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FluoroDOPA PET shows the nondopaminergic as well as dopaminergic destinations of levodopa

From the Departments of Radiology (Drs. Brown, Holden, and Nickles, and L.M. Malischke), Neurology (Dr. Brown), Medical Physics (Drs. Brown, Taylor, Roberts, Holden, DeJesus, and Nickles, and M.J. Schueller), and Psychology (Drs. Roberts and Oakes), University of Wisconsin—Madison.

Address correspondence and reprint requests to Dr. W. Douglas Brown, Department of Radiology E3/311, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792-3252.

OBJECTIVE: To evaluate the visible and quantitative anatomic distribution of fluorine-18–labeled L-DOPA in the healthy human brain, to thereby expand the understanding of extrastriatal sites of levodopa function, and to provide a broader foundation for clinical and research studies of fluoroDOPA accumulation in patients.

METHODS: The authors performed dynamic three-dimensional fluoroDOPA PET imaging in 10 healthy volunteers and analyzed the images visually and quantitatively. Twenty-eight regions of interest were applied to parametric images of the uptake rate constant (using the multiple-time graphic plot method with cortical input function) and also were used to quantitate regional radioactivity at 80 to 90 minutes. The authors correlated the uptake constants with published human regional neurotransmitter and decarboxylation data.

RESULTS: PET imaging with fluoroDOPA demonstrates trapping of labeled dopamine or its metabolites in substantial quantities in many areas of the brain other than the mesostriatal pathways, including considerable uptake in the serotonergic and noradrenergic areas of the hypothalamus and brainstem as well as in extrastriatal cerebral sites. Total fluoroDOPA uptake correlates best with the sum of catecholamine and indolamine concentrations in the brain and moderately well with regional activity of aromatic L-amino acid decarboxylase, but correlates poorly with extrastriatal dopamine concentration.

CONCLUSION: Neither L-DOPA nor its radiolabeled analog fluoroDOPA is metabolized or accumulates specifically in dopaminergic or even catecholaminergic neurons. Substantial dopamine production within serotonin and norepinephrine neurons may play a role in either therapeutic effects or adverse effects of therapy with L-DOPA.

Key words: FluoroDOPA—Dopamine—Norepinephrine—Serotonin—Positron emission tomography.

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