Diagnostic Evaluation of Technetium-99 metastable TRODAT-1 Single Photon Emission Computed Tomography-Computed Tomography in the Differential Diagnosis of Parkinsonism in Hospital Kuala Lumpur: A preliminary experience

Parkinsonian syndrome encompasses a group of movement disorders characterized by symptoms such as tremor, rigidity, bradykinesia, and postural instability. While Idiopathic Parkinson's disease is the most common cause, several other etiologies can also result in parkinsonism. Identifying the specific type of Parkinsonian syndrome is essential due to its varying therapeutic and prognostic implications. This study aims to evaluate the role of Technetium-99 metastable TRODAT-1 Single Photon Emission Computed Tomography-Computed Tomography (Tc-99m TRODAT-1 SPECT-CT) in patients with parkinsonism. The clinical data and scintigraphy findings of patients referred to the Department of Nuclear Medicine, Hospital Kuala Lumpur for Tc-99m TRODAT-1 SPECT-CT from July 2022 to July 2023 were retrospectively reviewed. Follow-up with primary team was conducted to determine the clinical implications and subsequent therapeutic management of the patients. Tc-99m TRODAT-1 SPECT-CT was performed on sixteen patients (10 females and 6 males) with a mean age of 55.2 years (range 26 to 75 years). Five patients exhibited normal scintigraphy findings, while eleven patients showed abnormal Tc-99m TRODAT-1 SPECT-CT results. The scintigraphy findings led to changes in therapeutic management for 81.3% of the patients. Additionally, 19% of the patients were referred for further evaluation with Fluorine-18 fluorodeoxyglucose PET to assist in diagnosing atypical Parkinsonian disease. Tc-99m TRODAT-1 SPECT-CT is a readily available tool for assessing presynaptic dopamine transporters in patients with parkinsonism. This study demonstrated that Tc-99m TRODAT-1 SPECT-CT significantly impacts the diagnostic and therapeutic outcomes for patients with parkinsonism.