Justificación e impacto del uso de la SPECT 123I-FP-CIT en el diagnóstico diferencial y manejo de los trastornos del movimiento (TM) en un hospital de referencia nacional

Abstract

Introduction

Cerebral single photon emission computed tomography (SPECT) using ¹²³I-FP-CIT is a key tool in the differential diagnosis of movement disorders (MD), but its appropriate indication is essential to optimize resources and avoid unnecessary tests.

Objective

To evaluate the adequacy and impact of SPECT ¹²³I-FP-CIT in the diagnosis and management of MD according to clinical guidelines.

Methodology

Retrospective study involving 249 patients with suspected parkinsonism (PK) of uncertain origin. All underwent SPECT ¹²³I-FP-CIT and had a clinical follow-up of exceeding 12 months. Requests were classified based on their adherence to clinical guidelines. Variables analyzed included sex, age, justification for the request, management after SPECT, and final diagnosis.

Results

91.57% of the requests were appropriate, while 8.43% did not adhere to the guidelines. Diagnosis changed in 48.6% of cases and management in 70.68% after the scan, especially in inconclusive cases and initiation of therapy. General neurologists evaluated more cases and made more appropriate requests (96,3% vs 76,67%;p < 0,001). However, MD specialists, despite less appropriate use of the text, achieved a higher number of conclusive diagnoses in complex cases.

Conclusion

SPECT ¹²³I-FP-CIT has significant clinical impact when used in accordance with clinical guidelines, improving the diagnosis and management of MD. Unjustified scans reduce its utility. Collaboration between general neurologists and MD specialists is fundamental; the latter, although showing less adherence to guidelines in requesting the test, achieve a higher number of conclusive diagnoses in complex cases.