Rationale and Objectives
This work is aimed at determining whether magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) may correlate with disease severity in a series of Parkinson disease (PD) patients.
Materials and Methods
We recruited a consecutive sample of 39 PD patients in several stages of the disease according to Hoehn and Yahr scale. There were 22 men, and the mean age was 74.5 years (SD 7.5). Disease severity was measured with the Unified Parkinson Disease Rating Scale (UPDRS). All of them underwent 1 H MRS in basal ganglia and the anterior cingulate area, as well as DTI in bilateral substantia nigra. Correlation was made between radiological findings and UPDRS.
Results
We found significant negative correlation between UPDRS scores and the Glx (glutamate+glutamine) levels in the right ( r = −0.35; P = .03) and the left ( r = −0.44; P = .006) lentiform nucleus; as well as with glutamate ( r = −0.43; P = .008), the Glx/Cr ratio in the right ( r = −0.41; P = .01), and in the left lentiform nucleus ( r = −0.36; P = .02). We also found positive correlation between UPDRS scores and DTI in right rostral substantia nigra ( r = 0.36; P = .02). Glx was increased in lentiform nucleus and fractional anisotropy was reduced in the rostral SN of subjects with PD in early stages.
Conclusions
The results are consistent with the view that more than half the dopaminergic neurons in the nigrostriatal projection are lost before the onset of PD.
Parkinson disease (PD) is a frequent disease in the elderly. To date and with exception of positron emission tomography there is no specific radiological marker of the disease. However a marker should be useful to monitor progression and response to treatment.
Magnetic resonance spectroscopy (MRS) provides a noninvasive method for characterizing chemical and cellular features in vivo. MRS can be used to measure the chemical composition of tissues, characterize certain tissue metabolic processes, and identify unanticipated chemical or metabolic relationships with disease. In brain tissue, the concentrations and mobility of MRS-visible, low-molecular-weight chemicals are measured as spectral peaks and can be used to detect abnormalities in brain regions that seem normal in magnetic resonance imaging (MRI) and to elucidate the pathology underlying MRI-visible abnormalities .
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Patients and methods
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Ethical Aspects
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Results
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Table 1
Values of Fractional Anisotropy
Explored ROI Means and SD (Left) Means and SD (Right) Rostral SN 0.259 (0.05) 0.242 (0.04) Medial SN 0.339 (0.055) 0.345 (0.07) Caudal SN 0.239 (0.058) 0.276 (0.05) Cerebral peduncle 0.344 (0.06) 0.382 (0.06)
ROI, region of interest; SD, standard deviation; SN, substantia nigra.
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Table 2
Metabolite Values (ppm) and Ratios to Creatine by Every Area of Exploration
Metabolite Anterior Cingulate Area Right Lentiform Nucleus Left Lentiform Nucleus Creatine 5.25 (1.3) 5.52 (0.6) 5.28 (0.68) Glutamate 7.22 (2.1) 6.98 (0.99) 7.29 (1.01) Glutamate/Cr 1.37 (0.38) 1.27 (0.18) 1.4 (0.2) mI 5.15 (1.86) 4.39 (0.83) 4.08 (0.81) mI/Cr 0.99 (0.28) 0.80 (0.12) 0.78 (0.13) NAA 5.15 (1.27) 5.23 (0.92) 5.43 (0.96) NAA/Cr 0.99 (0.23) 0.95 (0.17) 1.03 (0.17) Choline 1.45 (0.41) 1.51 (0.17) 1.4 (0.2) Choline/Cr 0.27 (0.48) 0.27 (0.24) 0.27 (0.31) Glx 11.06 (3.51) 11.32 (1.2) 10.98 (1.47) Glx/Cr 2.13 (0.64) 2.05 (0.27) 2.1 (0.34)
Cr, total creatine; Glx, glutamate+glutamine; mI, myo-inositol; NAA, N-acetyl-aspartate.
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Discussion
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Correlations between Brain Metabolites and Variables
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