{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:20:38Z","timestamp":1785320438324,"version":"3.55.0"},"reference-count":43,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nuklearmedizin"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To estimate (i) the rate of difficult-to-interpret cases in dopamine transporter (DAT)-SPECT with [123I]ioflupane and (ii) the diagnostic accuracy of binary visual categorization in difficult-to-interpret DAT-SPECT.<\/jats:p>\n                  <jats:p>The study included 178 control subjects (49% females, 63.7\u00b111.7y) and 178 sex- and age-matched patients with pre-screening clinical diagnosis of Parkinson\u2019s disease (PD) from the Parkinson\u2019s Progression Markers Initiative (PPMI). SPECT images reconstructed by the PPMI and a local method were visually interpreted twice by 2 independent readers with respect to Parkinson-like reduction of the striatal signal using the following 6-score: \u20133 = clearly reduced, \u20132 = probably reduced, \u20131 = more likely reduced than normal, 1 = more likely normal than reduced, 2 = probably normal, 3 = clearly normal. Cases with 6-score of \u20131 or 1 were considered \u201cdifficult-to-interpret\u201d, all other cases were considered \u201cconclusive\u201d. To assess diagnostic accuracy relative to the clinical group label (control, PD), the 6-score was binarized using 0 as cutoff.<\/jats:p>\n                  <jats:p>The proportion of difficult-to-interpret cases ranged between 3.4% (95%-CI 1.5\u20135.2%) and 7.6% (4.8\u201310.3%) across readers and reconstruction methods. The proportion of cases misclassified by the binarized score ranged between 17.4% (1.9\u201332.9%) and 50.0% (25.5\u201374.5%) among the difficult-to-interpret cases, and between 5.1% (2.7\u20137.4%) and 6.4% (3.8\u20139.0%) among the conclusive cases.<\/jats:p>\n                  <jats:p>(i) the proportion of difficult-to-interpret cases in DAT-SPECT for the diagnosis of parkinsonism is not larger than 10%, (ii) the diagnostic accuracy of binary decisions is severely reduced in these cases. We therefore recommend reporting difficult-to-interpret cases as \u201cinconclusive\u201d, unless in special situations.<\/jats:p>","DOI":"10.1055\/a-2784-7591","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T22:34:07Z","timestamp":1775169247000},"page":"83-92","source":"Crossref","is-referenced-by-count":1,"title":["Difficult-to-interpret dopamine transporter SPECT with [123I]ioflupane in the diagnosis of parkinsonism"],"prefix":"10.1055","volume":"65","author":[{"given":"Ivayla Ilieva","family":"Apostolova","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Buddenkotte","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"},{"name":"jung diagnostics GmbH, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loren","family":"Jedid","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Klutmann","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rickmer","family":"Braren","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp T","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Buchert","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"ref1","volume-title":"Parkinson-Kr\u00e1nkheit","author":"G H\u00f6glinger","year":"2023"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1038\/s41531-021-00185-8","article-title":"Clinical utility of DaTscan in patients with suspected Parkinsonian syndrome: a systematic review and meta-analysis","volume":"7","author":"D Bega","year":"2021","journal-title":"Npj Parkinsons 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Apostolova","year":"2017","journal-title":"Clin Nucl Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2800","DOI":"10.1007\/s00259-019-04502-5","article-title":"Automatic classification of dopamine transporter SPECT: deep convolutional neural networks can be trained to be robust with respect to variable image characteristics","volume":"46","author":"M Wenzel","year":"2019","journal-title":"Eur J Nucl Med Mol I"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.jns.2018.10.001","article-title":"[123I]Ioflupane imaging in Caucasians and non-Caucasians: Are there any differences?","volume":"395","author":"A Ahmed","year":"2018","journal-title":"J Neurol Sci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"235","DOI":"10.3389\/fmed.2020.00235","article-title":"Faster Acquisition for Dopamine Transporter Imaging Using Swiftscan Step and Shoot Continuous SPECT Without Impairing Visual and Semiquantitative 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