Importance of proper window setting in visual assessment of dopamine transporter imaging: A case of early-onset Parkinsonism related to Park2 gene mutation

ABSTRACT

In the early stages or atypical manifestation of parkinsonism, dopamine transporter imaging can assist the early diagnosis. We describe a 19 year-old man presenting with progressive gait disturbance, cervical dystonia and head tremor. 18F-FP-CIT PET (FluoroPropyl-Carbomethoxylodopropyl-nor-BTropane positron emission tomography) was done and interpreted as normal at other hospital, and his diagnosis remained baffling. He visited our hospital several months later, and the FP-CIT PET image was reviewed by the nuclear medicine physician in our hospital, who also interpreted it as normal. However, we reviewed his FP CIT-PET image because his clinical picture was strongly suggestive of juvenile parkinsonism. After adjusting the window setting of the PET image, we could appreciate the decreased uptake in the bilateral basal ganglia. Thus he was finally diagnosed as juvenile parkinsonism and gene test confirmed Park2 gene mutation. In conclusion, proper window setting is important during visual assessment of dopamine transporter imaging.