title: ¹⁸F-FP-(+)-DTBZ positron emission tomography detection of monoaminergic deficient network in patients with carbon monoxide related parkinsonism.
abstract: OBJECTIVE
  Although parkinsonism after carbon monoxide (CO) intoxication is well known, neurotransmitter deficient networks that are responsible for the severity of parkinsonism have rarely been systemically evaluated.
  
  
  METHODS
  Eighteen patients with CO-related parkinsonism and nine age- and sex-matched controls were enrolled for detailed neurological examinations, three-dimensional T1-weighted images, diffusion tensor imaging and (18)F-9-fluoropropyl-(+)-dihydrotetrabenzazine ((18)F-FP-(+)-DTBZ) positron emission tomography (PET). The structural analysis included voxel-based morphometry to assess grey matter atrophy and tract-based spatial statistics related to white matter involvement. For presynaptic monoaminergic assessment, volume of interest analysis in six subcortical regions and non-parametric voxel-wise comparison were performed on PET images with estimation of registration parameters from magnetic resonance images. All the imaging modalities were compared between the patients and controls. For the patients, a regression model for correlation with cognitive behaviour and Unified Parkinson's Disease Rating Scale (UPDRS) score was used.
  
  
  RESULTS
  In the patients, monoaminergic deficit networks were found in the caudate, anterior putamen, anterior insular, thalamus and anterior cingulate cortex. The UPDRS revealed significant correlations with the prefrontal white matter fractional anisotropy values and with the (18)F-FP-(+)-DTBZ uptake values in the caudate nucleus, insular, medial prefrontal and dorsomedial thalamus. The neuropsychiatric inventory score correlated with the (18)F-FP-(+)-DTBZ uptake values in the anterior cingulate cortex and dorsolateral prefrontal cortex.
  
  
  CONCLUSIONS
  Our study demonstrated monoaminergic deficits and white matter damage networks in CO-related parkinsonism that determined the severity of parkinsonism or behaviour changes. As the substantia nigra was spared, the monoaminergic topography of involvement suggests a different pathophysiology in CO-related parkinsonism.
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Chang
authors.forename: I-T
authors.initials: IT
authors.lastname: Hsiao
authors.forename: S-H
authors.initials: SH
authors.lastname: Huang
authors.forename: C-C
authors.initials: CC
authors.lastname: Lui
authors.forename: T-C
authors.initials: TC
authors.lastname: Yen
authors.forename: W-N
authors.initials: WN
authors.lastname: Chang
authors.forename: C-W
authors.initials: CW
authors.lastname: Huang
authors.forename: C-J
authors.initials: CJ
authors.lastname: Hsieh
authors.forename: Y-Y
authors.initials: YY
authors.lastname: Chang
authors.forename: K-J
authors.initials: KJ
authors.lastname: Lin
mesh_terms: D000328:Adult; D015306:Biogenic Monoamines / Q000378:metabolism*; D002249:Carbon Monoxide Poisoning / Q000150:complications*; D005260:Female; D005462:Fluorine Radioisotopes / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010302:Parkinson Disease, Secondary / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D049268:Positron-Emission Tomography / Q000379:methods*; D012720:Severity of Illness Index; D013747:Tetrabenazine / Q000031:analogs & derivatives / Q000378:metabolism; D066127:White Matter / Q000473:pathology*
chemical_list: D015306:Biogenic Monoamines; D005462:Fluorine Radioisotopes; C549477:florbenazine F 18; D013747:Tetrabenazine
keywords: 18F-9-fluoropropyl-(+)-dihydrotetrabenzazine; Unified Parkinson's Disease Rating Scale score; carbon monoxide; monoaminergic; parkinsonism