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. 2019 Jul 17:10:777.
doi: 10.3389/fneur.2019.00777. eCollection 2019.

Altered Neurometabolic Profile in Early Parkinson's Disease: A Study With Short Echo-Time Whole Brain MR Spectroscopic Imaging

Martin Klietz  1 , Paul Bronzlik  2 , Patrick Nösel  2 , Florian Wegner  1 , Dirk W Dressler  1 , Mete Dadak  2 , Andrew A Maudsley  3 , Sulaiman Sheriff  3 , Heinrich Lanfermann  2 , Xiao-Qi Ding  2
Affiliations

Altered Neurometabolic Profile in Early Parkinson's Disease: A Study With Short Echo-Time Whole Brain MR Spectroscopic Imaging

Martin Klietz et al. Front Neurol. .

Abstract

Objective: To estimate alterations in neurometabolic profile of patients with early stage Parkinson's disease (PD) by using a short echo-time whole brain magnetic resonance spectroscopic imaging (wbMRSI) as possible biomarker for early diagnosis and monitoring of PD. Methods: 20 PD patients in early stage (H&Y ≤ 2) without evidence of severe other diseases and 20 age and sex matched healthy controls underwent wbMRSI. In each subject brain regional concentrations of metabolites N-acetyl-aspartate (NAA), choline (Cho), total creatine (tCr), glutamine (Gln), glutamate (Glu), and myo-inositol (mIns) were obtained in atlas-defined lobar structures including subcortical basal ganglia structures (the left and right frontal lobes, temporal lobes, parietal lobes, occipital lobes, and the cerebellum) and compared between patients and matched healthy controls. Clinical characteristics of the PD patients were correlated with spectroscopic findings. Results: In comparison to controls the PD patients revealed altered lobar metabolite levels in all brain lobes contralateral to dominantly affected body side, i.e., decreases of temporal NAA, Cho, and tCr, parietal NAA and tCr, and frontal as well as occipital NAA. The frontal NAA correlated negatively with the MDS-UPDRS II (R = 22120.585, p = 0.008), MDS-UPDRS IV (R = -0.458, p = 0.048) and total MDS-UPDRS scores (R = -0.679, p = 0.001). Conclusion: In early PD stages metabolic alterations are evident in all contralateral brain lobes demonstrating that the neurodegenerative process affects not only local areas by dopaminergic denervation, but also the functional network within different brain regions. The wbMRSI-detectable brain metabolic alterations reveal the potential to serve as biomarkers for early PD.

Keywords: MRI; Parkinson's disease; biomarker; early diagnosis; spectroscopy; whole brain.

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Figures

Figure 1
Figure 1
Exemplary MR spectra of each brain lobe and cerebellum obtained from a PD patient (female, 62 years). Estimated anatomic assignment of brain areas to brain lobes of our study. Frontal lobe: BA 4, 6, 8, 9, 10, 11, 12, 24, 25, 32, 33, 44, 45, 46, 47, head of caudate nucleus, accumbens, anterior part of putamen and pallidum, anterior cingulum. Parietal lobe: BA 1, 2, 3, 5, 7, 23, 31, 39, 40, thalamus, subthalamic nucleus, posterior cingulum. Temporal lobe: BA 13, 14, 15, 16, 20, 21, 22, 26, 27, 28, 29, 30, 34, 35, 36, 37, 38, 41, 42, 43, hippocampus, posterior parts of putamen and pallidum, caudatus tail, amygdala. Occipital lobe: BA 17, 18, 19. RFL, right frontal lobe; LFL, left frontal lobe; RPL, right parietal lobe; LPL, left parietal lobe; RTL, right temporal lobe; LTL left temporal lobe; ROL right occipital lobe; LOL left occipital lobe; Cbl, cerebellum; BA, Broadman Area.
Figure 2
Figure 2
Lobar and cerebellar concentrations of NAA, Cho, tCr, Glu, Gln, and mIns measured in the PD patients and the healthy controls. NAA, N-acetyl-aspartat; mIns, myo-inusitol; Cho, choline; Glu, glutamate; Cr, creatinin; Gln, glumatine; RFL, right frontal lobe; LFL, left frontal lobe; RPL, right parietal lobe; LPL, left parietal lobe; RTL, right temporal lobe; LTL, left temporal lobe; ROL, right occipital lobe; LOL, left occipital lobe; Cbl, cerebellum.
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