[123I]β-CIT SPECT imaging of dopamine and serotonin transporters in Parkinson’s disease and multiple system atrophy

G. Berding; Th. Brücke; P. Odin; D. J. Brooks; H. Kolbe; P. Gielow; H. Harke; B. O. Knoop; R. Dengler; W. H. Knapp

doi:10.1055/s-0038-1623903

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2003; 42(01): 31-38
DOI: 10.1055/s-0038-1623903

Original Article

Schattauer GmbH

[¹²³I]β-CIT SPECT imaging of dopamine and serotonin transporters in Parkinson’s disease and multiple system atrophy^[*]

[¹²³I]β-CIT-SPECT Untersuchungen der Dopaminund Serotonintransporter bei Morbus Parkinson und Multisystematrophie

G. Berding

¹Department of Nuclear Medicine

,

Th. Brücke

²University Clinic of Neurology and Nuclear Medicine, Vienna, Austria

,

P. Odin

³Department of Neurology, Zentralkrankenhaus Reinkenheide, Bremerhaven, Germany

,

D. J. Brooks

⁴MRC Clinical Sciences Centre and Division of Neuroscience, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, UK

,

H. Kolbe

⁵Department of Neurology, University School of Medicine, Hannover, Germany

,

P. Gielow

¹Department of Nuclear Medicine

,

H. Harke

¹Department of Nuclear Medicine

,

B. O. Knoop

¹Department of Nuclear Medicine

,

R. Dengler

⁵Department of Neurology, University School of Medicine, Hannover, Germany

,

W. H. Knapp

¹Department of Nuclear Medicine

› Author Affiliations

Abstract

Summary

Aims: Definition of the regional pattern of dopamine transporter (DAT) dysfunction in advanced Parkinson’s disease (PD) and evaluation of a potential correlation between DAT binding and symptoms; elucidation of the role of DAT imaging in the differential diagnosis of PD and multiple system atrophy (MSA); assessment and comparison of serotonin transporter (SERT) binding in PD and MSA. Methods: [¹²³I]ß-CIT SPECT was performed in 14 patients with advanced PD, 10 with moderate MSA and 20 healthy persons. Specific to nonspecific tracer binding ratios (V₃’’) were calculated via ROI analysis of uptake images at 4 h (SERT binding) and 24 h (DAT binding) p. i. Results: In PD bilateral reduction of striatal DAT binding (63-70%) was seen. The caudate ipsilateral to the clinically predominantly affected side showed relatively the least impairment. Significant correlations (r = -0.54 to -0.64) between DAT binding and Hoehn and Yahr stage, UPDRS-scores and duration of disease were found. In MSA DAT binding was less reduced (40-48%) targeting the putamen contralateral to the side of clinical predominance. Significantly lower SERT binding was observed in PD midbrain and MSA hypothalamus compared to controls – and in MSA relative to PD mesial frontal cortex. Conclusions: In advanced PD striatal DAT binding is markedly reduced with the least reduction in caudate ipsilateral to the clinically predominantly affected side. In moderate MSA with asymmetrical symptoms DAT dysfunction is predominant in the contralateral putamen, a pattern seen in early PD. The reduction of SERT in the midbrain area of PD patients suggests additional tegmental degeneration while in MSA the serotonergic system seems to be more generally affected.

Zusammenfassung

Ziele: Bestimmung der regionalen Verteilung der Dopamintransporter(DAT)-Dysfunktion bei fortgeschrittenem Morbus Parkinson (MP) und Korrelation der DAT-Bindung zur Symptomatik; Klärung der Bedeutung der DAT-Darstel-lung für die Differenzialdiagnose von MP und Multisystematrophie (MSA); Einschätzung und Vergleich der Serotonintransporter(SERT)-Bindung bei MP und MSA. Methoden: [¹²³I]ß-CIT-SPECT wurde bei 14 Patienten mit fort-geschrittenem MP, 10 mit mittelgradiger MSA und 20 Gesunden durchgeführt. Quotienten von spezifischer zu unspezifischer Bindung des Tracers (V₃‘‘) wurden durch ROI-Analysen der Tomogramme nach 4 h (SERT-Bindung) und 24 h (DAT Bindung) p. i. bestimmt. Ergebnisse: Bei MP fanden sich beidseits signifikante Reduktionen (63-70%) der striatalen DAT-Bindung. Im Nucleus caudatus ipsilateral zur klinisch hauptsächlich betroffenen Seite zeigte sich die geringste Minderung. Signifikante Korrelationen (r = -0,54 bis -0,64) zwischen DAT-Bindung und Hoehn-Yahr-Stadium, UPDRS-Score und Erkrankungsdauer wurden beobachtet. Bei MSA war die DAT-Bindung geringer reduziert (um 40-48%) – am deutlichsten im kontralateralen Putamen. Signifikant vermindert war die SERTBindung im Mittelhirn von MP- und Hypothalamus von MSA-Patienten gegenüber Gesunden, sowie im mesialen frontalen Kortex bei MSA im Vergleich zum MP. Schlussfolgerungen: Bei fortgeschrittenem MP ist die DAT Bin-dung im ipsilateral zur klinisch hauptsächlich betroffenen Seite gelegenen Caudatus relativ erhalten und im übrigen Striatum deutlich reduziert. Bei mittelgradiger MSA mit asymmetrischer Symptomatik findet sich wie beim frühen MP die deutlichste DAT-Dysfunktion im kontralateralen Putamen. Die Reduktion der SERT-Bindung im Mittelhirn bei MP lässt auf zusätzliche tegmentale Degeneration schließen, während bei MSA eher das serotonerge System insgesamt betroffen zu sein scheint.

Keywords

Dopamine transporter - serotonin transporter - Parkinson’s disease - multiple system atrophy - SPECT - beta-CIT

Schlüsselwörter

Dopamintransporter - Serotonintransporter - Morbus Parkinson - Multisystematrophie - SPECT - beta-CIT

Full Text

References

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[123I]β-CIT SPECT imaging of dopamine and serotonin transporters in Parkinson’s disease and multiple system atrophy[*]

[¹²³I]β-CIT SPECT imaging of dopamine and serotonin transporters in Parkinson’s disease and multiple system atrophy^[*]