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Diminished Striatal D2 Dopamine Receptor Activity Demonstrated by 123I-IBZM Single Photon Emission Computed Tomography

Eric van Royen, MD, PhD; Nicolaas F. L. G. Verhoeff, MD; Johannes D. Speelman, MD, PhD; Erik Ch. Wolters, MD, PhD; Michael A. Kuiper, MD; Anthonius G. M. Janssen, MSc

Arch Neurol. 1993;50(5):513-516.

Abstract
• Objective.
—To measure D₂ dopamine receptors in the striatum in patients with multiple system atrophy and progressive supranuclear palsy by I 3-iodo-6-methoxybenzamide labeled with iodine I 123 (¹²³I-IBZM) single photon emission computed tomography and differentiate them from control subjects.

Design.
—Survey with the following as retrospective criterion standards: (1) parkinsonism, (2) negative apomorphine test, and (3) no or only slight reaction to dopaminergic medication.

Setting.
—Ambulatory or hospitalized care in an academic referral center.

Patients and Control Subjects.
—Twenty-one patients with parkinsonism not responding to dopaminergic medication (17 with multiple system atrophy and four with progressive supranuclear palsy) and 21 control subjects without parkinsonism.

Intervention.
—In vivo imaging by single photon emission computed tomography using the D₂ dopamine receptor specific radioligand ¹²³I-IBZM.

Main Outcome Measure.
—Striatum/occipital cortex ratio of count rate density as semiquantitative measurement for striatal D₂ dopamine receptor density.

Results.
—A highly significant loss of striatal uptake of ¹²³I-IBZM was observed in the patients in comparison to the control subjects with little or no overlap between values.

Conclusions.
—The hypothesized loss of D₂ receptors in multiple system atrophy has been confirmed. Use of ¹²³I-IBZM single photon emission computed tomography may be a cost-effective alternative to positron emission tomography in the differential diagnosis of parkinsonism and in the selection of patients for dopaminergic therapy.

Author Affiliations
From the Departments of Nuclear Medicine (Drs van Royen and Verhoeff) and Neurology (Dr Speelman), Academic Medical Centre, University of Amsterdam, the Department of Neurology, Academic Hospital, Free University (Drs Wolters and Kuiper), Amsterdam, the Netherlands; and the Cyclotron Group CYGNE (Mr Janssen), Technical University, Eindhoven, the Netherlands.

Footnotes
Accepted for publication October 16, 1992.

Reprint requests to Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands (Dr van Royen).

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