Purpose
To evaluate the effect of levodopa on apparent diffusion coefficient (ADC) value of the brain parenchyma in patients with idiopathic Parkinson disease (PD).
Material and Methods
Prospective study was conducted on native PD without treatment ( n = 25) and patients receiving levodopa (L-Dopa) ( n = 25). Diffusion magnetic resonance–weighted imaging was done using a single-shot spin echo type of echo planar imaging. The apparent diffusion coefficient (ADC) value at different regions of the brain on both sides was calculated.
Results
The ADC value of the putamen in patients with native PD was 0.732 ± 0.15 × 10-3 mm2/seconds and in patients receiving levodopa was 0.789 ± 0.24 × 10-3 mm2/second. There was a statistically significant difference in the ADC value at the putamen ( P = .001) between patients with native PD and patients receiving levodopa. When ADC value of the putamen at 0.745 × 10-3 mm2/second was used as a threshold value for differentiating native PD patients and patients receiving L-Dopa, the best results were obtained with an accuracy of 82%, sensitivity of 92%, specificity of 72%, positive predictive value of 77%, negative predictive value of 90%, and area under the curve of 0.955.
Conclusion
ADC value of the putamen is a promising parameter for predication of effect of levodopa on brain parenchyma in patients with PD.
Idiopathic Parkinson disease (PD) is the second most common neurodegenerative disorder. Although different therapy such as surgery, intervention, and gene therapy has been applied for patients with PD, medication with levodopa (L-Dopa) remains the first main most effective line of treatment of patients with of PD. Finding a parameter for the effect of L-Dopa on the brain is important because L-Dopa’s effect on patients’ signs and symptoms dwindles with time and can become toxic . Positron emission tomography scanning has been used to detect effect of L-Dopa on brain parenchyma, but it is limited by relatively poor resolution, lack of chemical specificity, and the need to inject a radioactive agent . Magnetic resonance (MR) spectroscopy shows reduced N Acetyl Aspertate in patients receiving L-Dopa compared to others, but its result overlaps . Voxel-based morphometry at T1 relaxation time was less in patients receiving L-Dopa compared to native PD patients . Also, blood oxygenation level dependent, perfusion, and diffusion MR imaging has been used for study the effect of L-Dopa on brain parenchyma .
The purpose of this work is to evaluate the effect of levodopa on apparent diffusion coefficient (ADC) value at various regions of the brain parenchyma in patients with idiopathic PD.
Materials and methods
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Table 1
Demographic Data of the Patients
Demographic data Native PD ( n = 25) Levo Dopa ( n = 25) Men/women 15/10 13/12 Mean age (y) 65.44 ± 5.22 66.33 ± 6.22 Mean age at disease onset 58.44 ± 4.32 59.37 ± 7.12 Median hoehn and yahr score 3.2 (1–5) 4 (3–5) Median unified parkinson disease rating scale score 44.25 (22–88) 51.50 (30–95)
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Results
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Table 2
The ADC Value at Different Regions of the Brain Parenchyma
ROI Native IPD
( n = 25) Levo Dopa
( n = 25)P value Putamen 0.732 ± 0.15 0.789 ± 0.24 .001 Thalamus 0.737 ± 0.17 0.734 ± 0.21 .52 Caudate nucleus 0.763 ± 0.12 0.760 ± 0.14 .35 Substantia nigra 0.738 ± 0.11 0.742 ± 0.06 .59 White matter 0.784 ± 0.08 0.782 ± 0.05 .32 Cerebellum 0.7452 ± 0.11 0.749 ± 0.08 .17
ADC, apparent diffusion coefficient; IPD, idiopathic Parkinson disease; ROI, region of interest.
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Discussion
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