Substantia Nigra and Parkinsons Disease

The Parkinson's-Reversing Breakthrough

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Idiopathic Parkinson's disease is associated with degeneration of the substantia nigra pars compacta, with selective loss of dopaminergic neurons. It is estimated that at least 60% of the dopaminergic neurons are lost before patients become symptomatic, preceded by 10 to 20 years of early disease progression. Calbindin D 28k immunohistochemical staining of the brainstem can differentiate the subanat-omy of the substantia nigra (Damier et al., 1999), including five different regions termed nigrosomes. Parkinson's disease is characterized by severe focal loss of neurons in the nigrosomes, and progression of the clinical findings corresponds to focal cell loss in these specific regions.

Availability of a noninvasive imaging method to evaluate specific small subdivisions of the substantia nigra with great accuracy would be an essential biomarker in the assessment of Parkinson's disease. Preliminary 8-T phase images suggest that there is a close relationship between the low signal phase regions of the sub-stantia nigra and the calbindin-staining regions. The substantia nigra demonstrated

Fig. 3.64. Axial 8 T gradient echo magnitude (A) and phase (B) image human brainstem (TR/TE/flip angle 600 ms/12 ms/20°, FOV 18 cm, 1024 x 768, 2-mm slice thickness). Note that the margins of the substantia nigra appearing on the phase images are similar to the calbindin stains (C) with flame-like margins.

Fig. 3.64. Axial 8 T gradient echo magnitude (A) and phase (B) image human brainstem (TR/TE/flip angle 600 ms/12 ms/20°, FOV 18 cm, 1024 x 768, 2-mm slice thickness). Note that the margins of the substantia nigra appearing on the phase images are similar to the calbindin stains (C) with flame-like margins.

"flame" margins laterally on the phase images that correlated very well with calbindin staining (Fig. 3.64). Thus, ultrahigh field MRI may become an important new means of evaluating patients with Parkinson's disease.

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