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2.008 MR IMAGING BIOMARKERS FOR DIFFERENTIATION OF PARKINSON DISEASE FROM HEALTHY CONTROLS USING DIFFUSION TENSOR IMAGING ON 3 TESLA MRI
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Tuesday, 13 December 2011 / Parkinsonism and Related Disorders 18S2 (2012) S81–S159
Conclusion: We found susceptibility modifications using a voxelbased analysis in different parkinsonian syndromes. Analyses of correlations with clinical data are ongoing and will precise the diagnosis value of SWI in elderly parkinsonian patients 2.004 CLINICAL OUTCOME OF DRUG-INDUCED PARKINSONISM CAN BE PREDICTED WITH TRANSCRANIAL MIDBRAIN SONOGRAPHY D.-Y. Kwon, M.H. Park, J.-M. Jung, S.-B. Koh, K.W. Park. Neurology, Korea University College of Medicine, Ansan, Republic of Korea Introduction: DIP is heterogeneous disorders, ranges from “pure” parkinsonism from previously normal individuals induced by drugs which inhibit dopaminergic transmission to precipitated, unmasked pre-symptomatic parkinsonism by some drugs. Pathophysiological basis of the DIP has not been elucidated until recently. Hyperechogenicity of SN determined by transcranial brain sonography (TCS) is a characteristic finding in idiopathic PD regardless of disease stages, while TCS finding in DIP has not been investigated so far. Objectives: The purpose of this study was to confirm if there is difference in TCS findings between IPD and DIP and to know if “pure” DIP and unmasked pre-symptomatic parkinsonism could be discriminated through TCS. Methods: 35 PD, 35 DIP and 40 controls were enrolled. Sonographic SN echogenic findings were compared between those three groups. According to the presence of improvement of motor scores of the UPDRS after cessation of the causative drugs, we classified DIP group and compared TCS findings. Results: There was significant hyperechogenicity in both SN area and SN/midbrain ratio in PD and DIP group compared with control group (p < 0.003). There was no statistically significant difference of SN echogenicity between IPD and DIP group. However, subgroup analysis of DIP patietns reveleaed the group with no definite improvement of motor score after drug cessation showed significant hyperechogenicity in TCS than clinical improved group. Conclusions: We found DIP patients showed significant SN hyperechogenicity on TCS but it depends on the subtype of DIP. 2.005 DIFFERENT SIGNALS OF MAGNETIC RESONANCE IMAGING AND ULTRASOUND FROM PARKINSONIAN SUBSTANTIA NIGRA AND CONTROL – IS IRON THE CAUSE? J. Galazka-Friedman1 , K. Szlachta1 , K. Sadowski2 , R. Kulinski3 , A. Friedman2 . 1 Faculty of Physics, Warsaw University of Technology, 2 Neurology, Medical University of Warsaw, 3 Nuclear Medicine and Magnetic Resonance, Brodno Regional Hospital, Warszawa, Poland Introduction: Symptoms of Parkinson’s disease (PD) are caused by a progressive degeneration of substantia nigra (SN). The cause of this process is unknown but may be related to iron mediated oxidative stress. The aim of this study was to understand the mechanism of the change of magnetic resonance (MRI) and ultrasound signal (USG) found in patients with PD, which were attributed by several authors to an important increase of the concentration of iron in SN. Material and Methods: USG and MRI measurements were performed on phantoms simulating human brain to which high amounts of iron were introduced. For USG porcine brains, whose structure may imitate the human one, in the MRI study the phantom consisted of plastic bottle containing one liter of water solution of five metabolites present in human brain grey matter tissue. USG was made before and after injections of ferritin containing high amount of iron, and before and after insertion of glial tissue. In MRI study we measured T2 as a function of the concentration of ferritin and iron added to the phantom. Results: The USG signal was unaffected by insertion of ironloaded ferritin, while it was by insertion of glial tissue. Injections of iron-loaded ferritin and iron ions to the phantoms decreased
T2 relaxation time to much higher degree than observed in parkinsonian brains. Conclusions: Our results suggest that the observed change of the signal from parkinsonian brains is probably due to a proliferation of glia and not to an increase of the concentration of iron. 2.006 COMPARASION STUDY OF VOLUME OF OLFACTORY BULB BY MRI BETWEEN PARKINSON’S DISEASE AND THE NORMAL PERSON M. Shao, S. Chen. Medical College of Guangzhou, Guangzhou, China Olfactory disfunction is very frequent in Idiopathic Parkinson’s disease (IPD) and thought to be one of the early non-motor symptems. Magnetic resonance imaging (MRI) can demonstrate the olfactory bulb (OB) and offers an ideal means to reliably evaluate the volume of the OB.20 IPD patients and 12 age-matched controls were investigated and estimated the Hoehn-yahr degrees, UPDRS (total Unified Parkinson disease Rating Scale Scores), MOCA, MMSE. The results shows that the volume of OB is notably decreased in IPD patients in contrast of the cntrols. There is no reference between the OB volume and the degree of H-Y, MMSE, MOCA and the age. However the OB volume was related to the course of disease. We conclude that the volume of the OB displayed by MRI coulde be one of the diagnosis of the Parkinson’s disease. 2.007 MR VOLUMETRIC ANALYSIS OF THE CORPUS CALLOSUM IN PATIENTS WITH PARKINSONISM L.-L. Chan, K.M. Ng, H. Rumpel, E.K. Tan. Singapore General Hospital, Singapore, Singapore Objective: To measure and compare the area of the corpus callosal area in patients with postural instability gait disorder parkinsonism (PIGD) and Parkinson’s disease (PD). Methods: Patients who were diagnosed clinically with PIDG and PD by a movement disorders specialist were recruited for the study. All patients underwent high field MR imaging using a standardized protocol. The area of the corpus callosum on a mid sagittal section of the high resolution MPRAGE (TR/TE/TI/FA 2200/3.0/900/9) series was quantified using the Analyze 8.1 (Mayo Clinic) program. The measured areas between the VP and PD cohorts were compared using the Student t test, and statistical significance defined at p < 0.05. Results: Twenty subjects were included. Volumetric analysis revealed a smaller mean corpus callosal areas in the PIGD (500.5 mm2 ) compared to PD (631.5 mm2 ) patients (p < 0.05). PIGD patients also had worse Tinetti gait scores. Conclusions: Corpus callosum atrophy could be an additional differential indicator of gait disability in subjects with parkinsonism and may be helpful differentiating PD from those with predominant gait problems. 2.008 MR IMAGING BIOMARKERS FOR DIFFERENTIATION OF PARKINSON DISEASE FROM HEALTHY CONTROLS USING DIFFUSION TENSOR IMAGING ON 3 TESLA MRI R. Kumari. IHBAS, Delhi, India Objective: To identify MR imaging biomarkers for differentiation of Parkinson disease patients form healthy age matched controls using diffusion tensor imaging (DTI) and tractography on 3 Tesla MRI. Using quantitative DTI on a 3 T MR scanner, it is possible to detect the early micro structural changes within these pathways not appreciated on conventional MR sequences thereby improving the detection and characterization of abnormalities in PD. Methods: Ten patients with denovo PD and ten age matched normal controls were scanned on a 3.0 T MR scanner. DTI data were analyzed using the Functool software. Symmetrical ROI’s were placed in the caudate nuclei, putamen, globus pallidus of basal ganglia, pars reticulata, pars compacta and red nucleus of substantia
Tuesday, 13 December 2011 / Parkinsonism and Related Disorders 18S2 (2012) S81–S159
nigra. Voxel-based analysis was used to compare ADC and FA maps in the basal ganglia and substantia nigra of the two groups and statistical significance was determined using the student t test. Results: DTI images in patients with PD demonstrated significantly reduced FA values (p value <0.05) in the caudate nucleus and putamen of basal ganglia and the pars compacta and red nuclei of the substantia nigra, with increased ADC values (p value >0.05). This accounted for loss of dopaminergic neurons characteristic of this disease. No significant difference was observed in the FA and ADC values of pars reticulata in PD as compared with normal controls. Conclusions: Visualization of the selective degeneration of individual structures along the nigrostriatal pathway using DTI on 3 Tesla adds qualitative data facilitating the early diagnosis of PD. 2.009 DIFFUSION TENSOR IMAGING AND TRACTOGRAPHY OF THE NIGROSTRIATAL AND MESOLIMBIC PATHWAYS IN PARKINSON DISEASE R. Gupta. BK Medical Centre, Delhi, India Objective: To evaluate the nigrostriatal and mesolimbic pathways of Parkinson’s disease (PD) patients and normal controls using diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) on 3 Tesla MRI. To determine whether there are detectable abnormalities of these tracts in PD patients as compared with controls. Methods: Fifteen patients with dopamine-responsive PD and thirty age matched normal controls were scanned on a 3.0 T MR scanner. DTI data was acquired using a single-shot EPI sequence with diffusion encoding in 32 directions and a voxel size of 2 2 2 mm3 . DTI data were analyzed and DTT was performed using the SPM2 analysis software. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) within each tract were determined. Voxel-based analysis was used to compare ADC and FA maps in the white matter of the two groups. Results: DTI and DTT images in patients with PD demonstrated degeneration of the nigrostriatal and mesolimbic tracts, with decreased FA and increased ADC. This accounted for loss of dopaminergic neurons characteristic of this disease. Threedimensional images of these white matter tracts using DTT demonstrated a reduction in fiber density in patients with PD as compared with normal controls. Conclusions: Measurements of FA and ADC values in dopaminergic fiber tracts (nigrostriatal and mesolimbic pathways) using DTI and DTT on 3 Tesla MRI aid in early diagnosis of PD and can be used for monitoring disease progression and assessing the effect of treatment. 2.010 CASE CONTROL DIFFUSION TENSOR IMAGING TRACTOGRAPHY STUDIES IN POSTURAL INSTABILITY GAIT DISORDER PARKINSONISM L.-L. Chan, K.-M. Ng, H. Rumpel, E.K. Tan. Singapore General Hospital, Singapore, Singapore Background: Postural instability and gait disorder (PIGD) parkinsonism is a common clinical problem. The pathophysiologic differences between PD and PIGD are unclear. Objective: Utilizing 2 region Diffusion Tensor Imaging (DTI) tractography, we conducted a case control study to determine if neural tracts in the various brain regions are differentially affected in early onset PIGD parkinsonism compared to PD and controls. Methods: On a 3Telsa MR machine, we determined the fractional anisotrophy (FA) and apparent diffusion coefficient (ADC) values on DTI for the various neural tracks and brain regions. FA and ADC were correlated with the Tinetti score. Analysis of receiver operating characteristics was used to assess the sensitivity and specificity of the DTI parameters.
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Results: Fifty subjects were included. We demonstrated greater DTI abnormalities in the substantia nigra, thalamus, corpus callosum, corpus callosum, centrum semiovale in PIGD compared to controls. The mean ADC values were greater in the thalamus, putamen, corpus callosum and centrum semiovale (medial) in PIGD compared to PD. However, in the multivariate analysis, only the FA (P = 0.02) and ADC (p = 0.001) values in the corpus callosum body differentiated between PIGD and PD. PIGD with low Tinetti score had a lower FA (p = 0.02) and a higher ADC value (corpus callosum) (p = 0.03) compared to those with a high score. Conclusions: Neural track abnormalities in the body of the corpus callosum but not the substantia nigra differentiated PIGD from PD and degree of corpus callosum abnormality correlated with the risk of falls. 2.011 DIFFUSION TENSOR IMAGING STUDY IN PARKINSON’S DISEASE WITH IMPULSE CONTROL DISORDERS G. Meco, M. Valente, R. Scatozza, A. Rubino, N. Caravona. Neurology and Psychiatry, Sapienza, University of Rome, Roma, Italy Introduction: In Parkinson’s disease (PD), there is an increasing evidence for disorders in the impulsive-compulsive spectrum (ICD), related either to the disease itself, or to the pharmacological management of this disease or both. Diffusion tensor imaging (DTI) offers a unique window on the connectivity changes, extending beyond the basal ganglia, which accompany the cognitive and psychiatric symptoms of Parkinson disease. Objectives: The primary purpose of this study was to assess the microstructural damage to cerebral white matter occurring in idiopathic PD, estimated by fractional anisotropy values in superior and middle frontal white matter. Methods: Our study included patients with PD without dementia and with at least one ICD (n: 8; mean age: 68±6.4; Unified Parkinson Disease Rating Scale part III: 15.2±3.2; Mini-Mental State Examination: 26.6±1.6, levodopa dose equivalent: 632.6±332.2) and age-matched PD control patients without dementia and ICD (n: 8, mean age: 68.5±7.2; Unified Parkinson Disease Rating Scale part III: 12.2±1.9; Mini-Mental State Examination, 27.2±1.8; levodopa dose equivalent: 598.4±284). DTI was performed on a 1.5T scanner, and mean diffusivity (MD) and fractional anisotropy (FA) maps in superior and middle frontal white matter were obtained. Results: MD and FA values were not significantly different between PD patients with ICD disorders and controls, although ICD patients showed tendentially higher MD and FA values. Conclusions: In our study, the integrity of the examined structures could indicate that the pathological process is due to functional anomalies rather than neuroanatomical alterations. 2.012 ARE FP-CIT ABNORMALITIES IN PARKINSON’S DISEASE AND PARKINSON’S DISEASE DEMENTIA CONSISTENT WITH THE BRAAK HYPOTHESIS? J. Birchall1 , I. Jones1 , N. Bajaj2 . 1 Department Nuclear Medicine, Royal Derby Hospital NHS Foundation Trust, Derby, 2 Clinical Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK Under the Braak hypothesis, motoric symptomotology in PD is a late stage phenomenon (Stage III). It is estimated that 60–80% of dopaminergic neurones are already lost at motor presentation. FP-CIT SPECT scan relies on the binding of label to dopamine transporter protein on presynaptic terminals and as such may give an indirect measure of the number of surviving dopaminergic neurones in the substantia nigra. If the assumption under Braak is correct, FP-CIT abnormality in PD patients with motoric symptoms should be marked and in patients with Parkinson’s disease dementia (PDD) might be expected to be even more severe (Braak Stage 4).
Tuesday, 13 December 2011 / Parkinsonism and Related Disorders 18S2 (2012) S81–S159
Conclusion: We found susceptibility modifications using a voxelbased analysis in different parkinsonian syndromes. Analyses of correlations with clinical data are ongoing and will precise the diagnosis value of SWI in elderly parkinsonian patients 2.004 CLINICAL OUTCOME OF DRUG-INDUCED PARKINSONISM CAN BE PREDICTED WITH TRANSCRANIAL MIDBRAIN SONOGRAPHY D.-Y. Kwon, M.H. Park, J.-M. Jung, S.-B. Koh, K.W. Park. Neurology, Korea University College of Medicine, Ansan, Republic of Korea Introduction: DIP is heterogeneous disorders, ranges from “pure” parkinsonism from previously normal individuals induced by drugs which inhibit dopaminergic transmission to precipitated, unmasked pre-symptomatic parkinsonism by some drugs. Pathophysiological basis of the DIP has not been elucidated until recently. Hyperechogenicity of SN determined by transcranial brain sonography (TCS) is a characteristic finding in idiopathic PD regardless of disease stages, while TCS finding in DIP has not been investigated so far. Objectives: The purpose of this study was to confirm if there is difference in TCS findings between IPD and DIP and to know if “pure” DIP and unmasked pre-symptomatic parkinsonism could be discriminated through TCS. Methods: 35 PD, 35 DIP and 40 controls were enrolled. Sonographic SN echogenic findings were compared between those three groups. According to the presence of improvement of motor scores of the UPDRS after cessation of the causative drugs, we classified DIP group and compared TCS findings. Results: There was significant hyperechogenicity in both SN area and SN/midbrain ratio in PD and DIP group compared with control group (p < 0.003). There was no statistically significant difference of SN echogenicity between IPD and DIP group. However, subgroup analysis of DIP patietns reveleaed the group with no definite improvement of motor score after drug cessation showed significant hyperechogenicity in TCS than clinical improved group. Conclusions: We found DIP patients showed significant SN hyperechogenicity on TCS but it depends on the subtype of DIP. 2.005 DIFFERENT SIGNALS OF MAGNETIC RESONANCE IMAGING AND ULTRASOUND FROM PARKINSONIAN SUBSTANTIA NIGRA AND CONTROL – IS IRON THE CAUSE? J. Galazka-Friedman1 , K. Szlachta1 , K. Sadowski2 , R. Kulinski3 , A. Friedman2 . 1 Faculty of Physics, Warsaw University of Technology, 2 Neurology, Medical University of Warsaw, 3 Nuclear Medicine and Magnetic Resonance, Brodno Regional Hospital, Warszawa, Poland Introduction: Symptoms of Parkinson’s disease (PD) are caused by a progressive degeneration of substantia nigra (SN). The cause of this process is unknown but may be related to iron mediated oxidative stress. The aim of this study was to understand the mechanism of the change of magnetic resonance (MRI) and ultrasound signal (USG) found in patients with PD, which were attributed by several authors to an important increase of the concentration of iron in SN. Material and Methods: USG and MRI measurements were performed on phantoms simulating human brain to which high amounts of iron were introduced. For USG porcine brains, whose structure may imitate the human one, in the MRI study the phantom consisted of plastic bottle containing one liter of water solution of five metabolites present in human brain grey matter tissue. USG was made before and after injections of ferritin containing high amount of iron, and before and after insertion of glial tissue. In MRI study we measured T2 as a function of the concentration of ferritin and iron added to the phantom. Results: The USG signal was unaffected by insertion of ironloaded ferritin, while it was by insertion of glial tissue. Injections of iron-loaded ferritin and iron ions to the phantoms decreased
T2 relaxation time to much higher degree than observed in parkinsonian brains. Conclusions: Our results suggest that the observed change of the signal from parkinsonian brains is probably due to a proliferation of glia and not to an increase of the concentration of iron. 2.006 COMPARASION STUDY OF VOLUME OF OLFACTORY BULB BY MRI BETWEEN PARKINSON’S DISEASE AND THE NORMAL PERSON M. Shao, S. Chen. Medical College of Guangzhou, Guangzhou, China Olfactory disfunction is very frequent in Idiopathic Parkinson’s disease (IPD) and thought to be one of the early non-motor symptems. Magnetic resonance imaging (MRI) can demonstrate the olfactory bulb (OB) and offers an ideal means to reliably evaluate the volume of the OB.20 IPD patients and 12 age-matched controls were investigated and estimated the Hoehn-yahr degrees, UPDRS (total Unified Parkinson disease Rating Scale Scores), MOCA, MMSE. The results shows that the volume of OB is notably decreased in IPD patients in contrast of the cntrols. There is no reference between the OB volume and the degree of H-Y, MMSE, MOCA and the age. However the OB volume was related to the course of disease. We conclude that the volume of the OB displayed by MRI coulde be one of the diagnosis of the Parkinson’s disease. 2.007 MR VOLUMETRIC ANALYSIS OF THE CORPUS CALLOSUM IN PATIENTS WITH PARKINSONISM L.-L. Chan, K.M. Ng, H. Rumpel, E.K. Tan. Singapore General Hospital, Singapore, Singapore Objective: To measure and compare the area of the corpus callosal area in patients with postural instability gait disorder parkinsonism (PIGD) and Parkinson’s disease (PD). Methods: Patients who were diagnosed clinically with PIDG and PD by a movement disorders specialist were recruited for the study. All patients underwent high field MR imaging using a standardized protocol. The area of the corpus callosum on a mid sagittal section of the high resolution MPRAGE (TR/TE/TI/FA 2200/3.0/900/9) series was quantified using the Analyze 8.1 (Mayo Clinic) program. The measured areas between the VP and PD cohorts were compared using the Student t test, and statistical significance defined at p < 0.05. Results: Twenty subjects were included. Volumetric analysis revealed a smaller mean corpus callosal areas in the PIGD (500.5 mm2 ) compared to PD (631.5 mm2 ) patients (p < 0.05). PIGD patients also had worse Tinetti gait scores. Conclusions: Corpus callosum atrophy could be an additional differential indicator of gait disability in subjects with parkinsonism and may be helpful differentiating PD from those with predominant gait problems. 2.008 MR IMAGING BIOMARKERS FOR DIFFERENTIATION OF PARKINSON DISEASE FROM HEALTHY CONTROLS USING DIFFUSION TENSOR IMAGING ON 3 TESLA MRI R. Kumari. IHBAS, Delhi, India Objective: To identify MR imaging biomarkers for differentiation of Parkinson disease patients form healthy age matched controls using diffusion tensor imaging (DTI) and tractography on 3 Tesla MRI. Using quantitative DTI on a 3 T MR scanner, it is possible to detect the early micro structural changes within these pathways not appreciated on conventional MR sequences thereby improving the detection and characterization of abnormalities in PD. Methods: Ten patients with denovo PD and ten age matched normal controls were scanned on a 3.0 T MR scanner. DTI data were analyzed using the Functool software. Symmetrical ROI’s were placed in the caudate nuclei, putamen, globus pallidus of basal ganglia, pars reticulata, pars compacta and red nucleus of substantia
Tuesday, 13 December 2011 / Parkinsonism and Related Disorders 18S2 (2012) S81–S159
nigra. Voxel-based analysis was used to compare ADC and FA maps in the basal ganglia and substantia nigra of the two groups and statistical significance was determined using the student t test. Results: DTI images in patients with PD demonstrated significantly reduced FA values (p value <0.05) in the caudate nucleus and putamen of basal ganglia and the pars compacta and red nuclei of the substantia nigra, with increased ADC values (p value >0.05). This accounted for loss of dopaminergic neurons characteristic of this disease. No significant difference was observed in the FA and ADC values of pars reticulata in PD as compared with normal controls. Conclusions: Visualization of the selective degeneration of individual structures along the nigrostriatal pathway using DTI on 3 Tesla adds qualitative data facilitating the early diagnosis of PD. 2.009 DIFFUSION TENSOR IMAGING AND TRACTOGRAPHY OF THE NIGROSTRIATAL AND MESOLIMBIC PATHWAYS IN PARKINSON DISEASE R. Gupta. BK Medical Centre, Delhi, India Objective: To evaluate the nigrostriatal and mesolimbic pathways of Parkinson’s disease (PD) patients and normal controls using diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) on 3 Tesla MRI. To determine whether there are detectable abnormalities of these tracts in PD patients as compared with controls. Methods: Fifteen patients with dopamine-responsive PD and thirty age matched normal controls were scanned on a 3.0 T MR scanner. DTI data was acquired using a single-shot EPI sequence with diffusion encoding in 32 directions and a voxel size of 2 2 2 mm3 . DTI data were analyzed and DTT was performed using the SPM2 analysis software. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) within each tract were determined. Voxel-based analysis was used to compare ADC and FA maps in the white matter of the two groups. Results: DTI and DTT images in patients with PD demonstrated degeneration of the nigrostriatal and mesolimbic tracts, with decreased FA and increased ADC. This accounted for loss of dopaminergic neurons characteristic of this disease. Threedimensional images of these white matter tracts using DTT demonstrated a reduction in fiber density in patients with PD as compared with normal controls. Conclusions: Measurements of FA and ADC values in dopaminergic fiber tracts (nigrostriatal and mesolimbic pathways) using DTI and DTT on 3 Tesla MRI aid in early diagnosis of PD and can be used for monitoring disease progression and assessing the effect of treatment. 2.010 CASE CONTROL DIFFUSION TENSOR IMAGING TRACTOGRAPHY STUDIES IN POSTURAL INSTABILITY GAIT DISORDER PARKINSONISM L.-L. Chan, K.-M. Ng, H. Rumpel, E.K. Tan. Singapore General Hospital, Singapore, Singapore Background: Postural instability and gait disorder (PIGD) parkinsonism is a common clinical problem. The pathophysiologic differences between PD and PIGD are unclear. Objective: Utilizing 2 region Diffusion Tensor Imaging (DTI) tractography, we conducted a case control study to determine if neural tracts in the various brain regions are differentially affected in early onset PIGD parkinsonism compared to PD and controls. Methods: On a 3Telsa MR machine, we determined the fractional anisotrophy (FA) and apparent diffusion coefficient (ADC) values on DTI for the various neural tracks and brain regions. FA and ADC were correlated with the Tinetti score. Analysis of receiver operating characteristics was used to assess the sensitivity and specificity of the DTI parameters.
S93
Results: Fifty subjects were included. We demonstrated greater DTI abnormalities in the substantia nigra, thalamus, corpus callosum, corpus callosum, centrum semiovale in PIGD compared to controls. The mean ADC values were greater in the thalamus, putamen, corpus callosum and centrum semiovale (medial) in PIGD compared to PD. However, in the multivariate analysis, only the FA (P = 0.02) and ADC (p = 0.001) values in the corpus callosum body differentiated between PIGD and PD. PIGD with low Tinetti score had a lower FA (p = 0.02) and a higher ADC value (corpus callosum) (p = 0.03) compared to those with a high score. Conclusions: Neural track abnormalities in the body of the corpus callosum but not the substantia nigra differentiated PIGD from PD and degree of corpus callosum abnormality correlated with the risk of falls. 2.011 DIFFUSION TENSOR IMAGING STUDY IN PARKINSON’S DISEASE WITH IMPULSE CONTROL DISORDERS G. Meco, M. Valente, R. Scatozza, A. Rubino, N. Caravona. Neurology and Psychiatry, Sapienza, University of Rome, Roma, Italy Introduction: In Parkinson’s disease (PD), there is an increasing evidence for disorders in the impulsive-compulsive spectrum (ICD), related either to the disease itself, or to the pharmacological management of this disease or both. Diffusion tensor imaging (DTI) offers a unique window on the connectivity changes, extending beyond the basal ganglia, which accompany the cognitive and psychiatric symptoms of Parkinson disease. Objectives: The primary purpose of this study was to assess the microstructural damage to cerebral white matter occurring in idiopathic PD, estimated by fractional anisotropy values in superior and middle frontal white matter. Methods: Our study included patients with PD without dementia and with at least one ICD (n: 8; mean age: 68±6.4; Unified Parkinson Disease Rating Scale part III: 15.2±3.2; Mini-Mental State Examination: 26.6±1.6, levodopa dose equivalent: 632.6±332.2) and age-matched PD control patients without dementia and ICD (n: 8, mean age: 68.5±7.2; Unified Parkinson Disease Rating Scale part III: 12.2±1.9; Mini-Mental State Examination, 27.2±1.8; levodopa dose equivalent: 598.4±284). DTI was performed on a 1.5T scanner, and mean diffusivity (MD) and fractional anisotropy (FA) maps in superior and middle frontal white matter were obtained. Results: MD and FA values were not significantly different between PD patients with ICD disorders and controls, although ICD patients showed tendentially higher MD and FA values. Conclusions: In our study, the integrity of the examined structures could indicate that the pathological process is due to functional anomalies rather than neuroanatomical alterations. 2.012 ARE FP-CIT ABNORMALITIES IN PARKINSON’S DISEASE AND PARKINSON’S DISEASE DEMENTIA CONSISTENT WITH THE BRAAK HYPOTHESIS? J. Birchall1 , I. Jones1 , N. Bajaj2 . 1 Department Nuclear Medicine, Royal Derby Hospital NHS Foundation Trust, Derby, 2 Clinical Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK Under the Braak hypothesis, motoric symptomotology in PD is a late stage phenomenon (Stage III). It is estimated that 60–80% of dopaminergic neurones are already lost at motor presentation. FP-CIT SPECT scan relies on the binding of label to dopamine transporter protein on presynaptic terminals and as such may give an indirect measure of the number of surviving dopaminergic neurones in the substantia nigra. If the assumption under Braak is correct, FP-CIT abnormality in PD patients with motoric symptoms should be marked and in patients with Parkinson’s disease dementia (PDD) might be expected to be even more severe (Braak Stage 4).