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PET Measurement of Cardiac and Nigrostriatal Denervation in Parkinsonian Syndromes

¹ Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan; ² Department of Biostatistics, University of Michigan, Ann Arbor, Michigan; and ³ Department of Neurology, University of Michigan, Ann Arbor, Michigan

View larger version (9K): [in a new window]   FIGURE 1.  Global mean 11C-HED RI values. NC = normal (healthy) control.

View larger version (51K): [in a new window]   FIGURE 2.  Representative parametric cardiac PET images and polar maps of 11C-HED retention. PET images are short-axis (SA), vertical long-axis (VLA), and horizontal long-axis (HLA) views for each subject. All PET images were normalized to integral of blood curve for each study, providing parametric 11C-HED RI images. PET images and polar maps of 11C-HED retention are all scaled to common maximum of 0.090 mL of blood per min per mL of tissue. For rainbow color table used, areas of low 11C-HED retention are shown in purple, blue and blue–green, moderate retention is shown in green and yellow, and normal retention is shown in orange, red, pink, and white. NC 3 images show high, uniform 11C-HED uptake in healthy control subject. IPD 6 images show extensive and severe denervation, as seen in 4 patients with IPD. MSA 2 images show extensive and severe denervation, as seen in 2 patients with MSA. MSA 8 images show nonuniform, more focal regional denervation, as seen in 2 patients with MSA. PSP 4 images show large regions of cardiac denervation, as seen in 2 patients with PSP. A = anterior wall; L = lateral wall; S = septal wall.

View larger version (12K): [in a new window]   FIGURE 3.  Relationship between cardiac innervation and striatal monoaminergic nerve density. Plotted is global mean 11C-HED RI vs. 11C-DTBZ binding potential in posterior putamen. NC = normal (healthy) control.

View larger version (47K): [in a new window]   FIGURE 4.  Representative parametric images of 11C-DTBZ DVR and corresponding 11C-HED RI polar maps. Parametric images of 11C-DTBZ DVR are all scaled to common maximum of 3.5. DVR is related to binding potential (BP) by equation BP = DVR – 1 and is unitless. Polar maps of 11C-HED RI values are all scaled to common maximum of 0.090 mL of blood per min per mL of tissue. NC 5 images show high striatal binding of 11C-DTBZ and high, uniform cardiac retention of 11C-HED in healthy control subject. MSA 1 images show low striatal 11C-DTBZ binding and extensive severe cardiac denervation, as seen in 2 patients with MSA. MSA 4 images show low striatal 11C-DTBZ binding and normal uniform cardiac 11C-HED retention, as seen in 4 patients with MSA. MSA 9 images show normal striatal 11C-DTBZ binding and normal uniform cardiac 11C-HED retention, as seen in 4 patients with MSA. IPD 3 images show low striatal 11C-DTBZ binding and extensive severe cardiac denervation, as seen in 4 patients with IPD. IPD 7 images show low 11C-DTBZ binding in posterior putamen (with uncharacteristically well-preserved 11C-DTBZ binding in caudate nucleus) and normal uniform cardiac innervation, as seen in 5 patients with IPD. PSP 3 images show low striatal 11C-DTBZ binding and nonuniform cardiac denervation, as seen in 2 patients with PSP. PSP 8 images show low striatal 11C-DTBZ binding and normal uniform cardiac denervation, as seen in 5 patients with PSP.