Pitfalls and Artifacts of DaTscan Imaging in Parkinsonian Syndromes- A quality improvement teaching tool.

Abstract

Methods: The aim of the current article is image quality improvement and a teaching tool on ¹²³I Ioflupane SPECT (DaTscan). The imaging uses the radiopharmaceutical ¹²³I Ioflupane (¹²³I–FP-CIT) to visualize the nigrostriatal pathway. Parkinson's disease and Parkinsonian syndromes are movement disorders that exhibit nigrostriatal degeneration, with a decreased Dopamine transporter level in the pathway and thus a decreased ¹²³I Ioflupane distribution. Other non-Parkinson's movement disorders, such as essential tremor, will have intact dopaminergic neurons and exhibit a normal distribution of the radiopharmaceutical throughout the striata. Parkinson's disorders are usually diagnosed clinically. However, DaTscan (GE Healthcare) can be a valuable tool when the clinical features are not sufficiently clear. Results: DaTscan image interpretation is not always straightforward. Many pitfalls, including biological factors, technical factors, medications, and various other factors, including age, race, ethnicity, body habitus, can make the interpretation challenging. Conclusion: The technologist and nuclear radiologist must identify the expected imaging findings to avoid the most common mistakes related to artifacts. Our main goal is to improve image quality by reviewing the most common pitfalls and artifacts of DaTscan that can compromise an accurate diagnosis and lead to misinterpretation.