EANM practice guideline/SNMMI procedure standard for dopaminergic imaging in Parkinsonian syndromes 1.0

European Journal of Nuclear Medicine and Molecular Imaging (2020) 47:1885–1912 https://doi.org/10.1007/s00259-020-04817-8 GUIDELINES EANM practice guideline/SNMMI procedure standard for dopaminergic imaging in Parkinsonian syndromes 1.0 Silvia Morbelli 1,2 & Giuseppe Esposito 3 & Javier Arbizu 4 & Henryk Barthel 5 & Ronald Boellaard 6 & Nico I. Bohnen 7 & David J Brooks 8,9 & Jacques Darcourt 10 & John C. Dickson 11 & David Douglas 12 & Alexander Drzezga 13,14,15 & Jacob Dubroff 16 & Ozgul Ekmekcioglu 17 & Valentina Garibotto 18,19 & Peter Herscovitch 20 & Phillip Kuo 21 & Adriaan Lammertsma 6 & Sabina Pappata 22 & Iván Peñuelas 4 & John Seibyl 23 & Franck Semah 24 & Livia Tossici-Bolt 25 & Elsmarieke Van de Giessen 26 & Koen Van Laere 27 & Andrea Varrone 28 & Michele Wanner 29 & George Zubal 30 & Ian Law 31 Received: 20 February 2020 / Accepted: 6 April 2020 / Published online: 9 May 2020 # The Author(s) 2020 Abstract Purpose This joint practice guideline or procedure standard was developed collaboratively by the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The goal of this guideline is to assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of dopaminergic imaging in parkinsonian syndromes. Methods Currently nuclear medicine investigations can assess both presynaptic and postsynaptic function of dopaminergic synapses. To date both EANM and SNMMI have published procedural guidelines for dopamine transporter imaging with single photon emission computed tomography (SPECT) (in 2009 and 2011, respectively). An EANM guideline for D2 SPECT imaging is also available (2009). Since the publication of these previous guidelines, new lines of evidence have been made available on semiquantification, harmonization, comparison with normal datasets, and longitudinal analyses of dopamine transporter imaging with SPECT. Similarly, details on acquisition protocols and simplified quantification methods are now available for dopamine transporter imaging with PET, including recently developed fluorinated tracers. Finally, [18F]fluorodopa PET is now used in some centers for the differential diagnosis of parkinsonism, although procedural guidelines aiming to define standard procedures for [18F]fluorodopa imaging in this setting are still lacking. Conclusion All these emerging issues are addressed in the present procedural guidelines for dopaminergic imaging in parkinsonian syndromes. Keywords Brain . DAT . DOPA . PET . SPECT . Parkinson . Parkinsonian syndromes Preamble The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. Its 15,000 members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. In addition to This article is part of the Topical Collection on Neurology * Silvia Morbelli Extended author information available on the last page of the article publishing journals, newsletters, and books, the SNMMI also sponsors international meetings and workshops designed to increase the competencies of nuclear medicine practitioners and to promote new advances in the science of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. The SNMMI/EANM periodically define new standards/ guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients. Existing standards/guidelines will be reviewed for modifications or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. As of February 2014, Eur J Nucl Med Mol Imaging (2020) 47:1885–1912 1886 the SNMMI guidelines are referred to as procedure standards. Any previous practice guideline or procedure guideline that describes how to perform a procedure is now considered an SNMMI procedure standard. Each standard/guideline, representing a policy statement by the SNMMI/EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI/EANM recognizes that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. The EANM and SNMMI have written and approved these standards/guidelines to promote the use of nuclear medicine procedures with high quality. These standards/guidelines are intended to assist practitioners in providing appropriate nuclear medicine care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the SNMMI/EANM cautions against the use of these standards/guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by medical professionals considering the unique circumstances of each case. Thus, there is no implication that an approach differing from the standards/guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the standards/guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the standards/guidelines. The practice of medicine involves not only the science but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to these standards/guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these standards/guidelines is to assist practitioners in achieving this objective. The present guideline/standard was developed collaboratively by the EANM and SNMMI. It summarizes the views of the Neuroimaging Committee of the EANM and the Brain Imaging Council of the SNMMI and reflects recommendations for which the EANM and SNMMI cannot be held responsible (...truncated)