Abstract
Positron emission tomography (PET) scan with tracer [18F]-fluorodeoxy-glucose (18F-FDG) is widely used to measure the glucose metabolism in neurodegenerative disease such as Idiopathic Parkinson’s disease (IPD). Previous studies using 18F-FDG PET mainly focused on the motor or non-motor symptoms but not the severity of IPD. In this study, we aimed to determine the metabolic patterns of 18F-FDG in different stages of IPD defined by Hoehn and Yahr rating scale (H-Y rating scale) and to identify regions in the brain that play critical roles in disease progression. Fifty IPD patients were included in this study. They were 29 men and 21 women (mean±SD, age 57.7±11.1 years, disease duration 4.0±3.8 years, H-Y 2.2±1.1). Twenty healthy individuals were included as normal controls. Following 18F-FDG PET scan, image analysis was performed using Statistical Parametric Mapping (SPM) and Resting-State fMRI Data Analysis Toolkit (REST). The metabolic feature of IPD and regions-of-interests (ROIs) were determined. Correlation analysis between ROIs and H-Y stage was performed. SPM analysis demonstrated a significant hypometabolic activity in bilateral putamen, caudate and anterior cingulate as well as left parietal lobe, prefrontal cortex in IPD patients. In contrast, hypermetabolism was observed in the cerebellum and vermis. There was a negative correlation (p=0.007, r=-0.412) between H-Y stage and caudate metabolic activity. Moreover, the prefrontal area also showed a negative correlation with H-Y (P=0.033, r=-0.334). Thus, the uptake of FDG in caudate and prefrontal cortex can potentially be used as a surrogate marker to evaluate the severity of IPD.
Highlights
Idiopathic Parkinson’s disease (IPD) is a age-related neurodegenerative disorder characterized by the asymmetrical loss of melanin-containing dopaminergic neurons in the substantia nigra [1]
In this study we explored the metabolic activity of different brain areas in IPD patients using 18F-FDG Positron emission tomography (PET)
We demonstrated that Statistical Parametric Mapping (SPM) is an effective tool to analyze the data and showed that the metabolic activity of caudate and prefrontal cortex negatively correlated with the severity of disease in IPD patients
Summary
Idiopathic Parkinson’s disease (IPD) is a age-related neurodegenerative disorder characterized by the asymmetrical loss of melanin-containing dopaminergic neurons in the substantia nigra [1]. Previous studies using FDG PET to analyze IPD patients mainly focused on the motor and no-motor symptoms such as cognitive, fatigue and anxiety[9,10,11,12,13], not the severity of disease. 18F-FDG PET metabolic imaging analysis can measure pathological activity and has been widely used in IPD. It can be potentially used as an objective, quantifiable and stable biomarker for the diagnosis of IPD as well as the evaluation of disease progression and the response to treatment [14, 15]. We evaluated the metabolic pattern of 18F-FDG using PET scan in 50 IPD patients and analyzed the relationship between metabolic activity of regions of interest (ROI) and H-Y stages. We identified the regions that were associated with disease progression
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