Regional correlation of subcortical structures with clinical phenotypes in Parkinson’s disease: DAT SPECT imaging approach

Objectives: To make use of SPECT imaging of Parkinson’s disease (PD), aligned to a common space, to investigate the correlation of functional neuroanatomy and regional contribution of subcortical structures with PD clinical phenotypes.

Methods: We analyzed 76 subjects with mild to severe PD and asymmetric motor symptom manifestation, based on the unified PD rating scale (UPDRS). A common coordinate system for the population was defined based on MR images and DAT SPECT intensities across subjects were compared. A multi stage surface registration algorithm was employed to arrive at a common standard space for all subjects. Image analysis included segmentation of the structures of interest in MRI, registration of SPECT images to MRI, and then overlaying of the structures segmented in MRI on the co-registered SPECT, followed by spatial normalization of the data to the standard space. Regional correlation using Pearson’s correlation was applied to SPECT intensities and clinical rating scales of disease symptoms to obtain the fine regional involvement in disease initiation and progression. The common template enabled us to explore and investigate regional effects of Parkinson’s Disease on subcortical structures such as caudate and putamen in relation to a variety of symptom subgroups such as gait, tremor, bradykinesia and rigidity.

Results: Our normalization methodology enabled fine regional analysis to generate new markers of disease initiation and progression. It allowed extraction of regional correlation of subcortical structures such as caudate and putamen with PD clinical features and introduced an indirect assessment of the level of regional neurodegeneration.

Conclusion: Effects of regional exploration on dopaminergic system in subcortical structures provides some evidences for regional nature of the neurodegeneration in Parkinson’s disease, leading toward more individualized and regional specific treatments such as stem cell treatment.

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