Discriminating among degenerative parkinsonisms using advanced ()I- ioflupane SPECT analyses. Geneva, Switzerland; Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden; Department. Discriminating among degenerative parkinsonisms using advanced hDepartment of Surgical Sciences, Radiology, Uppsala University, We here reappraise this issue by applying advanced image analysis techniques to separate . I-ioflupane SPECT data to discriminate 95 PD versus 94 controls. Discriminating among degenerative parkinsonisms using advanced I- ioflupane SPECT analyses. Article (PDF . Department of SurgicalSciences, Radiology, Uppsala University, Uppsala,Sweden. i. Department of.
advanced degenerative Discriminating using 123I-ioflupane Scien among - SPECT parkinsonisms analyses
Cerebral and extracranial Lewy-body-type degeneration in PD does not develops independently from each other but develop in a strongly coupled manner.
The cerebral and extracranial changes are driven by at least similar pathomechanisms [ 31 ]. Patients with PD have markedly reduced DAT levels in striatum, which correlated with disease severity and disease progression [ 32 ], whereas postsynaptic striatal D2 receptors are upregulated [ 33 ].
Similarly, another study reported that the mean I-IBZM striatal-occipital ratio of binding was significantly higher in PD patients than in controls. It suggested that factors other than nigrostriatal degeneration may contribute to disease severity [ 36 ]. One study including patients confirmed neuropathological models for reduced dopaminergic projection to the dorsal putamen in akinetic-rigid patients as well as the lateral putamen and caudate nucleus in tremor-dominant patients in vivo [ 37 ], and the serotonergic system is suggested to be implicated in PD [ 38 ].
Furthermore, another study showed that SERT-dependent I-FP-CIT uptake may allow a more comprehensive assessment of neurochemical disturbances in degenerative parkinsonisms [ 39 ]; this study suggested that the neurodegenerative process extends beyond nigrostriatal system and affects serotoninergic neurons in parkinsonisms. Since the in vivo molecular imaging techniques using SPECT have been introduced, the diagnosis of PD became more reliable by assessing dopaminergic and even nondopaminergic systems.
Various radiotracers have been used in the diagnosis of PD. DAT imaging is abnormal even in the earliest clinical presentation of PD [ 15 ]. But the results reported were controversial. However, no significant correlations were found between striatal I-FP-CIT binding ratios and disease severity [ 20 ]. Another study indicated that in patients with PD, the striatum, caudate, and putamen uptake was correlated with disease severity assessed by UPDRS and duration of disease [ 36 ].
More studies are needed to confirm these findings. Patients with unilateral PD showed a bilateral loss of striatal DA transporters [ 46 ]. It suggested that semi-quantitative analysis may be used to diagnose PD at early stage as well as to identify individuals developing bilateral dopaminergic damage [ 47 ]. The decrease of striatal uptake contralateral to the more affected side of the body was more prominent compared to the ipsilateral side [ 48 ].
Moreover, another study showed a significant loss of putaminal uptake ipsilateral to the symptoms was found in the stage I group compared with the healthy volunteers [ 49 ]. The mean reduction of binding was found in the order of putamen and caudate nucleus. DAT imaging is a sensitive method to detect presynaptic dopamine neuronal dysfunction. MIBG was used in the diagnosis of damaged tissue of the heart.
However, Sawada et al. Both early and delayed images showed that the heart to mediastinum ratios were significantly lower in the PD group than in the non-PD group [ 51 ]. The tracer uptake in patients with urinary dysfunction was significantly reduced than in those without urinary dysfunction. Clinical features of PD may be shared with other disorders; thus, the differential diagnosis of PD is extensive.
Atypical parkinsonian syndromes APSs such as multiple system atrophy MSA , progressive supranuclear palsy PSP , and corticobasal degeneration are characterized by poor response to antiparkinsonian medication and rapid clinical deterioration, which one often confused with PD. ET is a slowly progressive neurological disorder. DIP is developed when patients are treated with neuroleptic or dopamine receptor blocking agents. In most patients, Parkinsonism is reversible upon stopping the offending drug, though it may take several months to resolve fully but in some patients it may even persist.
Functional imaging of the DAT defines integrity of the dopaminergic system, and a normal scan suggests an alternative diagnosis such as ET, VP unless there is focal basal ganglia infarction , DIP, or psychogenic parkinsonism [ 17 , 54 ]. Furthermore, a semiquantitative analysis with a cut-off of striatal asymmetry index greater than There was an optimal discrimination threshold value between the reference population and the pathologic population for the putamen ratio by using volumes of interests, VOIs analysis [ 58 ].
To improve diagnostic accuracy, non-DAT tracers i. MSA is a neurodegenerative disorder characterized by neuropathologic demonstration of CNS alpha-synuclein-positive glial cytoplasmic inclusions with neurodegenerative changes in striatonigral or olivopontocerebellar structures [ 60 ]. It is difficult to differentiate it from other movement disorders, particularly in the early course of disease. SPECT with the tracer I-Ioflupane can also give an accurate and highly sensitive measure of dopamine degeneration [ 63 ].
A study showed that the degree of loss was higher in putamen than caudate in both PD and MSA patients. Another study showed that mean distribution volume ratios DVRs in the basal ganglia of MSA patients were significantly less than in controls, but generally higher than in PD patients.
However, D2 binding in posterior putamen was significantly increased in dopa-untreated PD, and it was significantly reduced in MSA. Quantification of these studies had limited utility since the overlapping of index values between normal and pathological restricts their use in individual cases [ 70 ].
More recently, a study using I-PE21 indicated that dopamine transporter scan has a high sensitivity and specificity in distinguishing between patients with and without striatal neurodegeneration.
Calculation of the striatal anterior-posterior ratio can assist in differentiating between idiopathic PD and APS [ 72 ]. But in two of the siblings, DAT binding was markedly increased. It suggested that the increased DAT binding may be an early preclinical finding [ 74 ].
SPECT is also useful for distinguishing PD from Dopa responsive dystonia DRD , or for assessing the integrity of the nigrostriatal dopaminergic pathway in atypical cases of postural tremor or iatrogenic parkinsonian syndromes.
In IPD, two different clinical phenotypes are usually distinguished: TD patients compared to ART patients are characterized by a slower disease progression and a minor cognitive impairment. There was a significantly higher FP-CIT uptake in contralateral putamen and a higher but not statistically significant uptake in all the other striatal regions in TD patients when compared to ART patients [ 77 ].
Neural Regen Res ; How to cite this URL: Apomorphine APO -induced rotational behavior in rats. The numbers of rotations towards the contralateral side to the 6-hydroxydopamine 6-OHDA injection within 30 minutes were recorded at 1, 2, 4, 6, and 8 weeks post-lesion.
Click here to view. A relatively symmetrical uptake was observed in the striatum in the control group A. Single-photon emission computed tomography; 6-OHDA: Changes in the numbers of TH-immunoreactive neurons in the substantia nigra pars compacta after 6-OHDA-induced injury.
A—D Representative images of tyrosine hydroxylase TH -immunoreactive neurons at 8 weeks post-lesion: The remaining numbers of TH-immunoreactive neurons were imaged in the substantia nigra pars compacta at 8 weeks post-lesion. Arrows indicate a gradual decrease in TH-immunoreactive neurons. E Histogram representing dopaminergic cell loss determined by the quantification of TH-positive neurons in the substantia nigra pars compacta at 8 weeks post-lesion.
Journal of the neurological sciences , , European journal of nuclear medicine and molecular imaging 43 3 , , Journal of Clinical Neurology 13 3 , , Journal of Clinical Neurology 13 4 , , Articles 1—20 Show more. From here to epilepsy: Scan without evidence of dopaminergic deficit: Clinical 12, , Iron-deficiency anemia as a rare cause of cerebral venous thrombosis and pulmonary embolism N Nicastro, A Schnider, B Leemann Case reports in medicine ,
BioMed Research International
Due to scientific advances in the field of metabolic and pathology-specific PET imaging, the use of SPECT I-Ioflupane/SPECT binding to striatal dopamine transporter (DAT) uptake in patients with Parkinson's Discriminating among degenerative parkinsonisms using advanced ()Iioflupane SPECT analyses. PD may be straightforward in cases with a classic Several uncertainties remain on the value of [I]FP-CIT and SPECT in KEywordS: atypical degenerative parkinsonism ▫ FP-CIT ▫ ioflupane ▫ . future science group ity (0–33%) in discriminating between MSA .. version of the Brain Analysis Software (BRASS. Clinical differential diagnosis in parkinsonism can be difficult especially at early stages. In the parkinson-plus group, MSA, PSP, and LBD could be discriminated in and perfusion SPECT in combination with discrimination analysis allows an .. I-Ioflupane/SPECT binding to striatal dopamine transporter (DAT) uptake.