Iodine-123 Ioflupane (DaTscan): Diagnosis of Parkinson’s Disease and Movement Disorders

Iodine-123 Ioflupane, also known as 123I-FP-CIT or DaTscan, is a radiopharmaceutical used for diagnosing and managing movement disorders such as Parkinson’s disease.  A selective radioligand binds to dopamine transporters (DAT) in the presynaptic terminals of dopaminergic neurons.  This enables the visualisation of the integrity of the nigrostriatal pathway using single-photon emission computed tomography (SPECT) imaging.

Iodine-123 Ioflupane was approved by the United States Food and Drug Administration (FDA) in 2011 and the European Medicines Agency (EMA) in 2000.  Its development has proven to be a game-changer in neuroimaging. It provides physicians a powerful diagnostic tool for assessing and differentiating PD and other movement disorders with similar clinical presentations.

DaTscan: Unveiling the Nigrostriatal Pathway in Parkinson’s Disease Diagnosis

The radiopharmaceutical is labelled with iodine-123, a gamma-emitting isotope, which allows for the detection of emitted gamma rays by the SPECT camera.  In addition, the compound ioflupane selectively binds to the DAT with high affinity and specificity.  This results in the accumulation of iodine-123 ioflupane in brain areas rich in dopamine transporters.  This enables the assessment of the distribution and density of DAT in the striatum, which includes the caudate nucleus and putamen, regions affected by PD and related disorders.

Imaging with iodine-123 ioflupane provides crucial information on the functional integrity of the nigrostriatal pathway.  In patients with PD, there is a significant reduction in DAT binding within the striatum, reflecting the loss of dopaminergic neurons.  However, a routine scan indicates an intact dopaminergic system and suggests a non-parkinsonian syndrome.  Thus, DaTscan can help differentiate between idiopathic PD and other conditions that mimic its clinical presentation, such as essential tremor, drug-induced parkinsonism, and atypical parkinsonian syndromes (e.g., multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration).

It is important to note that while iodine-123 ioflupane is a valuable diagnostic tool, it does not provide a definitive diagnosis of PD.  Instead, it is used as an adjunct to clinical evaluation, supporting and refining the diagnostic process.  Additionally, the DaTscan is ineffective in distinguishing between various Parkinsonian syndromes, as they all share a common feature of nigrostriatal dopaminergic degeneration.

Advancing Movement Disorder Diagnosis with Iodine-123 Ioflupane

Despite these limitations, iodine-123 ioflupane has significantly improved the accuracy and reliability of diagnosing movement disorders.  Early and accurate diagnosis is critical for implementing appropriate treatment strategies and management plans, ultimately improving patient outcomes and quality of life. Further research is underway to explore the potential applications of DaTscan in other neurological disorders and to enhance our understanding of the complex pathophysiology underlying these conditions.

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