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Dementia with Lewy bodies: a comparison of clinical diagnosis, FP-CIT single photon emission computed tomography imaging and autopsy

¹ University College London and Royal Free Hospitals, London, UK
² Department of Neuropathology, Newcastle General Hospital, UK
³ Barts and The London NHS Trust, London, UK
⁴ North Essex Mental Health Partnership NHS Trust, UK
⁵ University of Sheffield, Sheffield, UK
⁶ Institute for Ageing and Health, University of Newcastle upon Tyne, Newcastle upon Tyne, UK

Correspondence to:
Dr Zuzana Walker, Department of Mental Health Sciences, St Margaret’s Hospital, Epping, Essex, UK; z.walker{at}ucl.ac.uk

Methods: A single photon emission computed tomography (SPECT) scan was carried out with a dopaminergic presynaptic ligand [¹²³I]-2beta-carbometoxy-3beta-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT; ioflupane) on a group of patients with a clinical diagnosis of DLB or other dementia. An abnormal scan was defined as one in which right and left posterior putamen binding, measured semiquantitatively, was more than 2 SDs below the mean of the controls.

Results: Over a 10 year period it was possible to collect 20 patients who had been followed from the time of first assessment and time of scan through to death and subsequent detailed neuropathological autopsy. Eight patients fulfilled neuropathological diagnostic criteria for DLB. Nine patients had AD, mostly with coexisting cerebrovascular disease. Three patients had other diagnoses. The sensitivity of an initial clinical diagnosis of DLB was 75% and specificity was 42%. The sensitivity of the FP-CIT scan for the diagnosis of DLB was 88% and specificity was 100%.

Conclusion: FP-CIT SPECT scans substantially enhanced the accuracy of diagnosis of DLB by comparison with clinical criteria alone.

Abbreviations: AD, Alzheimer’s disease; CBD, cortico-basal degeneration; CVD, cerebrovascular disease; DLB, dementia with Lewy bodies; LB, Lewy body; NFT, neurofibrillary tangle; PD, Parkinson’s disease; PET, positron emission tomography; SMU, Strichman Medical Unit; SPECT, single photon emission computed tomography

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