Proton MR Spectroscopy for Diagnosis and Evaluation of Treatment Efficacy in Parkinson Disease

Purpose: To assess the neurochemical profile in the putamen of patients with parkinsonian syndromes undergoing L-3,4-dihydroxyphenylalanine (L-DOPA) treatment (drug-on) or after withdrawal of L-DOPA medication (drug-off) compared with healthy volunteers to identify dopaminergic therapy-sensitive biomarkers of Parkinson disease. Materials and Methods: The local institutional review board approved the study, and all participants gave informed consent. A short echotime (29 msec) single-voxel (1-cm(3)) proton (hydrogen 1 [H-1]) magnetic resonance (MR) spectroscopic approach was used at 3 T to explore the metabolic profile in the putamen of patients with Parkinson disease. Spectra obtained from 20 healthy volunteers were blindly compared with spectra obtained from 20 patients with parkinsonian syndromes in drug-on and drug-off conditions in a randomized permuted block study to assess the accuracy of diagnostic biomarkers for Parkinson disease and efficacy of L-DOPA therapy. The statistical tests were two sided, with a type-I error set at a of.05. Random-effects models were used to compare healthy subjects and patients with parkinsonian syndromes in drug-on or drug-off conditions. Results: Measured concentrations of putaminal total N-acetylaspartate (tNAA) (8.1 +/- 0.2 vs 9.4 +/- 0.4; P < .01), total creatine (tCr) (7.5 +/- 0.2 vs 8.3 +/- 0.3; P < .01), and myo-inositol (m-Ins) (3.8 +/- 0.3 vs 5.6 +/- 0.4; P < .001) were significantly lower in patients with parkinsonian syndromes in drug-off condition than in healthy volunteers. Moreover, L-DOPA therapy restored tNAA (9.1 +/- 0.4 vs 8.1 +/- 0.2; P < .01) and tCr (8.1 +/- 0.3 vs 7.5 +/- 0.2; P < .01) levels, whereas m-Ins levels remained unchanged. The combined glutamate and glutamine and choline showed no changes in drug-off or drug-on condition compared with those in control subjects. Conclusion: tNAA, tCr, and m-Ins were identified as putative biomarkers of Parkinson disease in the putamen of patients. tNAA and tCr levels are responsive to L-DOPA therapy. (C) RSNA, 2015