0:00

There are other imaging options for

0:02

Parkinson's disease besides MRI,

0:05

and these include fluorodeoxyglucose PET,

0:08

which tends to be more valuable in individuals

0:11

that have a strong dementia component

0:13

to their Parkinson's disease,

0:15

to try and help differentiate Lewy Body

0:18

Dementia or Lewy Body Disease, LBD,

0:21

from classic PD or Parkinson's disease.

0:24

And we'll discuss a little bit later on how

0:27

you might use these techniques.

0:29

Fluorodopa PET gives you some specificity for

0:32

dopaminergic function in the brain,

0:35

although I found it less helpful as a standalone

0:38

technique to differentiate LBD,

0:41

Lewy Body Dementia,

0:42

from Parkinson's disease.

0:44

But it is a good way for research purposes and

0:47

treatment purposes to document the severity

0:51

and loss of dopaminergic function.

0:53

Now, this axial FLAIR image demonstrates

0:56

another finding of PD,

0:58

which is depigmentation of the red nucleus.

1:01

It's a pretty big structure, the nucleus ruber,

1:05

and it should be seen as a slightly,

1:07

at least slightly hypointense,

1:09

round structure on a FLAIR or a BSI,

1:12

or blood-sensitive image, or a gradient echo

1:15

or even a T2 or an echo planar image,

1:17

and we don't see it.

1:19

This axial view of a patient who has early

1:25

Parkinson's disease with two slices,

1:28

and later Parkinson's disease,

1:30

shows the effect of Flourodopa PET,

1:33

which is staining specifically for dopaminergic function.

1:38

On the upper images,

1:39

look how much more dopaminergic uptake we have.

1:43

Look at the thickness of the substantia nigra

1:46

compared to how thinned out it is

1:50

in late Parkinson's disease.

1:52

There's no uptake in the red nucleus.

1:55

It's been depigmented,

1:56

and the dopaminergic function

1:58

has essentially failed here.

2:00

And then look laterally how attenuated the lateral

2:04

uptake of Fluorodopa is in the outer half of the

2:08

substantia nigra in a patient with rigidity,

2:12

difficulty initiating movements,

2:15

resting tremor with classic Parkinson's disease.

2:19

Finally,

2:20

here's an FDG PET in a normal individual

2:24

and a fluorodopa PET in a normal individual,

2:27

showing nigral or striatal nigral uptake

2:32

that is rather intense on the Fluorodopa PET.

2:35

But in the Parkinson's patient,

2:37

not only are we able to see it,

2:38

we're also able to qualify and quantify

2:42

the degree of striatal nigral loss

2:46

in this axial specimen or axial

2:49

section from a PET.

2:50

Let's move on, shall we?