Objective: Our object is to evaluate the cirrhotic patients with parkinsonism using the presynaptic dopamine transporter (DAT) positron emission tomography (PET) imaging for dopaminergic deficit.

Background: Manganese (Mn) can cause an extrapyramidal symptoms including parkinsonism, dystonia, postural instability or tremor. Mn-induced parkinsonism are classically associated with the occupational exposure in welders, ore minors, smelters and battery factory workers. During past decades, non-occupational Mn exposure, such as liver cirrhosis, prolonged total parenteral nutrition, and intravenous ephedrone abuse have been of growing interest for their association with the parkinsonism related to chronic Mn accumulation in the brain. Recent PET technique using 18F-labeled 2b-carbomethoxy-3b-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT) allows non-invasive evaluation of the integrity and change of dopaminergic neurotransmission related to Mn exposure with superior spatial resolutions.

Methods: All consecutive patients who had concurrent liver cirrhosis and parkinsonism were investigated in the Department of Neurology, Ulsan University Hospital, Korea. Parkinsonism was defined by the presence of at least 2 of the following signs: rest tremor, rigidity and bradykinesia. All study patients were not exposed to Mn occupationally. We performed structured neurological examination, routine blood test including serum Mn, and neuroimaging assessments including 18F-labeled FP-CIT brain PET/CT and brain magnetic resonance imaging (MRI).

Results: We enrolled four cirrhotic patients with concurrent parkinsonism from our movement disorder clinic. All four patients showed high signal changes on the basal ganglia of T1-weighted MRI, which are compatible with the Mn accumulations in the brain. Functional DAT imaging of patient 1 and patient 2 showed presynaptic dopaminergic deficits with a rostro-caudal gradient. Patient 3 and patient 4 showed showed normal DAT density in the presynaptic dopaminergic PET. 

Conclusions: We report the clinical features and imaging results of 18F-labeld FP-CIT presynaptic dopaminergic PET findings in four liver cirrhosis patients with parkinsonism. Our results using DAT PET in cirrhosis-related parkinsonism showed two different functional imaging patterns well related to the clinical features of patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/18f-labeled-fp-cit-pet-findings-in-a-series-of-cirrhotic-patients-with-parkinsonism/