DAT Imaging as a Clinical Decision Tool in Parkinsonism: A Two-Year Audit from a North Welsh UK Movement Disorder Service

Background:
Diagnosing Parkinsonism remains a common and clinically significant challenge within movement disorder services, particularly in early disease and in atypical or non-motor–predominant presentations. Dopamine transporter (DAT) imaging is recommended by NICE where diagnostic uncertainty persists; however, real-world evidence demonstrating its impact on clinical decision-making beyond diagnostic confirmation remains limited.

Methods:
We conducted a retrospective audit of all DAT scans requested within a UK specialist movement disorder service between January 2023 and December 2024. Data were extracted from referral documentation and clinical records, including presenting symptom profiles, imaging indications, diagnostic outcomes, and documented post-scan management decisions. Findings were analysed descriptively, with comparison across audit years to identify trends in utilisation and clinical impact.

Results:
Core motor symptoms remained the primary indication for DAT imaging, reflecting guideline-aligned practice within a specialist setting. A substantial proportion of scans were requested in patients with atypical or non-motor–predominant presentations, highlighting the diagnostic complexity encountered in routine clinical care. DAT imaging was frequently employed to address differential diagnostic uncertainty, although the proportion of scans requested for this indication reduced over time, suggesting increasing diagnostic confidence and refinement of referral practices. The vast majority of scans resulted in diagnostic confirmation or meaningful clarification, & scan results directly influenced clinical management, including initiation of dopaminergic therapy where presynaptic dopaminergic deficit was demonstrated and avoidance of inappropriate treatment where imaging findings were normal.

Conclusion:
This audit demonstrates appropriate and effective use of DAT imaging in line with NICE guidance. DAT scanning functions as a clinically effective decision-making tool rather than a purely confirmatory investigation, improving diagnostic confidence and supporting patient-centred management. These findings support continued, targeted use of DAT scans within UK movement disorder services and underline their value in improving diagnostic confidence and patient-centred care.