The Combination of DAT-SPECT, Structural and Diffusion MRI Predicts Clinical Progression in Parkinson’s Disease

There is an increasing interest in identifying non-invasive biomarkers of disease severityand prognosis in idiopathic Parkinson’s disease (PD). Dopamine-transporter SPECT(DAT-SPECT), diffusion tensor imaging (DTI), and structural magnetic resonance imaging(sMRI) provide unique information about the brain’s neurotransmitter and microstructuralproperties. In this study, we evaluate the relative and combined capability of theseimaging modalities to predict symptom severity and clinical progression inde novoPDpatients. To this end, we used MRI, SPECT, and clinical data ofde novodrug-naïvePD patients (n= 205, mean age 61±10) and age-, sex-matched healthy controls(n= 105, mean age 58±12) acquired at baseline. Moreover, we employed clinical dataacquired at 1 year follow-up for PD patients with or withoutL-Dopa treatment in orderto predict the progression symptoms severity. Voxel-based group comparisons andcovariance analyses were applied to characterize baseline disease-related alterations forDAT-SPECT, DTI, and sMRI. Cortical and subcortical alterations inde novoPD patientswere found in all evaluated imaging modalities, in line with previously reported midbrain-striato-cortical network alterations. The combination of these imaging alterations wasreliably linked to clinical severity and disease progression at 1 year follow-up in thispatient population, providing evidence for the potential use of these modalities asimaging biomarkers for disease severity and prognosis that can be integrated intoclinical trials