Korean J Radiol.  2002 Sep;3(3):180-188. 10.3348/kjr.2002.3.3.180.

Metabolic Alterations in Parkinson's Disease after Thalamotomy, as Revealed by 1H MR Spectroscopy

• Baik HM
• Choe BY
• Lee HK
• Suh TS
• Son BC
• Lee JM

• KMID: 754060
• DOI: http://doi.org/10.3348/kjr.2002.3.3.180

Abstract

OBJECTIVE
To determine, using proton magnetic resonance spectroscopy (1H MRS) whether thalamotomy in patients with Parkinson's disease gives rise to significant changes in regional brain metabolism.
MATERIALS AND METHODS
Fifteen patients each underwent stereotactic thalamotomy for the control of medically refractory parkinsonian tremor. Single-voxel 1H MRS was performed on a 1.5T unit using a STEAM sequence (TR/TM/TE, 2000/14/20 msec), and spectra were obtained from substantia nigra, thalamus and putamen areas, with volumes of interest of 7-8ml, before and after thalamotomy. NAA/Cho, NAA/Cr and Cho/Cr metabolite ratios were calculated from relative peak area measurements, and any changes were recorded and assessed.
RESULTS
In the substantia nigra and thalamus, NAA/Cho ratios were generally low. In the substantia nigra of 80% of patients (12/15) who showed clinical improvement, decreased NAA/Cho ratios were observed in selected voxels after thalamic surgery (p < 0.05). In the thalamus of 67% of such patients (10/15), significant decreases were also noted (p < 0.05).
CONCLUSION
Our results suggest that the NAA/Cho ratio may be a valuable criterion for the evaluation of Parkinson's disease patients who show clinical improvement following surgery. By highlighting variations in this ratio, 1H MRS may help lead to a better understanding of the pathophysiologic processes occurring in those with Parkinson's disease.

Keyword

Parkinson's disease; Thalamotomy; Metabolism; Proton magnetic resonance spectroscopy (1H MRS)

MeSH Terms

Adult
Aged
Aspartic Acid/*analogs & derivatives/metabolism
Brain/*metabolism/pathology
Choline/metabolism
Female
Human
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Male
Middle Age
Parkinson Disease/*metabolism/pathology/*surgery
Protons
Putamen/metabolism/pathology
Substantia Nigra/metabolism/pathology
Thalamus/*metabolism/pathology/*surgery

Figure

• 

  Fig. 1 Typical T2-weighted axial MR images obtained approximately 4 months after stereotactic thalamotomy show no apparent morphologic abnormalities. Voxels of (A) substantia nigra, (B) thalamus, and (C) putamen of the hemisphere that did undergo surgery were selected for localized in-vivo 1H magnetic resonance spectroscopy.

• 

  Fig. 2 In-vivo 1H magnetic resonance spectra obtained before and after thalamotomy from selected voxels of (A) substantia nigra, (B) thalamus, and (C) putamen in patients with Parkinson's disease.

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  Fig. 3 Comparison of NAA/Cho ratios obtained before and after thalamotomy from selected voxels of (A) substantia nigra, (B) thalamus, and (C) putamen in patients with Parkinson's disease. The results indicate significant postoperative metabolic reduction in NAA/Cho ratios in the substantia nigra, thalamus, and putamen of the hemisphere that did undergo surgery.

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