Performance of 123I‐ioflupane SPECT striatal binding in dementia with Lewy bodies

INTRODUCTION: We aimed to determine whether ¹²³I-ioflupane single-photon emission computed tomography (SPECT) striatal binding ratio (SBR) correlated with parkinsonian motor symptoms in dementia with Lewy bodies (DLB) and if SBR predicts worsening of parkinsonism over time. METHODS: A retrospective cohort study of the U.S. Dementia with Lewy Bodies Consortium dataset including individuals with DLB with baseline ¹²³I-ioflupane SPECT analyzed with DaTQUANT and baseline and 24-month Movement Disorder Society Unified Parkinson's Disease Rating Scale-Part III (MDS-UPDRS-III). A subset had cerebrospinal fluid α-synuclein seed amplification assay (SAA) evaluation. RESULTS: Baseline mean SBRs were significant predictors of baseline and 24-month MDS-UPDRS-III scores, although they did not predict meaningful worsening over time. SAA positivity was associated with lower SBRs; Z score cut-off values are provided. DISCUSSION: In suspected DLB, ¹²³I-ioflupane SPECT, at diagnosis, could be used to confirm underlying dopamine deficiency; it does not predict meaningful worsening of motor parkinsonism. More severe dopamine deficiency increases confidence in presence of synucleinopathy. HIGHLIGHTS: ¹²³I-ioflupane single-photon emission computed tomography (SPECT) can confirm underlying dopamine deficiency. Striatal binding ratio (SBR) Z scores predicted 24-month Unified Parkinson's Disease Rating Scale-Part III (UPDRS-III) scores. SBR Z scores are not predictive of subsequent meaningful worsening of parkinsonism. More severe dopamine dysfunction on SPECT is associated with presence of seed amplification assay (SAA). SBR Z score cut-offs that indicate cerebrospinal fluid SAA positivity are provided.