynepatic Parkinsonism Syndromes (Parkinsonism Disease, Multiple System Atrophy, Corticobasal Degeneration, and Progressive Supranuclear Palsy).
c) Early detection of Parkinsonism Disease.
d) Assessment of the disease severity and progression.
e) Differentiation of Dementia with lewy bodies from other Dementias.
Dopamine Transporter Imaging with 99mTc-TRODAT is a simple technique that can sensitively detect or rule out degeneration of presynaptic striatal dopaminergic nerve cells. It can differentiate Presynaptic Parkinsonian Syndromes (PD, MSA, PSP) from Essential Tremors, Drug-Induced Parkinsonism and Psychogenic Parkinsonism.