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Semin Neurol 2008; 28(4): 435-445
DOI: 10.1055/s-0028-1083690
© Thieme Medical Publishers

The Role of Structural and Functional Imaging in Parkinsonian States with a Description of PET Technology

David J. Brooks1
  • 1Division of Neuroscience and Medical Research Council Clinical Sciences Centre, Imperial College, London, United Kingdom
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Publication History

Publication Date:
08 October 2008 (online)

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ABSTRACT

In this article, after providing a description of the technique of brain positron emission tomography (PET), the review focuses on the application of PET and other recent advances of neuroimaging in understanding the structural, pathophysiological, and pharmacological changes associated with Parkinson's disease (PD). In early cases of PD, demonstration of the presence of nigral structural abnormalities with transcranial sonography and striatal dopaminergic dysfunction with functional imaging provides a rationale for the use of dopaminergic medications. The presence of altered striatal signal with diffusion-weighted magnetic resonance imaging (DWI) or reduced lentiform nucleus glucose metabolism with fluorodeoxyglucose PET suggests the presence of an atypical PD variant. Finally, the value of functional imaging as a biomarker for following the progression of PD and for understanding mechanisms of dementia when present is debated.

KEYWORDS

PET - SPECT - MRI - Parkinson - dementia

REFERENCES

  • 1 Fearnley J M, Lees A J. Ageing and Parkinson's disease: substantia nigra regional selectivity.  Brain. 1991;  114 2283-2301
    CrossrefPubMedSearch in Google Scholar
  • 2 Gasser T. Update on the genetics of Parkinson's disease.  Mov Disord. 2007;  22 (suppl 17) S343-S350
    CrossrefPubMedSearch in Google Scholar
  • 3 Siderowf A, Stern M B. Preclinical diagnosis of Parkinson's disease: are we there yet?.  Curr Neurol Neurosci Rep. 2006;  6 295-301
    CrossrefPubMedSearch in Google Scholar
  • 4 Berg D, Siefker C, Becker G. Echogenicity of the substantia nigra in Parkinson's disease and its relation to clinical findings.  J Neurol. 2001;  248 684-689
    PubMedSearch in Google Scholar
  • 5 Brooks D J. Neuroimaging in Parkinson's disease.  NeuroRx. 2004;  1 243-254
    CrossrefPubMedSearch in Google Scholar
  • 6 Laruelle M, Baldwin R M, Malison R T et al.. SPECT imaging of dopamine and serotonin transporters with [123I]beta-CIT: pharmacological characterization of brain uptake in nonhuman primates.  Synapse. 1993;  13 295-309
    CrossrefPubMedSearch in Google Scholar
  • 7 Eidelberg D, Moeller J R, Dhawan V et al.. The metabolic topography of parkinsonism.  J Cereb Blood Flow Metab. 1994;  14 783-801
    CrossrefPubMedSearch in Google Scholar
  • 8 Feigin A, Fukuda M, Dhawan V et al.. Metabolic correlates of levodopa response in Parkinson's disease.  Neurology. 2001;  57 2083-2088
    PubMedSearch in Google Scholar
  • 9 Eckert T, Barnes A, Dhawan V et al.. FDG PET in the differential diagnosis of parkinsonian disorders.  Neuroimage. 2005;  26 912-921
    CrossrefPubMedSearch in Google Scholar
  • 10 Hutchinson M, Raff U. Structural changes of the substantia nigra in Parkinson's disease as revealed by MR imaging.  AJNR Am J Neuroradiol. 2000;  21 697-701
    PubMedSearch in Google Scholar
  • 11 Hu M T, White S J, Herlihy A H et al.. A comparison of (18)F-dopa PET and inversion recovery MRI in the diagnosis of Parkinson's disease.  Neurology. 2001;  56 1195-1200
    PubMedSearch in Google Scholar
  • 12 Minati L, Grisoli M, Carella F et al.. Imaging degeneration of the substantia nigra in Parkinson disease with inversion-recovery MR imaging.  AJNR Am J Neuroradiol. 2007;  28 309-313
    PubMedSearch in Google Scholar
  • 13 Michaeli S, Oz G, Sorce D J et al.. Assessment of brain iron and neuronal integrity in patients with Parkinson's disease using novel MRI contrasts.  Mov Disord. 2007;  22 334-340
    CrossrefPubMedSearch in Google Scholar
  • 14 Geng D Y, Li Y X, Zee C S. Magnetic resonance imaging-based volumetric analysis of basal ganglia nuclei and substantia nigra in patients with Parkinson's disease.  Neurosurgery. 2006;  58 256-262
    CrossrefPubMedSearch in Google Scholar
  • 15 Savoiardo M. Differential diagnosis of Parkinson's disease and atypical parkinsonian disorders by magnetic resonance imaging.  Neurol Sci. 2003;  24(suppl 1) S35-S37
    CrossrefPubMedSearch in Google Scholar
  • 16 Schrag A, Good C D, Miszkiel K et al.. Differentiation of atypical parkinsonian syndromes with routine MRI.  Neurology. 2000;  54 697-702
    CrossrefPubMedSearch in Google Scholar
  • 17 Schocke M F, Seppi K, Esterhammer R et al.. Diffusion-weighted MRI differentiates the Parkinson variant of multiple system atrophy from PD.  Neurology. 2002;  58 575-580
    CrossrefPubMedSearch in Google Scholar
  • 18 Seppi K, Schocke M F, Esterhammer R et al.. Diffusion-weighted imaging discriminates progressive supranuclear palsy from PD, but not from the parkinson variant of multiple system atrophy.  Neurology. 2003;  60 922-927
    CrossrefPubMedSearch in Google Scholar
  • 19 Nicoletti G, Lodi R, Condino F et al.. Apparent diffusion coefficient measurements of the middle cerebellar peduncle differentiate the Parkinson variant of MSA from Parkinson's disease and progressive supranuclear palsy.  Brain. 2006;  129(Pt 10) 2679-2687
    CrossrefPubMedSearch in Google Scholar
  • 20 Paviour D C, Thornton J S, Lees A J, Jager H R. Diffusion-weighted magnetic resonance imaging differentiates Parkinsonian variant of multiple-system atrophy from progressive supranuclear palsy.  Mov Disord. 2007;  22 68-74
    CrossrefPubMedSearch in Google Scholar
  • 21 Stockner H, Sojer M et al.. Midbrain sonography in patients with essential tremor.  Mov Disord. 2007;  22 414-417
    CrossrefPubMedSearch in Google Scholar
  • 22 Walter U, Hoeppner J, Prudente-Morrissey L et al.. Parkinson's disease-like midbrain sonography abnormalities are frequent in depressive disorders.  Brain. 2007;  130(Pt 7) 1799-1807
    CrossrefPubMedSearch in Google Scholar
  • 23 Prestel J, Schweitzer K J, Hofer A, Gasser T, Berg D. Predictive value of transcranial sonography in the diagnosis of Parkinson's disease.  Mov Disord. 2006;  21 1763-1765
    CrossrefPubMedSearch in Google Scholar
  • 24 Berg D, Merz B, Reiners K, Naumann M, Becker G. Five-year follow-up study of hyperechogenicity of the substantia nigra in Parkinson's disease.  Mov Disord. 2005;  20 383-385
    CrossrefPubMedSearch in Google Scholar
  • 25 Berg D, Roggendorf W, Schroder U et al.. Echogenicity of the substantia nigra: association with increased iron content and marker for susceptibility to nigrostriatal injury.  Arch Neurol. 2002;  59 999-1005
    CrossrefPubMedSearch in Google Scholar
  • 26 Walter U, Dressler D, Probst T et al.. Transcranial brain sonography findings in discriminating between parkinsonism and idiopathic Parkinson disease.  Arch Neurol. 2007;  64 1635-1640
    CrossrefPubMedSearch in Google Scholar
  • 27 Morrish P K, Sawle G V, Brooks D J. Clinical and [18F]dopa PET findings in early Parkinson's disease.  J Neurol Neurosurg Psychiatry. 1995;  59 597-600
    CrossrefPubMedSearch in Google Scholar
  • 28 Marek K L, Seibyl J P, Zoghbi S S et al.. [123I] beta-CIT/SPECT imaging demonstrates bilateral loss of dopamine transporters in hemi-Parkinson's disease.  Neurology. 1996;  46 231-237
    CrossrefPubMedSearch in Google Scholar
  • 29 Benamer T S, Patterson J, Grosset D G et al.. Accurate differentiation of parkinsonism and essential tremor using visual assessment of [123I]-FP-CIT imaging: The [123I]-FP-CIT Study Group.  Mov Disord. 2000;  15 503-510
    CrossrefPubMedSearch in Google Scholar
  • 30 Jennings D L, Seibyl J P, Oakes D et al.. (123I) beta-CIT and single-photon emission computed tomographic imaging vs clinical evaluation in Parkinsonian syndrome: unmasking an early diagnosis.  Arch Neurol. 2004;  61 1224-1229
    CrossrefPubMedSearch in Google Scholar
  • 31 Catafau A M, Tolosa E. Impact of dopamine transporter SPECT using 123I-Ioflupane on diagnosis and management of patients with clinically uncertain Parkinsonian syndromes.  Mov Disord. 2004;  19 1175-1182
    CrossrefPubMedSearch in Google Scholar
  • 32 Tolosa E, Borght T V, Moreno E. Accuracy of DaTSCAN ((123)I-ioflupane) SPECT in diagnosis of patients with clinically uncertain parkinsonism: 2-year follow-up of an open-label study.  Mov Disord. 2007;  22 2346-2351
    CrossrefPubMedSearch in Google Scholar
  • 33 Hughes A J, Ben-Shlomo Y, Daniel S E, Lees A J. What features improve the accuracy of clinical diagnosis in Parkinson's disease: a clinicopathological study.  Neurology. 1992;  42 1142-1146
    PubMedSearch in Google Scholar
  • 34 Fahn S, Oakes D, Shoulson I et al.. Levodopa and the progression of Parkinson's disease.  N Engl J Med. 2004;  351 2498-2508
    CrossrefPubMedSearch in Google Scholar
  • 35 Parkinson Study Group . Dopamine transporter brain imaging to assess the effects of pramipexole vs levodopa on Parkinson disease progression.  JAMA. 2002;  287 1653-1661
    CrossrefPubMedSearch in Google Scholar
  • 36 Whone A L, Watts R L, Stoessl J et al.. Slower progression of PD with ropinirol versus L-dopa: the REAL-PET study.  Ann Neurol. 2003;  54 93-101
    CrossrefPubMedSearch in Google Scholar
  • 37 Marshall V L, Patterson J, Hadley D M, Grosset K A, Grosset D G. Two-year follow-up in 150 consecutive cases with normal dopamine transporter imaging.  Nucl Med Commun. 2006;  27 933-937
    CrossrefPubMedSearch in Google Scholar
  • 38 Ahlskog J E. Slowing Parkinson's disease progression: recent dopamine agonist trials.  Neurology. 2003;  60 381-389
    PubMedSearch in Google Scholar
  • 39 Jenner P, Olanow C W. Understanding cell death in Parkinson's disease.  Ann Neurol. 1998;  44 S72-S84
    PubMedSearch in Google Scholar
  • 40 Schapira A H, Olanow C W. Neuroprotection in Parkinson disease: mysteries, myths, and misconceptions.  JAMA. 2004;  291 358-364
    CrossrefPubMedSearch in Google Scholar
  • 41 Emre M. Dementia associated with Parkinson's disease.  Lancet Neurol. 2003;  2 229-237
    CrossrefPubMedSearch in Google Scholar
  • 42 Summerfield C, Junque C, Tolosa E et al.. Structural brain changes in Parkinson disease with dementia: a voxel-based morphometry study.  Arch Neurol. 2005;  62 281-285
    CrossrefPubMedSearch in Google Scholar
  • 43 Ramirez-Ruiz B, Marti M J, Tolosa E et al.. Longitudinal evaluation of cerebral morphological changes in Parkinson's disease with and without dementia.  J Neurol. 2005;  252 1345-1352
    PubMedSearch in Google Scholar
  • 44 Burton E J, McKeith I G, Burn D J, O'Brien J T. Brain atrophy rates in Parkinson's disease with and without dementia using serial magnetic resonance imaging.  Mov Disord. 2005;  20 1571-1576
    CrossrefPubMedSearch in Google Scholar
  • 45 Foster N L, Chase T N, Fedio P et al.. Alzheimer's disease: focal cortical changes shown by positron emission tomography.  Neurology. 1983;  33 961-965
    PubMedSearch in Google Scholar
  • 46 Peppard R F, Martin W RW, Carr G D et al.. Cerebral glucose metabolism in Parkinson's disease with and without dementia.  Arch Neurol. 1992;  49 1262-1268
    CrossrefPubMedSearch in Google Scholar
  • 47 Vander-Borght T, Minoshima S, Giordani B et al.. Cerebral metabolic differences in Parkinson's and Alzheimer's disease matched for dementia severity.  J Nucl Med. 1997;  38 797-802
    PubMedSearch in Google Scholar
  • 48 Yong S W, Yoon J K, An Y S, Lee P H. A comparison of cerebral glucose metabolism in Parkinson's disease, Parkinson's disease dementia and dementia with Lewy bodies.  Eur J Neurol. 2007;  14 1357-1362
    CrossrefPubMedSearch in Google Scholar
  • 49 Hu M TM, Taylor-Robinson S D, Chaudhuri K R et al.. Cortical dysfunction in non-demented Parkinson's disease patients: a combined (31)P-MRS and (18FDG)-PET study.  Brain. 2000;  123 340-352
    CrossrefPubMedSearch in Google Scholar
  • 50 Walker Z, Costa D C, Walker R W et al.. Differentiation of dementia with Lewy bodies from Alzheimer's disease using a dopaminergic presynaptic ligand.  J Neurol Neurosurg Psychiatry. 2002;  73 134-140
    CrossrefPubMedSearch in Google Scholar
  • 51 Walker Z, Jaros E, Walker R W et al.. Dementia with Lewy bodies: a comparison of clinical diagnosis, FP-CIT SPECT imaging and autopsy.  J Neurol Neurosurg Psychiatry. 2007;  78 1176-1181
    CrossrefPubMedSearch in Google Scholar
  • 52 O'Brien J T, Colloby S, Fenwick J et al.. Dopamine transporter loss visualized with FP-CIT SPECT in the differential diagnosis of dementia with Lewy bodies.  Arch Neurol. 2004;  61 919-925
    CrossrefPubMedSearch in Google Scholar
  • 53 Ito K, Nagano-Saito A, Kato T et al.. Striatal and extrastriatal dysfunction in Parkinson's disease with dementia: a 6-[18F]fluoro-L-dopa PET study.  Brain. 2002;  125(Pt 6) 1358-1365
    CrossrefPubMedSearch in Google Scholar
  • 54 Kuhl D E, Minoshima S, Fessler J A et al.. In vivo mapping of cholinergic terminals in normal aging, Alzheimer's disease, and Parkinson's disease.  Ann Neurol. 1996;  40 399-410
    CrossrefPubMedSearch in Google Scholar
  • 55 Hilker R, Thomas A V, Klein J C et al.. Dementia in Parkinson disease: functional imaging of cholinergic and dopaminergic pathways.  Neurology. 2005;  65 1716-1722
    CrossrefPubMedSearch in Google Scholar
  • 56 Bohnen N I, Kaufer D I, Hendrickson R et al.. Cognitive correlates of cortical cholinergic denervation in Parkinson's disease and parkinsonian dementia.  J Neurol. 2006;  253 242-247
    CrossrefPubMedSearch in Google Scholar
  • 57 Bacskai B J, Frosch M P, Freeman S H et al.. Molecular imaging with Pittsburgh Compound B confirmed at autopsy: a case report.  Arch Neurol. 2007;  64 431-434
    CrossrefPubMedSearch in Google Scholar
  • 58 Klunk W E, Engler H, Nordberg A et al.. Imaging brain amyloid in Alzheimer's disease with Pittsburgh Compound-B.  Ann Neurol. 2004;  55 306-319
    CrossrefPubMedSearch in Google Scholar
  • 59 Edison P, Archer H A, Hinz R et al.. Amyloid, hypometabolism, and cognition in Alzheimer disease—an [11C]PIB and [18F]FDG PET study.  Neurology. 2007;  68 501-508
    CrossrefPubMedSearch in Google Scholar
  • 60 Rowe C C, Ng S, Ackermann U et al.. Imaging beta-amyloid burden in aging and dementia.  Neurology. 2007;  68 1718-1725
    CrossrefPubMedSearch in Google Scholar

David J BrooksM.D. D.Sc. F.R.C.P. F.Med.Sci. 

Hartnett Professor of Neurology, Cyclotron Building, Hammersmith Hospital, Du Cane Road

London W12 0NN, United Kingdom

Email: david.brooks@csc.mrc.ac.uk