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The aim of this study was to investigate whether visual assessment of (123)I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropan ((123)I-FP-CIT) single photon emission computed tomography (SPECT) in addition to quantitative analyses can help to differentiate idiopathic Parkinson's disease (PD) from atypical parkinsonian syndromes (APS). From a consecutive series of patients examined with (123)I-FP-CIT SPECT (n = 190) over a three-year period we identified 165 patients with a clinical diagnosis of PD (n = 120) or APS (n = 45). (123)I-FP-CIT SPECT results were analysed visually and quantitatively and compared for PD and APS and for the subgroup of patients with early PD and APS (disease duration <5 years). According to predefined visual patterns of dopaminergic degeneration the results were graded as normal (grade 5) or abnormal (grade 1-4), distinguishing a posterior-anterior degeneration pattern ("egg shape") from a global and severe degeneration pattern ("burst striatum"). Visual assessment of (123)I-FP-CIT SPECT showed significant different dopaminergic degeneration patterns for PD and APS patients. A grade 1 ("burst striatum") degeneration pattern was predominantly associated with APS patients. In contrast to that, a grade 2 (egg shape) degeneration pattern was the characteristic finding in PD patients. In a subgroup of patients with early disease, visual assessment with identification of the burst striatum degeneration pattern provided 90% positive predictive value and 99% specificity for the diagnosis of APS. Quantitative analysis of striatal binding ratios failed to depict these different degeneration patterns in PD and APS patients. Visual assessment of the pattern of dopaminergic loss in (123)I-FP-CIT SPECT shows different patterns of dopaminergic degeneration for PD and APS patients. Therefore, it could provide valuable information to distinguish APS from PD patients, especially in early stages of disease. Within the first 5 years of disease, the occurrence of a burst striatum degeneration pattern has a high positive predictive value of APS.

In order to investigate lymph drainage from the retrobulbar space colloid solutions (198Au-colloid and 99mTc-sulfur-colloid) were injected into the right retrobulbar space of 31 rabbits. The distribution of radioactivity was measured in vitro after dissection with a sodium iodine crystal well counter and in some animals in vivo with the Gamma camera. More than 90% of the applied activity of either colloid solution was found in some animals up to the eighth day post injection in the retrobulbar space and in the liver. The remaining activity was recovered mainly from the regional lymph nodes, due to its smaller particle size higher values were registered in the experiments with 198Au than in those with 99mTc. The highest concentrations with up to 4,6% of the activity were observed in the deep cervical lymph nodes on both sides. Minor concentrations of activity were found ipsilateral in the superficial cervical and mandibular lymph nodes. Furthermore, small but significant activities were demonstrated in the optic nerves as well as in the contralateral retrobulbar space. The present data clearly substantiate the existence of lymph drainage, although a slow one, from the retrobulbar space. Moreover they indicate a reverse prelymphatic-lymphatic flow toward the optic nerves and the contralateral retrobulbar space. These results are of importance in the discussions of lymphostatic ophthalmopathy. The clinical application of this method is desirable; however, at present it is not yet practicable without further studies.

Drainage of a lymphotropic solution of Tc-99m sulfur colloid from the vitreous body was studied in twelve rabbits. Shortly after the application of this tracer, six of these rabbits had an injection of 0.06 ml, 0.5% dionine (Aethylmorphin) solution into the retrobulbar space. After the dionine injection, the decay of radio-activity from the eyes was significantly increased. The radio-activity in the control group approximated to 81.6% of the total applied radio-activity after six hours, whereas the radio-activity in the eyes of the dionine treated group was, on average, only 5% after the same time interval. Simultaneously, the radio-activity in the cervical lymph nodes increased significantly from approximately 0.10% in the control group to 0.67% in the dionine treated group. It is not known, as yet, whether dionine increases lymph drainage in man.