NucMed Boards Prep
IMAGE INTERPRETATION · BRAIN IMAGING

Dementia with Lewy Bodies on DaTscan

I-123 DaTSCAN SPECT (transverse slices) showing asymmetrically reduced striatal dopamine transporter uptake
I-123 DaTSCAN SPECT (transverse slices) showing asymmetrically reduced striatal dopamine transporter uptake

Provided clinical image

Question

A patient presents with visual hallucinations, fluctuating cognitive impairment, and mild parkinsonian features. DaTSCAN shows reduced and asymmetric striatal uptake similar to Parkinson's disease. This combination of clinical features and abnormal DaTSCAN is MOST consistent with:

  1. ADementia with Lewy bodies (DLB) — abnormal DaTSCAN with nigrostriatal degeneration supports DLB diagnosis
  2. BAlzheimer's disease
  3. CEssential tremor
  4. DDrug-induced parkinsonism
Show the answer and explanation

A. Dementia with Lewy bodies (DLB) — abnormal DaTSCAN with nigrostriatal degeneration supports DLB diagnosis

Dementia with Lewy bodies (DLB) is a synucleinopathy characterized by: (1) fluctuating cognition; (2) recurrent well-formed visual hallucinations; (3) parkinsonism; (4) REM sleep behavior disorder. DLB involves nigrostriatal dopaminergic degeneration (like PD), so DaTSCAN is typically ABNORMAL (reduced striatal DAT uptake). An abnormal DaTSCAN in a patient with these features strongly supports DLB over Alzheimer's disease (which has normal DaTSCAN) and drug-induced parkinsonism (normal DaTSCAN). In fact, an abnormal DaTSCAN is one of the 'indicative biomarkers' in the updated DLB diagnostic criteria.

More brain imaging images

Brain FDG-PET — hypometabolism pattern in Alzheimer's diseaseAlzheimer’s Disease on FDG PET Brain perfusion SPECT, transverse slices showing focal perfusion defectFocal Perfusion Defect on Brain SPECT Brain perfusion SPECT, transverse slices showing focal perfusion defectBrain Perfusion SPECT: Injection Environment Brain perfusion SPECT (Tc-99m ECD), transverse slices — normal studyNormal Tc-99m ECD Brain SPECT: Gray vs White Matter Brain perfusion SPECT (Tc-99m ECD), transverse slices — normal studyBrain SPECT: When to Image After ECD Injection DaTSCAN (I-123 ioflupane) SPECT — midbrain axial sliceDaTscan (I-123 Ioflupane): What It Evaluates
← Ictal SPECT: Hyperperfusion at the Seizure FocusAlzheimer’s Disease on FDG PET →

All 130 nuclear medicine images by category →

Practise image interpretation in the app

All 130 images as an interactive quiz, alongside 500 NMTCB and ARRT(N) questions with worked explanations, case studies and timed mock exams. 25 questions are free, no card and no account.

Start free — no card

Download on the App StoreGet it on Google Play