Objective: We tried to show divisional evaluation of caudate and putamen in [¹²³I] FP-CIT(DAT) -SPECT has use for assessment of PD symptoms and capture the association between dopaminergic neuron deficit and cerebellar fiber alteration in PD by analysis of diffusion MRI techniques.

Background: DAT-SPECT, the striatal dopamine transporter image indirectly reflects dopaminergic neurodegeneration, and has association with PD pathophysiology. Caudate and putamen have an important part of the mental and motor functions, respectively. In addition, cerebellar degeneration in PD has been discussed recently although its cause and pathophysiology remain to be vague.

Method: 71PD patients with clinical and image data available were reviewed, and the SCENIUM (Siemens Healthineers) was used to calculate caudate and putamen distribution volume ratio (DVR).  Then we assessed correlation between DVR and clinical scales and white matter tracts calculated from dMRI techniques.

Results: Putamen and caudate DVR were correlated with akinetic scores negatively and with tremor scores positively. Tremor dominant (TD) score was not associated with average caudate DVR (r=0.1692, p=0.1745), and average putamen DVR (r=0.1930, p=0.1204) while postural instability and gait difficulty (PIGD) score was associated with average caudate DVR (r=-0.4001, p=0.0009), and average putamen DVR (r=-0.3839, p=0.0015). Caudate DVR was also correlated with cognition scales, for instance, caudate DVR was associated with MMSE positively (r=0.2485, p=0.0367) and average Putamen DVR/Caudate DVR ratio (P/C ratio) with MMSE negatively (r=-0.3086, p=0.0088). Comparing between TD and PIGD, caudate and putamen DVR of TD were significantly higher than PIGD despite equal duration from onset to DAT-SPECT and MDS-UPDRS part3. In TOI analysis, between caudate or putamen DVR and dMRI, superior and inferior cerebellar peduncle (SCP, ICP) change in dMRI has correlation to caudate and putamen DVR, and in addition, MK and RK of TD were significantly higher than PIGD in SCP.

Conclusion: Our result showed that caudate and putamen function could be associated with motor symptoms of PD, especially with akinetic symptoms and that caudate function with cognitive decline in PD. Furthermore, SCP and ICP fiber alterations could be associated with dopaminergic neuron deficit in caudate and putamen of PD, and compared to PIGD, SCP fiber preservation of TD was suggested.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/correlation-between-striatal-degeneration-and-cerebellar-fiber-alterations-of-parkinsons-disease/