Brain perfusion differences in Parkinsonian disorders

Abstract

We aimed to objectively examine the brain perfusion differences between PD, Parkinson variant of multiple system atrophy, and progressive supranuclear palsy. (99m) Tc ethylcysteinate dimer single-photon emission CT (SPECT) was performed in 28 patients with PD, 12 with Parkinson variant of multiple system atrophy, 19 with progressive supranuclear palsy, and 17 age- and sex-matched control subjects. A voxel-by-voxel group analysis, using statistical parametric mapping 8, was performed to detect the differences of regional cerebral blood flow among three diseases and control groups. Regional cerebral blood flow was measured using the noninvasive Patlak plot method and calculated using a fully automated region of interest technique. Progressive supranuclear palsy showed decreased regional cerebral blood flow in the cingulate gyrus and thalamus, whereas Parkinson variant of multiple system atrophy showed decreased regional cerebral blood flow in the cerebellum, compared with other patients and controls. Regional cerebral blood flow in the thalamus could be used to discriminate progressive supranuclear palsy from other diseases and control subjects with high sensitivity. These findings suggest that parkinsonian disorders, such as PD, Parkinson variant of multiple system atrophy, and progressive supranuclear palsy show a distinct SPECT pattern in the frontal cortex, thalamus, and cerebellum. Moreover, the measurements of regional cerebral blood flow in the thalamus and cerebellum may be helpful in screening for the differential diagnosis of parkinsonian syndrome.

Differential Diagnosis of Parkinsonism Using Dual-Phase F-18 FP-CIT PET Imaging

“…They classified these images as normal, MSA-P, MSA-C, PSP, or DLB, based on previous criteria of their glucose metabolism or brain perfusion, decreased regional uptake of the putamen, pons and cerebellum in MSA-P, decreased regional uptake of the cerebellum in MSA-C, decreased regional uptake of the caudate nucleus, the thalamus, midbrain and the cingulate gyrus in PSP, and decreased regional uptake of the occipital area, posterior cingulate cortex and temporo-parietal association area in DLB [11,22,[26][27][28]. The interobserver agreement and rate of correct classification were measured.…”

Effect of White Matter Lesions on Brain Perfusion in Alzheimer’s Disease

“…Brain perfusion single photon emission computed tomography (SPECT) and statistical analysis techniques of SPECT images, including Statistical Parametric Mapping (SPM) program, have been used to evaluate cerebral function in neurodegenerative disease [13]. There are only a few SPECT studies of the relationship between WMLs and regional cerebral blood flow (rCBF) in AD patients [14][15][16][17].…”

The utility of cerebral perfusion SPECT analysis using SPM8, eZIS and vbSEE for the diagnosis of multiple system atrophy-parkinsonism

“…The extent and severity of cerebellar hypoperfusion exhibited a higher discrimination power than any other regional hypoperfusion. The cardinal finding in MSA patients is a reduction in perfusion of the putamen, cerebellum, and brainstem [5][6][7][16][17][18][19]. Hypoperfusion at the level of the cerebellum, pons, and putamen is consistent with pathological degeneration typically associated with MSA.…”

“…Thus, when reader expertise is not available, computer-assisted evaluations can be particularly useful in supporting imaging diagnoses by non-experts. However, in contrast to FDG-PET studies, data on the diagnostic accuracy of computer-assisted evaluations of cerebral perfusion SPECT in the ascertainment of single cases have not been examined in detail [5][6][7]. The aim of the present study was to evaluate the diagnostic value of voxel-based analysis using the statistical parametric mapping (SPM), easy Z-score imaging system (eZIS), and voxel-based stereotactic extraction estimation (vbSEE) programs to differentiate between MSA-P at the early stage and PD.…”

“…In this study, the bilateral putamen (Level 5 Brodmann level), cerebellum (Level 1 hemisphere level), and pons (Level 2 lobe level) were selected based on the previous studies in which the cardinal finding of MSA-P was hypoperfusion in these anatomical regions ( Fig. 1) [5][6][7][16][17][18][19]. Using the extent and severity in the target VOIs of bilateral hemispheres as a threshold, we employed IBM SPSS statistics 21 (IBM SPSS Inc, Chicago, IL, USA) to determine ROC curves when discriminating MSA-P and PD patients.…”