The semicolon sign: Dopamine transporter imaging artifact from head tilt

Matthew F. Covington, Natalie A. McMillan, Ryan J. Avery, Phillip H Kuo

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Dopamine transporter (DAT) imaging is a valuable tool to aid in the diagnosis of Parkinson disease and other Parkinsonian syndromes. DAT imaging is special among clinical nuclear medicine scans in that the already small caudate and putamen are presented in multiple thin axial cuts. Because the imaged basal ganglia are small, slight differences in head tilt may result in a significant artifact that we have termed the semicolon sign. The semicolon sign occurs when forward head tilt creates select images that show the caudate nuclei separate from the putamen. This gives the false impression that DAT activity in the putamen is decreased or absent. To avoid falsely attributing this artifact to loss of putaminal activity, it is imperative that the interpreting physician first recognize the artifact and then mentally integrate all provided images to identify normal activity in the putamen on subsequent levels. Furthermore, quantitative software packages for automated DAT scan interpretation are now available. If images demonstrating the semicolon sign are used for automated interpretation, loss of activity in the putamen may be falsely calculated, thereby contributing to erroneous results. Quality control measures are essential to ensure that technologists correctly position each patient's head to minimize head tilt artifact on DAT scan images. A protocol to obtain optimal head positioning is presented.

Original languageEnglish (US)
Pages (from-to)105-107
Number of pages3
JournalJournal of Nuclear Medicine Technology
Volume41
Issue number2
DOIs
StatePublished - Jun 2013

Fingerprint

Dopamine Plasma Membrane Transport Proteins
Putamen
Artifacts
Head
Caudate Nucleus
Clinical Medicine
Nuclear Medicine
Parkinsonian Disorders
Basal Ganglia
Quality Control
Parkinson Disease
Software
Physicians

Keywords

  • Basal ganglia
  • Dopamine transporter (DAT) imaging
  • Imaging artifact
  • Parkinson disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

The semicolon sign : Dopamine transporter imaging artifact from head tilt. / Covington, Matthew F.; McMillan, Natalie A.; Avery, Ryan J.; Kuo, Phillip H.

In: Journal of Nuclear Medicine Technology, Vol. 41, No. 2, 06.2013, p. 105-107.

Research output: Contribution to journalArticle

Covington, Matthew F. ; McMillan, Natalie A. ; Avery, Ryan J. ; Kuo, Phillip H. / The semicolon sign : Dopamine transporter imaging artifact from head tilt. In: Journal of Nuclear Medicine Technology. 2013 ; Vol. 41, No. 2. pp. 105-107.
@article{d914bcf743514dc0ad070d8f9995aad5,
title = "The semicolon sign: Dopamine transporter imaging artifact from head tilt",
abstract = "Dopamine transporter (DAT) imaging is a valuable tool to aid in the diagnosis of Parkinson disease and other Parkinsonian syndromes. DAT imaging is special among clinical nuclear medicine scans in that the already small caudate and putamen are presented in multiple thin axial cuts. Because the imaged basal ganglia are small, slight differences in head tilt may result in a significant artifact that we have termed the semicolon sign. The semicolon sign occurs when forward head tilt creates select images that show the caudate nuclei separate from the putamen. This gives the false impression that DAT activity in the putamen is decreased or absent. To avoid falsely attributing this artifact to loss of putaminal activity, it is imperative that the interpreting physician first recognize the artifact and then mentally integrate all provided images to identify normal activity in the putamen on subsequent levels. Furthermore, quantitative software packages for automated DAT scan interpretation are now available. If images demonstrating the semicolon sign are used for automated interpretation, loss of activity in the putamen may be falsely calculated, thereby contributing to erroneous results. Quality control measures are essential to ensure that technologists correctly position each patient's head to minimize head tilt artifact on DAT scan images. A protocol to obtain optimal head positioning is presented.",
keywords = "Basal ganglia, Dopamine transporter (DAT) imaging, Imaging artifact, Parkinson disease",
author = "Covington, {Matthew F.} and McMillan, {Natalie A.} and Avery, {Ryan J.} and Kuo, {Phillip H}",
year = "2013",
month = "6",
doi = "10.2967/jnmt.112.117184",
language = "English (US)",
volume = "41",
pages = "105--107",
journal = "Journal of Nuclear Medicine Technology",
issn = "0091-4916",
publisher = "Society of Nuclear Medicine Inc.",
number = "2",

}

TY - JOUR

T1 - The semicolon sign

T2 - Dopamine transporter imaging artifact from head tilt

AU - Covington, Matthew F.

AU - McMillan, Natalie A.

AU - Avery, Ryan J.

AU - Kuo, Phillip H

PY - 2013/6

Y1 - 2013/6

N2 - Dopamine transporter (DAT) imaging is a valuable tool to aid in the diagnosis of Parkinson disease and other Parkinsonian syndromes. DAT imaging is special among clinical nuclear medicine scans in that the already small caudate and putamen are presented in multiple thin axial cuts. Because the imaged basal ganglia are small, slight differences in head tilt may result in a significant artifact that we have termed the semicolon sign. The semicolon sign occurs when forward head tilt creates select images that show the caudate nuclei separate from the putamen. This gives the false impression that DAT activity in the putamen is decreased or absent. To avoid falsely attributing this artifact to loss of putaminal activity, it is imperative that the interpreting physician first recognize the artifact and then mentally integrate all provided images to identify normal activity in the putamen on subsequent levels. Furthermore, quantitative software packages for automated DAT scan interpretation are now available. If images demonstrating the semicolon sign are used for automated interpretation, loss of activity in the putamen may be falsely calculated, thereby contributing to erroneous results. Quality control measures are essential to ensure that technologists correctly position each patient's head to minimize head tilt artifact on DAT scan images. A protocol to obtain optimal head positioning is presented.

AB - Dopamine transporter (DAT) imaging is a valuable tool to aid in the diagnosis of Parkinson disease and other Parkinsonian syndromes. DAT imaging is special among clinical nuclear medicine scans in that the already small caudate and putamen are presented in multiple thin axial cuts. Because the imaged basal ganglia are small, slight differences in head tilt may result in a significant artifact that we have termed the semicolon sign. The semicolon sign occurs when forward head tilt creates select images that show the caudate nuclei separate from the putamen. This gives the false impression that DAT activity in the putamen is decreased or absent. To avoid falsely attributing this artifact to loss of putaminal activity, it is imperative that the interpreting physician first recognize the artifact and then mentally integrate all provided images to identify normal activity in the putamen on subsequent levels. Furthermore, quantitative software packages for automated DAT scan interpretation are now available. If images demonstrating the semicolon sign are used for automated interpretation, loss of activity in the putamen may be falsely calculated, thereby contributing to erroneous results. Quality control measures are essential to ensure that technologists correctly position each patient's head to minimize head tilt artifact on DAT scan images. A protocol to obtain optimal head positioning is presented.

KW - Basal ganglia

KW - Dopamine transporter (DAT) imaging

KW - Imaging artifact

KW - Parkinson disease

UR - http://www.scopus.com/inward/record.url?scp=84878823398&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878823398&partnerID=8YFLogxK

U2 - 10.2967/jnmt.112.117184

DO - 10.2967/jnmt.112.117184

M3 - Article

C2 - 23520210

AN - SCOPUS:84878823398

VL - 41

SP - 105

EP - 107

JO - Journal of Nuclear Medicine Technology

JF - Journal of Nuclear Medicine Technology

SN - 0091-4916

IS - 2

ER -