Dopamine Transporter Imaging in Movement Disorders

Dopamine transporter imaging has emerged as a pivotal tool for the in vivo characterisation of presynaptic dopaminergic integrity in movement disorders. By targeting the protein responsible for dopamine reuptake at nigrostriatal synapses, this approach enables direct visualisation and quantification of neuronal loss in conditions such as Parkinson’s disease, atypical parkinsonisms and dementia with Lewy bodies. Two main modalities are employed: single photon emission computed tomography (SPECT), most commonly using [123I]FP-CIT, and positron emission tomography (PET), with advanced tracers like [18F]FE-PE2I offering improved resolution and quantification. Quantitative measures such as specific binding ratio and binding potential facilitate longitudinal monitoring of disease progression, assessment of therapeutic efficacy and enrichment of clinical trials. Clinically, dopamine transporter imaging refines diagnostic accuracy where symptoms are equivocal, distinguishes degenerative from non-degenerative parkinsonism and supports early detection of prodromal disease. Harmonisation efforts across imaging centres, including phantom calibration and standardised acquisition protocols, have bolstered reliability. As a surrogate biomarker, dopamine transporter imaging also underpins research into compensatory mechanisms, correlates of motor severity and the development of disease-modifying strategies. Its global significance extends from routine clinical practice to multicentre trials aiming to slow or halt neurodegeneration.

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Dopamine Transporter Imaging in Movement Disorders publication trend

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Technical terms

Dopamine transporter (DAT): A presynaptic membrane protein responsible for the reuptake of dopamine from the synaptic cleft, serving as a direct marker of nigrostriatal neuron integrity.

Radiotracer: A radioactive compound that binds selectively to molecular targets (e.g. DAT), enabling their detection and quantification by nuclear imaging.

Single photon emission computed tomography (SPECT): A nuclear imaging modality that detects gamma photons emitted by radiotracers to generate three-dimensional functional images.

Positron emission tomography (PET): An imaging technique using positron-emitting radiotracers that provides high spatial resolution and quantitative measures of tracer distribution.

Specific binding ratio (SBR): A semi-quantitative index calculated as the ratio of radiotracer bound to target regions versus a reference region, reflecting transporter density.

References

1. Clinical correlates of dopamine transporter availability in cross-sectional and longitudinal studies with [18F]FE-PE2I PET: independent validation with new insights. Brain Communications (2024).
2. The diagnostic performance of functional dopaminergic scintigraphic imaging in the diagnosis of dementia with Lewy bodies: an updated systematic review. European Journal of Nuclear Medicine and Molecular Imaging (2023).
3. Dopamine transporter single photon emission computed tomography (DaT-SPECT) use in the diagnosis and clinical management of parkinsonism: an 8-year retrospective study. Journal of Neurology (2023).