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Reduced uptake of FDOPA PET in end-stage liver disease with elevated manganese levels.

Abstract

OBJECTIVE
To investigate whether manganese toxicity secondary to end-state liver disease is associated with nigrastriatal dysfunction as measured by 6-[(18)F]fluoro-L-DOPA (FDOPA) positron emission tomographic (PET) imaging.
DESIGN
Observational case report.
SETTING
The Movement Disorder Center at Washington University, St Louis, Missouri.
PATIENT
An individual with manganese toxicity secondary to end-stage liver disease. His FDOPA PET was compared with those of 10 idiopathic Parkinson disease patients and 10 age- and sex-matched healthy controls.
MAIN OUTCOME MEASURE
The average estimated net FDOPA uptake by Patlak graphical analysis for caudate, anterior putamen, and posterior putamen.
RESULTS
The FDOPA uptake for the patient with secondary manganese toxicity was reduced across all regions by more than 2 SDs compared with healthy controls: caudate (reduced 24.7%), anterior putamen (28.0%), and posterior putamen (29.3%). The ratio of uptake between the caudate/posterior putamen was 0.99 and was different from that of idiopathic Parkinson disease patients, in whom the greatest reduction of FDOPA was in the posterior putamen (mean [SD] ratio, 1.65 [0.41]).
CONCLUSIONS
Reduce striatal uptake of FDOPA uptake indicates dysfunction of the nigrostriatal pathways in manganese toxicity secondary to end-stage liver disease. The pattern of striatal involvement with equal reduction of FDOPA uptake in the caudate compared with posterior putamen appears different from those previously reported in individuals with occupational manganese toxicity and idiopathic Parkinson disease and may be specific to manganese toxicity secondary to end-stage liver disease.

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  • Authors

    Criswell SR, Perlmutter JS, Crippin JS, Videen TO, Moerlein SM, Flores HP, Birke AM, Racette BA

    Institution

    Washington University School of Medicine, 660 S Euclid Avenue, St Louis, MO 63110, USA. criswells@neuro.wustl.edu

    Source

    Archives of neurology 69:3 2012 Mar pg 394-7

    MeSH

    Caudate Nucleus
    Ceruloplasmin
    Dihydroxyphenylalanine
    End Stage Liver Disease
    Hepatitis B
    Humans
    Image Processing, Computer-Assisted
    Imaging, Three-Dimensional
    Liver Cirrhosis, Alcoholic
    Magnetic Resonance Imaging
    Male
    Manganese
    Middle Aged
    Parkinson Disease
    Putamen
    Radiopharmaceuticals

    Pub Type(s)

    Case Reports
    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22410448