Topography of dopamine transporter availability in progressive supranuclear palsy: a voxelwise [123I]beta-CIT SPECT analysis

Arch Neurol. 2006 Aug;63(8):1154-60. doi: 10.1001/archneur.63.8.1154.


Background: Dopaminergic loss can be visualized by means of iodine I 123-labeled 2beta-carbomethoxy-3beta-(4-iodophenyl)tropane ([(123)I]beta-CIT) single-photon emission computed tomography (SPECT) in several neurodegenerative parkinsonian disorders. Most previous SPECT studies have adopted region-of-interest methods for analysis, which are subjective and operator dependent.

Objective: To objectively localize the cerebral dopamine transporter status in the early stages of progressive supranuclear palsy (PSP).

Design: Prospective study.

Setting: Parkinson disease outpatient clinic.

Patients: Fourteen patients with PSP, 17 with Parkinson disease (PD), 15 with Parkinson-variant multiple-system atrophy (MSA-P), and 13 healthy control subjects, matched for age and disease duration.

Interventions: Statistical parametric mapping applied to [(123)I]beta-CIT SPECT.

Main outcome measures: Differences in [(123)I]beta-CIT uptake.

Results: All patients with the different parkinsonian disorders showed a significant decrease in striatal [(123)I]beta-CIT uptake without any overlap with the control group. In patients with MSA-P and PSP, an additional reduction in brainstem [(123)I]beta-CIT signal compared with controls and patients with PD was identified with statistical parametric mapping. Midbrain [(123)I]beta-CIT uptake discriminated atypical parkinsonian disorders from PD with an overall correct classification of 91.3%. On the other hand, [(123)I]beta-CIT SPECT failed to discriminate PSP and MSA-P.

Conclusion: By applying statistical parametric mapping to [(123)I]beta-CIT SPECT images of patients with PSP, a widespread decline of monoaminergic transporter availability including the striatum and brainstem was localized in PSP, discriminating patients with PSP from patients with PD, but not from those with MSA-P. Quantification of midbrain dopamine transporter signal may therefore enhance the utility of SPECT imaging in the differential diagnosis of patients with parkinsonism.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Brain / diagnostic imaging
  • Brain / metabolism
  • Cocaine / analogs & derivatives*
  • Cocaine / metabolism
  • Dopamine Plasma Membrane Transport Proteins / metabolism*
  • Female
  • Humans
  • Iodine Radioisotopes
  • Male
  • Middle Aged
  • Prospective Studies
  • Radiopharmaceuticals*
  • Supranuclear Palsy, Progressive / diagnostic imaging*
  • Supranuclear Palsy, Progressive / metabolism*
  • Tomography, Emission-Computed, Single-Photon* / methods


  • Dopamine Plasma Membrane Transport Proteins
  • Iodine Radioisotopes
  • Radiopharmaceuticals
  • 2beta-carbomethoxy-3beta-(4-iodophenyl)tropane
  • Cocaine