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PET measurement of cardiac and nigrostriatal denervation in Parkinsonian syndromes.
J Nucl Med. 2006 Nov; 47(11):1769-77.JN

Abstract

Scintigraphic imaging with (123)I-metaiodobenzylguanidine ((123)I-MIBG) has demonstrated extensive losses of cardiac sympathetic neurons in idiopathic Parkinson's disease (IPD). In contrast, normal cardiac innervation has been observed in (123)I-MIBG studies of multiple-system atrophy (MSA) and progressive supranuclear palsy (PSP). Consequently, it has been hypothesized that cardiac denervation can be used to differentiate IPD from MSA and PSP. We sought to test this hypothesis by mapping the distribution of cardiac sympathetic neurons in patients with IPD, MSA, and PSP by using PET and (11)C-meta-hydroxyephedrine ((11)C-HED). Also, the relationship between cardiac denervation and nigrostriatal denervation was investigated by measuring striatal presynaptic monoaminergic nerve density with PET and (11)C-dihydrotetrabenazine ((11)C-DTBZ).

METHODS

(11)C-HED and (11)C-DTBZ scans were obtained for patients with IPD (n = 9), MSA (n = 10), and PSP (n = 8) and for age-matched control subjects (n = 10). Global and regional measurements of (11)C-HED retention were obtained to assess the extent of cardiac sympathetic denervation. (11)C-DTBZ binding was measured in the caudate nucleus, anterior putamen, and posterior putamen.

RESULTS

As expected, extensive cardiac denervation was observed in several of the patients with IPD. However, substantial cardiac denervation was also seen in some patients with MSA and PSP. (11)C-DTBZ studies demonstrated striatal denervation in all patients with IPD and in most patients with MSA and PSP. No correlation was found between cardiac (11)C-HED retention and striatal (11)C-DTBZ binding.

CONCLUSION

Cardiac sympathetic denervation was found to occur not only in IPD but also in other movement disorders, such as MSA and PSP. This finding implies that scintigraphic detection of cardiac sympathetic denervation cannot be used independently to discriminate IPD from other movement disorders, such as MSA and PSP. Cardiac sympathetic denervation was not correlated with striatal denervation, suggesting that the pathophysiologic processes underlying cardiac denervation and striatal denervation occur independently in patients with parkinsonian syndromes. These findings provide novel information about central and peripheral denervation in patients with neurodegenerative disorders.

Authors+Show Affiliations

Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA. raffel@umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17079809

Citation

Raffel, David M., et al. "PET Measurement of Cardiac and Nigrostriatal Denervation in Parkinsonian Syndromes." Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, vol. 47, no. 11, 2006, pp. 1769-77.
Raffel DM, Koeppe RA, Little R, et al. PET measurement of cardiac and nigrostriatal denervation in Parkinsonian syndromes. J Nucl Med. 2006;47(11):1769-77.
Raffel, D. M., Koeppe, R. A., Little, R., Wang, C. N., Liu, S., Junck, L., Heumann, M., & Gilman, S. (2006). PET measurement of cardiac and nigrostriatal denervation in Parkinsonian syndromes. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, 47(11), 1769-77.
Raffel DM, et al. PET Measurement of Cardiac and Nigrostriatal Denervation in Parkinsonian Syndromes. J Nucl Med. 2006;47(11):1769-77. PubMed PMID: 17079809.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - PET measurement of cardiac and nigrostriatal denervation in Parkinsonian syndromes. AU - Raffel,David M, AU - Koeppe,Robert A, AU - Little,Roderick, AU - Wang,Chia-Ning, AU - Liu,Suyu, AU - Junck,Larry, AU - Heumann,Mary, AU - Gilman,Sid, PY - 2006/11/3/pubmed PY - 2006/12/27/medline PY - 2006/11/3/entrez SP - 1769 EP - 77 JF - Journal of nuclear medicine : official publication, Society of Nuclear Medicine JO - J Nucl Med VL - 47 IS - 11 N2 - UNLABELLED: Scintigraphic imaging with (123)I-metaiodobenzylguanidine ((123)I-MIBG) has demonstrated extensive losses of cardiac sympathetic neurons in idiopathic Parkinson's disease (IPD). In contrast, normal cardiac innervation has been observed in (123)I-MIBG studies of multiple-system atrophy (MSA) and progressive supranuclear palsy (PSP). Consequently, it has been hypothesized that cardiac denervation can be used to differentiate IPD from MSA and PSP. We sought to test this hypothesis by mapping the distribution of cardiac sympathetic neurons in patients with IPD, MSA, and PSP by using PET and (11)C-meta-hydroxyephedrine ((11)C-HED). Also, the relationship between cardiac denervation and nigrostriatal denervation was investigated by measuring striatal presynaptic monoaminergic nerve density with PET and (11)C-dihydrotetrabenazine ((11)C-DTBZ). METHODS: (11)C-HED and (11)C-DTBZ scans were obtained for patients with IPD (n = 9), MSA (n = 10), and PSP (n = 8) and for age-matched control subjects (n = 10). Global and regional measurements of (11)C-HED retention were obtained to assess the extent of cardiac sympathetic denervation. (11)C-DTBZ binding was measured in the caudate nucleus, anterior putamen, and posterior putamen. RESULTS: As expected, extensive cardiac denervation was observed in several of the patients with IPD. However, substantial cardiac denervation was also seen in some patients with MSA and PSP. (11)C-DTBZ studies demonstrated striatal denervation in all patients with IPD and in most patients with MSA and PSP. No correlation was found between cardiac (11)C-HED retention and striatal (11)C-DTBZ binding. CONCLUSION: Cardiac sympathetic denervation was found to occur not only in IPD but also in other movement disorders, such as MSA and PSP. This finding implies that scintigraphic detection of cardiac sympathetic denervation cannot be used independently to discriminate IPD from other movement disorders, such as MSA and PSP. Cardiac sympathetic denervation was not correlated with striatal denervation, suggesting that the pathophysiologic processes underlying cardiac denervation and striatal denervation occur independently in patients with parkinsonian syndromes. These findings provide novel information about central and peripheral denervation in patients with neurodegenerative disorders. SN - 0161-5505 UR - https://www.unboundmedicine.com/medline/citation/17079809/PET_measurement_of_cardiac_and_nigrostriatal_denervation_in_Parkinsonian_syndromes_ L2 - http://jnm.snmjournals.org/cgi/pmidlookup?view=long&pmid=17079809 DB - PRIME DP - Unbound Medicine ER -