• Nuclear Medicine and Molecular Imaging
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• v.43 no.2
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• pp.100-106
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• 2009

Purpose: The study was to assess I-123-N-(3-iodopropen-2-yl)-2[beta]-carbomethoxy-3[beta]-(4-cholorophenyl) tropane(IPT) SPECT in differential diagnosis among early stage of Parkinson's disease(PD) and essential tremor(ET) and normal control(NL) groups quantitatively. Materials and Methods: I-123 IPT brain SPECT of 50 NL, 20 early PD, 30 advanced PD, and 20 ET were performed at 20 minutes and 2 hours. Specific/nonspecific binding of striatum was calculated by using right and left striatal specific to occipital non-specific uptake ratio(striatum-OCC/OCC). Results: Mean value of specific/nonspecific binding ratio was significantly different between advanced PD group and NL group. However, significant overlap of striatal specific/nonspecific binding ratio was observed between PD group and ET group. Bilateral striatal specific/nonspecific binding ratios were decreased in advanced PD. Lateralized differences in the striatal uptake of I-123 IPT correlated with asymmetry in clinical findings in PD group. Conclusion: I-123 IPT SPECT may be a useful method for the diagnosis of PD and objective evaluation of progress of clinical stages. Care should be made in the differential diagnosis of early stage of PD and other motor disturbances mimicking PD such as ET in view of significant overlap in striatal I-123 specific/nonspecific binding ratio.

• The Korean Journal of Nuclear Medicine
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• v.32 no.1
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• pp.10-19
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• 1998

The SPECT radiopharmaceuticals labeled with I-123 for dopamine transporter imaging have been used to measure dopamine transporters in patients with movement disorders. However, a cyclotron produced I-123 limits its availiability and ease of use as a radioisotope to be labeled with pharmaceuticals in routine clinical diagnostic procedures. Recently, new radiophannaceuticals for Tc-99m which has optimal characteristic for SPECT imaging have been developed to overcome the limits of using I-123. The purpose of this study was to compare the quality of [Tc-99m]TRODAT-1 with [I-123]IPT SPECT data and then to evaluate the usefulness of [Tc-99m]TRODAT-1 SPECT by using three noninvasive simplified quantitative methods. TRODAT-1 labeled with Tc-99m($15.93{\pm}0.82mCi$) and IPT labeled with I-123($6.60{\pm}0.11mCi$) were injected into five normal controls. Dynamic [Tc-99m]TRODAT-1 SPECT scans of brain were performed for 10 minutes each over 180 minnutes, and for 20 minutes at 4 hrs and 5 hrs. [I-123]IPT SPECT scans were performed for 5 minutes each over 120 minutes. Time activity curves were generated for the left basal ganglia(LBG), right basal ganglia(RBG), and occipital cortex(OCC). Dopamine transporter parameters were ohtained using (BG-OCC)/OCC, graphical method($R_V$), and area ratio method($R_A$). TRODAT-1 and IPT SPECT imaging showed high uptake at the level of the basal ganglia. (BG-OCC)/OCC ratios for TRODAT-1 and IPT were $0.80{\pm}0.14$, and $3.22{\pm}0.81$, $R_Vs$ were $0.62{\pm}0.12$, and $2.30{\pm}0.35$, and $R_As$ were $0.37{\pm}0.08$ and $1.73{\pm}0.31$, respectively. In conclusion, further improvement of [Tc-99m]TRODAT-1 imaging characteristics may be required to estimate the dopamine transporter concentrations in human brains although it shows clear BG localization.

• The Korean Journal of Nuclear Medicine
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• v.30 no.3
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• pp.315-324
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• 1996

The purpose of this study was to compare the specific binding ratio method with model-based methods in estimating the transporter parameter $k_3/k_4$ in normal controls and Parkinson's patients with [I-123]IPT SPECT and to evaluate the usefulness of [I-123]IPT SPECT. $6.5{\pm}1.1$ mCi ($239.0{\pm}40.3$ MBq) of [$^{123}I$]IPT was intravenouly injected as a bolus into six normal controls(age:$45{\pm}13$) and seventeen patients(age:$55{\pm}8$) with Pakinson's disease(PD). The transporter parameter $k_3/k_4$ was derived using the Ichise's graphical method($R_v$) and Lassen's area ratio method($R_A$) for the dynamic IPT SPECT data without blood samples. Then, the relationships between the transporter parameter $R-v,\;R_A$ and the ratio of (BG-OCC)/OCC at 115 minutes were evaluated by linear regression analysis. $R_vs$ by Ichise's graphical method for NC and PD were $2.08{\pm}0.29$ and $0.78{\pm}0.31$, respectively. $R_As$ by Lassen's area ratio method for NC and PD were $1.48{\pm}0.16$ and $0.65{\pm}0.24$, respectively. The correlation coefficients between (BG-OCC)/OCC and $R_v$, (BG-OCC)/OCC and $R_A$, and $R_v$ and $R_A$ were 0.93, 0.90, 0.99 and their corresponding slopes were 0.54, 0.34, and 0.65, respectively. The $R_v$ and $R_A$ of NC were significantly higher than the ones of PD. That is, the $k_3/k_4$ of NC was clearly separated from the one of PD. $k_3/k_4$ showed a good correlation with the ratio of (BG-OCC)/OCC. The results indicate that the noninvasive simplified quantitative methods may be useful to measure the transporter parameter $k_3/k_4$ and the specific binding ratio method can be used for quantitative studies of dopamine transporter with [I-123]IPT SPECT in humans brains.

• Proceedings of the KSMRM Conference
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• 2002.11a
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• pp.107-107
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• 2002

목적： I-123 IPT SPECT에서 striatum에 ROI를 설정하여 Strial Binding Ratio를 측정하기 위해 사용되는 육안적인 방법과 MR Template based Coregistration 방법을 비교 평가하였다. 대상 및 방법： 파킨슨씨병 환자(IPD) 15명(남/녀：8/7, 63.3$\pm$4.8세)과 정상인 8명(남/녀：2/6, 61.4$\pm$16.5세) 에서 I-123 IPT(259MBq)를 주사한 후 2시간에 SPECT 영상을 얻었고 미상핵과 조가비핵의 전, 후부 및 후두엽에 각각 육안적인 방법과 MR Template based Coregistration방법으로 ROI를 설정하였다. MR Template based Coregistration 방법은 MNI TIMR template을 이용하여 SPECT영상을 voxel based intensity matching 방법으로 coregistration한 후midthalamic level에서 striatum의 경계를 따라 설정된 ROI를 이용하였다. 육안적인 방법은 striatal uptake가 가장 높은 level에서 3개의 ROI template를 striatum에 위치하였다. 두 방법으로 SBR과 nnterior/posterior ratio of SBR(APR)를 측정하였고 정상인과 파킨슨씨병 환자에서 두 방법을 비교하였다.

• The Korean Journal of Nuclear Medicine
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• v.37 no.4
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• pp.235-244
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• 2003

Purpose: Attention deficit hyperactivity disorder (ADHD) has been known as psychiatric disorder in childhood associated with dopamine dysregulation. In present study, we investigated changes in dopamine transporter (DAT) density of the basal ganglias using I-123 N-(3-iodopropen-2-yl) -2-carbomethoxy-3beta-(4-chlorophenyl) tropane [I-123 IPT] SPECT in children with ADHD before and after methylphenidate treatment. Materials and Method: Nine drug-naive children with ADHD and seven normal children were included in the study. We peformed brain SPECT two hours after the intravenous administration of I-123 IPT and made both quantitative and qualitative analyses using the obtained SPECT data, which were reconstructed for the assessment of soecific/nonspecific DAT binding ratios in the basal ganglia. All children with ADHD reperformed [123I]IPT SPECT after treatment with methylphenidate(0.7mg/kg/d) during about 8 weeks. SPECT data reconstructed for the assessment of specific/nonspecific DAT binding ratio of the basal ganglia were compared between before and after treatment methylphenidate. We investigated correlation between the change of ADHD symptom severity assessed with ADHD rating scale-IV and specific/nonspecific DAT binding ratio of basal ganglia. Results: Children with ADHD had a significantly greater specificinonspecific DAT binding ratio of the basal ganglia comparing to normal children(Right : z = 2.057, p = 0.041 : Left : z : 2.096, p = 0.032). Under treatment with methylphenidate in all children with ADHD, specificinonspecific DAT binding ratio of both basal ganglia decreased significantly greater than before treatment with methylphenidate (Right : t = 3.239, p = 0.018 ; Left : t = 3.133, p = 0.020). However, no significant correlation between the change of ADHD symptom severity scores and specific/nonspecific DAT binding ratio of the basal ganglia were found. Conclusions: These findings support the complex dysregulation of the dopaminergic neurotransmitter system in children with ADHD.

• Progress in Medical Physics
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• v.14 no.4
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• pp.268-278
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• 2003

Purpose：The aim of this study was to evaluate the striatal binding ratio, the anterior/posterior ratio and reproducibility using a template based registration method using the standard MR template as a replacement for each patients MR image. Materials and Methods：This study analyzed the 123I IPT SPECT images of 30 patients with IPD, who were subdivided into 17 patients (56.6$\pm$10.8 yr, M/F : 8/9.) with mild IPD, and 13 patients (56.4$\pm$11.1 yr, M/F : 8/5) with severe IPD. In addition, 11 normal controls (57.8$\pm$14.4 yr, M/F : 4/7) were also analyzed. The ROIs were positioned manually in the same slice showing the highest striatal activity using the traditional manual method, whereas those were positioned automatically in a mid striatal slice of the SPECT image coregistered to the standard T1 weighted MR template. Results : The specific binding ratio (SBR) obtained using the template based registration method strongly correlated with those using the manual method in all groups : normal controls (r=0.85, P<0.001), mild IPD (r=0.84, P<0.001) and severe IPD (r=0.7, P=0.01). The SBRs obtained using both methods were significantly different among the three groups (P=0.05) and the SBRs obtained by the template based registration method were higher than those by the manual method (P=0.05) in all three groups. The APRs obtained by the template based registration correlated with those using manual method in only mild IPD (r=0.72, P=0.0). The APRs obtained by the template based registration method were significantly different from the normal controls and those with mild or severe IPD (P<0.05), whereas those obtained using the manual method were not significantly different among the three groups (P＞0.1). The reproducibility (rmsCV) of the template based registration method was 7.2% (normal controls：5.2%, mild IPD：4.2%, severe IPD：10.8%), whereas the reproducibility of the manual method was 31% (normal controls：19.7%, mild IPD：21.7%, severe IPD：46.2%). Conclusion：These results show that the use of $^{123}$ I-IPT SPECT for assessing IPD is affected by the methods used to position the striatal ROI. The template based registration method using the standard MR template can be useful in diagnosing IPD and assessing the disease severity with a high reproducibility. Therefore, the template based registration method appears to be a good replacement for the manual method.

• The Korean Journal of Nuclear Medicine
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• v.30 no.3
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• pp.372-378
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• 1996

In the case of $^{123}I$ from the $^{124}Te$(p,2n)reaction, the radionuclidic impurity is the high-energy gamma-emitting $^{124}I$, which interferes greatly with nuclear medicine images. The choice of a collimator can affect the quality of clinical SPECT images of [I-123]MIBG, [I-123] ${\beta}$-CIT, or [I-123]IPT. The tradeoffs that two different collimators make among spatial resolution, sensitivity, and scatter were studied by imaging a line source at 5cm, 10cm, 15cm distance using a number of plexiglass sheets between source and collimator, petri dish, two-dimensional Hoffman brain phantom, Jaszczak phantom, and three-dimensional Hoffman brain phantom after filling with $^{123}I$. (FWHM, FWTM, Sensitivity) for low-energy ultrahigh-resolution parallel - hole (LEUHRP) collimator and medium- energy general - purpose (MEGP) collimator were measured as (9.27mm, 61.27mm, $129CPM/{\mu}Ci$) and (10.53mm, 23.17mm, $105CPM/{\mu}Ci$), respectively. The image quality of two-dimensional Hoffman brain phantom with LEUHRP looked better than the one with MEGP. However, the image quality of Jaszczak phantom and three-dimensional Hoffman brain phantom with LEUHRP looked much worse than the one with MEGP because of scatter contributions in three-dimensional imaging situation. The results suggest that the MEGP is preferable to LEUHRP for three-dimensional imaging studies of [I-123]MIBG, [I-123] ${\beta}$-CIT, or [I-123]IPT.

• The Korean Journal of Nuclear Medicine
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• v.38 no.1
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• pp.41-51
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• 2004

PURPOSE: Tourette's disorder (TD), which is characterized by multiple waxing and waning motor tics and one or more vocal tics, is known to be associated with abnormalities in the dopaminergic system. To testify our hypothesis that risperidone would improve tic symptoms of TD patients through the change of the dopaminergic system, we measured the dopamine transporter (DAT) densities between drug-naive children with TD and normal children, and investigated the DAT density before and after treatment with risperidone in drug-naive children with TD, using iodine-123 labelled $N-(3-iodopropen-2-yl)-2{\beta}-carbomethoxy-3beta-(4-chlorophenyl)tropane$ ($[^{123}I]IPT$) single photon omission computed tomography (SPECT). MATERIALS and METHODS: $[^{123}I]IPT$ SPECT Imaging and Yale Global Tic Severity Scale-Korean version (YGTSS-K) for assessing the tic symptom severity were carried out before and after treatment with risperidone for 8 weeks in nine drug-naive children with TD. Eleven normal children also underwent SPECT imaging 2 hours after an intravenous administration of $[^{123}I]IPT$. RESULTS: Drug-naive children with TD had a significantly greater increase in the specific/nonspecific DAT binding ratio of both basal ganglia compared with the normal children. However, no significant difference in the specific/nonspecific DAT binding ratio of the basal ganglia before and after treatment with risperidone in children with TD was found, although tic symptoms were significantly improved with risperidone. CONCLUSION: These findings suggest that DAT densities are directly associated with the pathophysiology of TD, however, that the effect of risperidone on tic symptoms in children with TD is not attributed to the change of dopaminergic system.

• The Korean Journal of Nuclear Medicine
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• v.30 no.1
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• pp.35-46
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• 1996

Dopamine transporter concentrations have been known to decrease in Parkinson's disease (PD) or increase in Tourette's disorder. The purpose of this study was to evaluate the effectiveness of [I-123]N-(3-iodopropene-2-yl)-$2{\beta}$-carbomethoxy-$3{\beta}$-(4-chlorophenyl) tropane (IPT) as an imaging agent for measuring changes in transporter concentrations with PD. IPT labelled with 6.69+/-0.64 mCi(247.53+/-23.68 MBq) of I-123 was intravenously injected into ten patients(age: 55+/-11) with PD, and six normal controls(NC)(age: 46+/-14) as a bolus. Dynamic SPECT scans of the brain were then performed for 5 minutes each over 120 minutes on a triple headed camera. Time activity curves were generated for the left basal ganglia(LBG), right basal ganglia(RBC), and occipital cortex(OCC). The statistical parameters included the time to peak activity, the contrast ratio of LBG and RBG to OCC at several time points, and the accumulated specific binding counts/mCi/pixel(ASBC) from 0 to 115 minutes. The uptake of IPT in the brains of PD and NC peaked within 10 minutes of injection in all subjects. The maximum target to background ratio in the basal ganglia of PD and NC occurred at 85+/-20 min and 110+/-6 min of injection, respectively. The BG/OCC ratios at 115 minutes for PD and NC were 2.15+/-0.54 and 4.26+/-0.73, respectively. The ASBC at 115 minutes for PD and NC were 152.91+/-50.09 and 289.51+/-49.00, respectively. The ratio of BG/OCC for the NC was significantly higher than the ratio for PD. SPECT data matched with clinical diagnosis for PDs. The ratio between BG and OCC and the ASBC for PD were clearly separated from NC and may be useful outcome measures for clinical diagnosis. The findings suggest that IPT may be a very useful tracer for early diagnosis of PD and study of dopamine reuptake site.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.342-348
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• 2001

Objective : Dopamine transporter concentrations have been known to decrease in Parkinson's disease(PD). The aim of the present study was to evaluate the correlation between SPECT measurements of [I-123]N-(3-iodopropene-2-yl)-$2{\beta}$-carbomethoxy-$3{\beta}$-(4-chlorophenyl) tropane(IPT) as an imaging agent for measuring changes in transporter concentrations with PD. Patients and Methods : IPT labelled with $4.87{\pm}1.29mCi$($180.19{\pm}47.73MBq$) of [I-123] was intravenously injected into 23 patients(age : $58{\pm}12$) with PD and three normal controls(NC)(age : $37{\pm}7$) as bolus. Brain SPECT were then performed at 1 hour and 2 hours after injection on a double headed camera. The statistical parameters were the contrast ratio of left basal ganglia(BG) and right basal ganglia to occipital cortex(OCC) per milli curies of injected radiotracer at 1 hour and 2 hours. The correlations were evaluated between these parameters and Hoehn-Yahr classification of the patients. Results : The(BG - OCC)/OCC/mCi ratios at 1 hour and 2 hours for PD and NC were $0.14{\pm}0.07$ and $0.27{\pm}0.07$(1 hour) and $0.12{\pm}0.07$ and $0.34{\pm}0.04$(2 hour), respectively. The(BG - OCC)/OCC/mCi ratios of Parkinson's disease were decreased with higher grade of Hoehn-Yahr classification of the patients. The ratio between BG and OCC for PD were clearly separated from NC and may be useful outcome measures for clinical diagnosis. Conclusion : The findings suggest that IPT may be a very useful tracer for early diagnosis and treatment of PD and study of dopamine re-uptake site.