Pitfalls and Artifacts of 123I-Ioflupane SPECT in Parkinsonian Syndromes: A Quality Improvement Teaching Tool

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Abstract
The aim of the current article is to describe how to improve the quality of imaging with I-123-ioflupane SPECT and to serve as a teaching tool on this topic. The radiopharmaceutical I-123-ioflupane is used to visualize the nigrostriatal pathway. Parkinson disease and parkinsonian syndromes are movement disorders that exhibit nigrostriatal degeneration, with a decreased dopamine transporter level in the pathway and thus a decreased I-123-ioflupane distribution. Other nonparkinsonian movement disorders, such as essential tremor, will have intact dopaminergic neurons and exhibit a normal distribution of the radiopharmaceutical throughout the striata. Parkinsonian disorders are usually diagnosed clinically. However, I-123-ioflupane SPECT can be a valuable tool when the clinical features are not sufficiently clear. I-123-ioflupane SPECT image interpretation is not always straightforward. Many pitfalls, including biologic factors, technical factors, medications, and factors such as age, race, ethnicity, and body habitus, can make the interpretation challenging. The technologist and nuclear radiologist must identify the expected imaging findings to avoid the most common mistakes related to artifacts. This article reviews the usual pitfalls and artifacts of I-123-ioflupane SPECT that can compromise an accurate diagnosis and lead to misinterpretation of image findings.

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