What is DAT? Imaging of the Dopamine Transporter; Indications, Interpretation and Cases 
Authors:
A Haughey1, S Liddy2, R Killeen3

Institutions:
St. Vincent's University Hospital, Co. Dublin, Europe, 2St. Vincent's University Hospital, Dublin, Europe, 3St. Vincent's University Hospital, Dublin, Ireland

Presenting Author:
Aoife Haughey, MB BCh BAO MRCPI  
St. Vincent's University Hospital

Submitter:
Aoife Haughey, MB BCh BAO MRCPI  
St. Vincent's University Hospital

Purpose:
In this presentation, we discuss dopamine transporter (DAT) imaging of the brain, with I-123 ioflupane (DaTSCAN). We illustrate the uses and benefits of DaTSCAN imaging in clinical practice, using cases from our institution.

Approach/Methods:
In this presentation we detail the scientific basis for utilising the radiopharmaceutical I-123 Ioflupane (DaTSCAN), in functional brain imaging.
We review the practical applications of DaTSCAN imaging.
We outline the qualitative and semi- quantitative approach to DaTSCAN imaging analysis.
Finally, we present a number of cases from our institution where DaTSCAN imaging is used in combination with cross sectional imaging +/- PET CT for diagnosis of neurodegenerative processes.

Findings/Discussion:
DaTSCAN is a cocaine analogue used for imaging the dopamine transporter (DaT), a sodium chloride-dependent transmembrane protein on the presynaptic nigrostriatal cell surface. Postmortem studies have shown marked reduction in the cocaine-binding dopamine receptors in patients with idiopathic parkinson's disease.
We review the practical applications of DaTSCAN imaging and its use in investigating patients for idiopathic Parkinsonism (IPD) and in differentiating IPD from essential tremor and IPD-like processes including multiple systems atrophy and supranuclear palsy (also known as Parkinson's plus syndromes).
There are both qualitative and semi- quantitative approaches to DaTSCAN imaging analysis and we illustrate the various patterns of possible uptake.
We review the imaging findings of a multitude of neurodegenerative disorders including findings on DaTSCAN imaging, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography CT, using cases from our institution. We include Parkinson's disease (PD), Alzheimers disease (AD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasilar degeneration (CBD), Lewy Body Dementia (LBD).

Summary/Conclusion:
Imaging with DaTSCAN is an effective study that can confirm whether there is dopaminergic neurodegeneration present in patients presenting with Parkinsonian symptoms.
We present a multitude of cases where imaging with DaTSCAN, in combination with CT, MRI or PET CT enables diagnosis of the underlying disorder.

Categories:
FUNCTIONAL/ADVANCED IMAGING, Spectroscopy

Reference One:
Booth TC et al. The role of functional dopamine-transporter SPECT imaging in parkinsonian syndromes, part 1. AJNR Am J Neuroradiol. 2015 Feb;36(2):229-35.
Reference Two:
Varrone A. European multicentre database of healthy controls for [123I]FP-CIT SPECT (ENC-DAT): age-related effects, gender differences and evaluation of different methods of analysis. Eur J Nucl Med Mol Imaging. 2013 Jan;40:213-227.
doi: 10.1007/s00259-012-2276-8.
Reference Three:
Surendranathan A, O'Brien JT. Clinical imaging in dementia with Lewy bodies. Evid Based Ment Health. 2018 May;21(2):61-65.
Reference Four:
Walker, Z., Gandolfo, F., Orini, S. et al. Clinical utility of FDG PET in Parkinson’s disease and atypical parkinsonism associated with dementia. Eur J Nucl Med Mol Imaging (2018) 45: 1534.

What is DAT?  Imaging of the Dopamine Transporter; Indications, Interpretation and Cases

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