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Ariz M, Martínez M, Alvarez I, Fernández-Seara MA, Castellanos G, Pastor P, Pastor MA, Ortiz de Solórzano C. Automatic Segmentation and Quantification of Nigrosome-1 Neuromelanin and Iron in MRI: A Candidate Biomarker for Parkinson's Disease. J Magn Reson Imaging 2024; 60:534-547. [PMID: 37915245 DOI: 10.1002/jmri.29073] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND There is a lack of automated tools for the segmentation and quantification of neuromelanin (NM) and iron in the nigrosome-1 (N1). Existing tools evaluate the N1 sign, i.e., the presence or absence of the "swallow-tail" in iron-sensitive MRI, or globally analyze the MRI signal in an area containing the N1, without providing a volumetric delineation. PURPOSE Present an automated method to segment the N1 and quantify differences in N1's NM and iron content between Parkinson's disease (PD) patients and healthy controls (HCs). Study whether N1 degeneration is clinically related to PD and could be used as a biomarker of the disease. STUDY TYPE Prospective. SUBJECTS Seventy-one PD (65.3 ± 10.3 years old, 34 female/37 male); 30 HC (62.7 ± 7.8 years old, 17 female/13 male). FIELD STRENGTH/SEQUENCE 3 T Anatomical T1-weighted MPRAGE, NM-MRI T1-weighted gradient with magnetization transfer, susceptibility-weighted imaging (SWI). ASSESSMENT N1 was automatically segmented in SWI images using a multi-image atlas, populated with healthy N1 structures manually annotated by a neurologist. Relative NM and iron content were quantified and their diagnostic performance assessed and compared with the substantia nigra pars compacta (SNc). The association between image parameters and clinically relevant variables was studied. STATISTICAL TESTS Nonparametric tests were used (Mann-Whitney's U, chi-square, and Friedman tests) at P = 0.05. RESULTS N1's relative NM content decreased and relative iron content increased in PD patients compared with HCs (NM-CRHC = 22.55 ± 1.49; NM-CRPD = 19.79 ± 1.92; NM-nVolHC = 2.69 × 10-5 ± 1.02 × 10-5; NM-nVolPD = 1.18 × 10-5 ± 0.96 × 10-5; Iron-CRHC = 10.51 ± 2.64; Iron-CRPD = 19.35 ± 7.88; Iron-nVolHC = 0.72 × 10-5 ± 0.81 × 10-5; Iron-nVolPD = 2.82 × 10-5 ± 2.04 × 10-5). Binary logistic regression analyses combining N1 and SNc image parameters yielded a top AUC = 0.955. Significant correlation was found between most N1 parameters and both disease duration (ρNM-CR = -0.31; ρiron-CR = 0.43; ρiron-nVol = 0.46) and the motor status (ρNM-nVol = -0.27; ρiron-CR = 0.33; ρiron-nVol = 0.28), suggesting NM reduction along with iron accumulation in N1 as the disease progresses. DATA CONCLUSION This method provides a fully automatic N1 segmentation, and the analyses performed reveal that N1 relative NM and iron quantification improves diagnostic performance and suggest a relative NM reduction along with a relative iron accumulation in N1 as the disease progresses. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Mikel Ariz
- Ciberonc and Biomedical Engineering Program, CIMA University of Navarra, Pamplona, Spain
- Department of Electrical, Electronic and Communications Engineering, Public University of Navarre, Pamplona, Spain
| | - Martín Martínez
- Neuroimaging Laboratory, University of Navarra, School of Medicine, Pamplona, Spain
| | - Ignacio Alvarez
- Movement Disorders Unit, Neurology, University Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Maria A Fernández-Seara
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Gabriel Castellanos
- Department of Physiological Sciences, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pau Pastor
- Unit of Neurodegenerative Diseases, Department of Neurology, University Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Maria A Pastor
- Neuroimaging Laboratory, University of Navarra, School of Medicine, Pamplona, Spain
- Movement Disorders Unit, Neurology, University of Navarra, Pamplona, Spain
| | - Carlos Ortiz de Solórzano
- Ciberonc and Biomedical Engineering Program, CIMA University of Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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Alushaj E, Hemachandra D, Ganjavi H, Seergobin KN, Sharma M, Kashgari A, Barr J, Reisman W, Khan AR, MacDonald PA. Increased mean diffusivity of the caudal motor SNc identifies patients with REM sleep behaviour disorder and Parkinson's disease. NPJ Parkinsons Dis 2024; 10:128. [PMID: 38951528 PMCID: PMC11217278 DOI: 10.1038/s41531-024-00731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
Idiopathic rapid eye movement sleep behaviour disorder (iRBD)-a Parkinson's disease (PD) prodrome-might exhibit neural changes similar to those in PD. Substantia nigra pars compacta (SNc) degeneration underlies motor symptoms of PD. In iRBD and early PD (ePD), we measured diffusion MRI (dMRI) in the caudal motor SNc, which overlaps the nigrosome-1-the earliest-degenerating dopaminergic neurons in PD-and in the striatum. Nineteen iRBD, 26 ePD (1.7 ± 0.03 years), and 46 age-matched healthy controls (HCs) were scanned at Western University, and 47 iRBD, 115 ePD (0.9 ± 0.01 years), and 56 HCs were scanned through the Parkinson's Progression Markers Initiative, using 3T MRI. We segmented the SNc and striatum into subregions using automated probabilistic tractography to the cortex. We measured mean diffusivity (MD) and fractional anisotropy (FA) along white-matter bundles and subregional surfaces. We performed group-level and classification analyses. Increased caudal motor SNc surface MD was the only iRBD-HCs and ePD-HCs difference replicating across datasets (padj < 0.05). No iRBD-ePD differences emerged. Caudal motor SNc surface MD classified patient groups from HCs at the single-subject level with good-to-excellent balanced accuracy in an independent sample (0.91 iRBD and 0.86 iRBD and ePD combined), compared to fair performance for total SNc surface MD (0.72 iRBD and ePD). Caudal motor SNc surface MD correlated significantly with MDS-UPDRS-III scores in ePD patients. Using dMRI and automated segmentation, we detected changes suggesting altered microstructural integrity in iRBD and ePD in the nigrostriatal subregion known to degenerate first in PD. Surface MD of the caudal motor SNc presents a potential measure for inclusion in neuroimaging biomarkers of iRBD and PD.
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Affiliation(s)
- Erind Alushaj
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Western Institute for Neuroscience, Western University, London, ON, Canada
| | - Dimuthu Hemachandra
- Robarts Research Institute, Western University, London, ON, Canada
- School of Biomedical Engineering, Western University, London, ON, Canada
| | - Hooman Ganjavi
- Department of Psychiatry, Western University, London, ON, Canada
| | - Ken N Seergobin
- Western Institute for Neuroscience, Western University, London, ON, Canada
| | - Manas Sharma
- Department of Radiology, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Alia Kashgari
- Department of Medicine, Respirology Division, Western University, London, ON, Canada
| | - Jennifer Barr
- Department of Psychiatry, Western University, London, ON, Canada
| | - William Reisman
- Department of Medicine, Respirology Division, Western University, London, ON, Canada
| | - Ali R Khan
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Penny A MacDonald
- Western Institute for Neuroscience, Western University, London, ON, Canada.
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.
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Alushaj E, Handfield-Jones N, Kuurstra A, Morava A, Menon RS, Owen AM, Sharma M, Khan AR, MacDonald PA. Increased iron in the substantia nigra pars compacta identifies patients with early Parkinson'sdisease: A 3T and 7T MRI study. Neuroimage Clin 2024; 41:103577. [PMID: 38377722 PMCID: PMC10944193 DOI: 10.1016/j.nicl.2024.103577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
Degeneration in the substantia nigra (SN) pars compacta (SNc) underlies motor symptoms in Parkinson's disease (PD). Currently, there are no neuroimaging biomarkers that are sufficiently sensitive, specific, reproducible, and accessible for routine diagnosis or staging of PD. Although iron is essential for cellular processes, it also mediates neurodegeneration. MRI can localize and quantify brain iron using magnetic susceptibility, which could potentially provide biomarkers of PD. We measured iron in the SNc, SN pars reticulata (SNr), total SN, and ventral tegmental area (VTA), using quantitative susceptibility mapping (QSM) and R2* relaxometry, in PD patients and age-matched healthy controls (HCs). PD patients, diagnosed within five years of participation and HCs were scanned at 3T (22 PD and 23 HCs) and 7T (17 PD and 21 HCs) MRI. Midbrain nuclei were segmented using a probabilistic subcortical atlas. QSM and R2* values were measured in midbrain subregions. For each measure, groups were contrasted, with Age and Sex as covariates, and receiver operating characteristic (ROC) curve analyses were performed with repeated k-fold cross-validation to test the potential of our measures to classify PD patients and HCs. Statistical differences of area under the curves (AUCs) were compared using the Hanley-MacNeil method (QSM versus R2*; 3T versus 7T MRI). PD patients had higher QSM values in the SNc at both 3T (padj = 0.001) and 7T (padj = 0.01), but not in SNr, total SN, or VTA, at either field strength. No significant group differences were revealed using R2* in any midbrain region at 3T, though increased R2* values in SNc at 7T MRI were marginally significant in PDs compared to HCs (padj = 0.052). ROC curve analyses showed that SNc iron measured with QSM, distinguished early PD patients from HCs at the single-subject level with good diagnostic accuracy, using 3T (mean AUC = 0.83, 95 % CI = 0.82-0.84) and 7T (mean AUC = 0.80, 95 % CI = 0.79-0.81) MRI. Mean AUCs reported here are from averages of tests in the hold-out fold of cross-validated samples. The Hanley-MacNeil method demonstrated that QSM outperforms R2* in discriminating PD patients from HCs at 3T, but not 7T. There were no significant differences between 3T and 7T in diagnostic accuracy of QSM values in SNc. This study highlights the importance of segmenting midbrain subregions, performed here using a standardized atlas, and demonstrates high accuracy of SNc iron measured with QSM at 3T MRI in identifying early PD patients. QSM measures of SNc show potential for inclusion in neuroimaging diagnostic biomarkers of early PD. An MRI diagnostic biomarker of PD would represent a significant clinical advance.
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Affiliation(s)
- Erind Alushaj
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada; Western Institute for Neuroscience, Western University, London, Ontario N6A 3K7, Canada
| | - Nicholas Handfield-Jones
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada; Western Institute for Neuroscience, Western University, London, Ontario N6A 3K7, Canada
| | - Alan Kuurstra
- Robarts Research Institute, Western University, London, Ontario N6A 3K7, Canada; Department of Medical Biophysics, Western University, London, Ontario N6A 3K7, Canada
| | - Anisa Morava
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario N6A 3K7, Canada
| | - Ravi S Menon
- Robarts Research Institute, Western University, London, Ontario N6A 3K7, Canada; Department of Medical Biophysics, Western University, London, Ontario N6A 3K7, Canada
| | - Adrian M Owen
- Western Institute for Neuroscience, Western University, London, Ontario N6A 3K7, Canada; Department of Physiology and Pharmacology, Western University, London, Ontario N6A 3K7, Canada
| | - Manas Sharma
- Department of Radiology, Western University, London, Ontario N6A 3K7, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario N6A 3K7, Canada
| | - Ali R Khan
- Robarts Research Institute, Western University, London, Ontario N6A 3K7, Canada; Department of Medical Biophysics, Western University, London, Ontario N6A 3K7, Canada
| | - Penny A MacDonald
- Western Institute for Neuroscience, Western University, London, Ontario N6A 3K7, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario N6A 3K7, Canada.
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Trujillo P, Aumann MA, Claassen DO. Neuromelanin-sensitive MRI as a promising biomarker of catecholamine function. Brain 2024; 147:337-351. [PMID: 37669320 PMCID: PMC10834262 DOI: 10.1093/brain/awad300] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/17/2023] [Accepted: 08/20/2023] [Indexed: 09/07/2023] Open
Abstract
Disruptions to dopamine and noradrenergic neurotransmission are noted in several neurodegenerative and psychiatric disorders. Neuromelanin-sensitive (NM)-MRI offers a non-invasive approach to visualize and quantify the structural and functional integrity of the substantia nigra and locus coeruleus. This method may aid in the diagnosis and quantification of longitudinal changes of disease and could provide a stratification tool for predicting treatment success of pharmacological interventions targeting the dopaminergic and noradrenergic systems. Given the growing clinical interest in NM-MRI, understanding the contrast mechanisms that generate this signal is crucial for appropriate interpretation of NM-MRI outcomes and for the continued development of quantitative MRI biomarkers that assess disease severity and progression. To date, most studies associate NM-MRI measurements to the content of the neuromelanin pigment and/or density of neuromelanin-containing neurons, while recent studies suggest that the main source of the NM-MRI contrast is not the presence of neuromelanin but the high-water content in the dopaminergic and noradrenergic neurons. In this review, we consider the biological and physical basis for the NM-MRI contrast and discuss a wide range of interpretations of NM-MRI. We describe different acquisition and image processing approaches and discuss how these methods could be improved and standardized to facilitate large-scale multisite studies and translation into clinical use. We review the potential clinical applications in neurological and psychiatric disorders and the promise of NM-MRI as a biomarker of disease, and finally, we discuss the current limitations of NM-MRI that need to be addressed before this technique can be utilized as a biomarker and translated into clinical practice and offer suggestions for future research.
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Affiliation(s)
- Paula Trujillo
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Megan A Aumann
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
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Langley J, Hwang KS, Huddleston DE, Hu XP. Nigral volume loss in prodromal, early, and moderate Parkinson's disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.19.23294281. [PMID: 37645770 PMCID: PMC10462207 DOI: 10.1101/2023.08.19.23294281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The loss of melanized neurons in the substantia nigra pars compacta (SNc) is a hallmark pathology in Parkinson's disease (PD). Melanized neurons in SNc can be visualized in vivo using magnetization transfer (MT) effects. Nigral volume was extracted in data acquired with a MT-prepared gradient echo sequence in 33 controls, 83 non-manifest carriers (42 LRRK2 and 41 GBA nonmanifest carriers), 65 prodromal hyposmic participants, 105 de novo PD patients and 26 48-month PD patients from the Parkinson's Progressive Markers Initiative. No difference in nigral volume was seen between controls and LRRK2 and GBA non-manifest carriers (F=0.076; P=0.927). A significant main effect in group was observed between controls, prodromal hyposmic participants, and overt PD patients (F=5.192; P=0.002). Longer disease duration significantly correlated with lower nigral volume (r=-0.252; P=0.010). This study shows that nigral depigmentation can be robustly detected in prodromal hyposmic participants and overt PD patients.
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Affiliation(s)
- Jason Langley
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, CA, USA
| | - Kristy S. Hwang
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | | | - Xiaoping P. Hu
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, CA, USA
- Department of Bioengineering, University of California Riverside, Riverside, CA, USA
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Huddleston DE, Chen X, Hwang K, Langley J, Tripathi R, Tucker K, McKay JL, Hu X, Factor SA. Neuromelanin-sensitive MRI correlates of cognitive and motor function in Parkinson's disease with freezing of gait. FRONTIERS IN DEMENTIA 2023; 2:1215505. [PMID: 39082000 PMCID: PMC11285586 DOI: 10.3389/frdem.2023.1215505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2024]
Abstract
Substantia nigra pars compacta (SNc) and locus coeruleus (LC) are neuromelanin-rich nuclei implicated in diverse cognitive and motor processes in normal brain function and disease. However, their roles in aging and neurodegenerative disease mechanisms have remained unclear due to a lack of tools to study them in vivo. Preclinical and post-mortem human investigations indicate that the relationship between tissue neuromelanin content and neurodegeneration is complex. Neuromelanin exhibits both neuroprotective and cytotoxic characteristics, and tissue neuromelanin content varies across the lifespan, exhibiting an inverted U-shaped relationship with age. Neuromelanin-sensitive MRI (NM-MRI) is an emerging modality that allows measurement of neuromelanin-associated contrast in SNc and LC in humans. NM-MRI robustly detects disease effects in these structures in neurodegenerative conditions, including Parkinson's disease (PD). Previous NM-MRI studies of PD have largely focused on detecting disease group effects, but few studies have reported NM-MRI correlations with phenotype. Because neuromelanin dynamics are complex, we hypothesize that they are best interpreted in the context of both disease stage and aging, with neuromelanin loss correlating with symptoms most clearly in advanced stages where neuromelanin loss and neurodegeneration are coupled. We tested this hypothesis using NM-MRI to measure SNc and LC volumes in healthy older adult control individuals and in PD patients with and without freezing of gait (FOG), a severe and disabling PD symptom. We assessed for group differences and correlations between NM-MRI measures and aging, cognition and motor deficits. SNc volume was significantly decreased in PD with FOG compared to controls. SNc volume correlated significantly with motor symptoms and cognitive measures in PD with FOG, but not in PD without FOG. SNc volume correlated significantly with aging in PD. When PD patients were stratified by disease duration, SNc volume correlated with aging, cognition, and motor deficits only in PD with disease duration >5 years. We conclude that in severe or advanced PD, identified by either FOG or disease duration >5 years, the observed correlations between SNc volume and aging, cognition, and motor function may reflect the coupling of neuromelanin loss with neurodegeneration and the associated emergence of a linear relationship between NM-MRI measures and phenotype.
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Affiliation(s)
- Daniel E. Huddleston
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, United States
| | - Xiangchuan Chen
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, United States
| | - Kristy Hwang
- Department of Neurology, University of California, San Diego, La Jolla, CA, United States
| | - Jason Langley
- Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, United States
| | - Richa Tripathi
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, United States
| | - Kelsey Tucker
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, United States
| | - J. Lucas McKay
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, United States
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States
| | - Xiaoping Hu
- Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, United States
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, United States
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Huddleston DE, Chen X, Hwang K, Langley J, Tripathi R, Tucker K, McKay JL, Hu X, Factor SA. Neuromelanin-sensitive MRI correlates of cognitive and motor function in Parkinson's disease with freezing of gait. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.04.23292227. [PMID: 37461735 PMCID: PMC10350131 DOI: 10.1101/2023.07.04.23292227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Substantia nigra pars compacta (SNc) and locus coeruleus (LC) are neuromelanin-rich nuclei implicated in diverse cognitive and motor processes in normal brain function and disease. However, their roles in aging and neurodegenerative disease mechanisms have remained unclear due to a lack of tools to study them in vivo. Preclinical and post-mortem human investigations indicate that the relationship between tissue neuromelanin content and neurodegeneration is complex. Neuromelanin exhibits both neuroprotective and cytotoxic characteristics, and tissue neuromelanin content varies across the lifespan, exhibiting an inverted U-shaped relationship with age. Neuromelanin-sensitive MRI (NM-MRI) is an emerging modality that allows measurement of neuromelanin-associated contrast in SNc and LC in humans. NM-MRI robustly detects disease effects in these structures in neurodegenerative and psychiatric conditions, including Parkinson's disease (PD). Previous NM-MRI studies of PD have largely focused on detecting disease group effects, but few studies have reported NM-MRI correlations with phenotype. Because neuromelanin dynamics are complex, we hypothesize that they are best interpreted in the context of both disease stage and aging, with neuromelanin loss correlating with symptoms most clearly in advanced stages where neuromelanin loss and neurodegeneration are coupled. We tested this hypothesis using NM-MRI to measure SNc and LC volumes in healthy older adult control individuals and in PD patients with and without freezing of gait (FOG), a severe and disabling PD symptom. We assessed for group differences and correlations between NM-MRI measures and aging, cognition and motor deficits. SNc volume was significantly decreased in PD with FOG compared to controls. SNc volume correlated significantly with motor symptoms and cognitive measures in PD with FOG, but not in PD without FOG. SNc volume correlated significantly with aging in PD. When PD patients were stratified by disease duration, SNc volume correlated with aging, cognition, and motor deficits only in PD with disease duration >5 years. We conclude that in severe or advanced PD, identified by either FOG or disease duration >5 years, the observed correlations between SNc volume and aging, cognition, and motor function may reflect the coupling of neuromelanin loss with neurodegeneration and the associated emergence of a linear relationship between NM-MRI measures and phenotype.
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Affiliation(s)
- Daniel E. Huddleston
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
| | - Xiangchuan Chen
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
| | - Kristy Hwang
- Department of Neurology, University of California, San Diego
| | - Jason Langley
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, CA, USA
| | - Richa Tripathi
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
| | - Kelsey Tucker
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
| | - J. Lucas McKay
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA
| | - Xiaoping Hu
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, CA, USA
- Department of Bioengineering, University of California Riverside, Riverside, CA, USA
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University, Atlanta, GA, USA
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Martínez M, Ariz M, Alvarez I, Castellanos G, Aguilar M, Hernández-Vara J, Caballol N, Garrido A, Bayés À, Vilas D, Marti MJ, Pastor P, de Solórzano CO, Pastor MA. Brainstem neuromelanin and iron MRI reveals a precise signature for idiopathic and LRRK2 Parkinson's disease. NPJ Parkinsons Dis 2023; 9:62. [PMID: 37061532 PMCID: PMC10105708 DOI: 10.1038/s41531-023-00503-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/24/2023] [Indexed: 04/17/2023] Open
Abstract
Neuromelanin (NM) loss in substantia nigra pars compacta (SNc) and locus coeruleus (LC) reflects neuronal death in Parkinson's disease (PD). Since genetically-determined PD shows varied clinical expressivity, we wanted to accurately quantify and locate brainstem NM and iron, to discover whether specific MRI patterns are linked to Leucine-rich repeat kinase 2 G2019S PD (LRRK2-PD) or idiopathic Parkinson's disease (iPD). A 3D automated MRI atlas-based segmentation pipeline (3D-ABSP) for NM/iron-sensitive MRI images topographically characterized the SNc, LC, and red nucleus (RN) neuronal loss and calculated NM/iron contrast ratio (CR) and normalized volume (nVol). Left-side NM nVol was larger in all groups. PD had lower NM CR and nVol in ventral-caudal SNc, whereas iron increased in lateral, medial-rostral, and caudal SNc. The SNc NM CR reduction was associated with psychiatric symptoms. LC CR and nVol discriminated better among subgroups: LRRK2-PD had similar LC NM CR and nVol as that of controls, and larger LC NM nVol and RN iron CR than iPD. PD showed higher iron SNc nVol than controls, especially among LRRK2-PD. ROC analyses showed an AUC > 0.92 for most pairwise subgroup comparisons, with SNc NM being the best discriminator between HC and PD. NM measures maintained their discriminator power considering the subgroup of PD patients with less than 5 years of disease duration. The SNc iron CR and nVol increase was associated with longer disease duration in PD patients. The 3D-ABSP sensitively identified NM and iron MRI patterns strongly correlated with phenotypic PD features.
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Affiliation(s)
- Martín Martínez
- Neuroimaging Laboratory, University of Navarra, School of Medicine, Pamplona, Spain
- School of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Mikel Ariz
- Ciberonc and Solid Tumours and Biomarkers Program, CIMA University of Navarra, Pamplona, Spain
| | - Ignacio Alvarez
- Movement Disorders Unit, Neurology, University Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Gabriel Castellanos
- Department of Physiological Sciences, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Miquel Aguilar
- Movement Disorders Unit, Neurology, University Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Jorge Hernández-Vara
- Neurology Department, Hospital Universitari Vall D´Hebron, Neurodegenerative Diseases Research Group, Vall D'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Núria Caballol
- Department of Neurology, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
- Parkinson and Movement disorders Unit, Hospital Quirón-Teknon, Barcelona, Spain
| | - Alicia Garrido
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, IDIBAPS, CIBERNED, Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas: CB06/05/0018-ISCIII), ERN-RND Hospital Clínic i Provincial de Barcelona, Barcelona, Catalonia, Spain
- Department of Medicine & Institut de Neurociències of the University of Barcelona, Barcelona, Catalonia, Spain
| | - Àngels Bayés
- Parkinson and Movement disorders Unit, Hospital Quirón-Teknon, Barcelona, Spain
| | - Dolores Vilas
- Unit of Neurodegenerative diseases, Department of Neurology, University Hospital Germans Trias i Pujol, Badalona, Spain
- Neurosciences, The Germans Trias i Pujol Research Institute (IGTP) Badalona, Badalona, Catalonia, Spain
| | - Maria Jose Marti
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, IDIBAPS, CIBERNED, Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas: CB06/05/0018-ISCIII), ERN-RND Hospital Clínic i Provincial de Barcelona, Barcelona, Catalonia, Spain
- Department of Medicine & Institut de Neurociències of the University of Barcelona, Barcelona, Catalonia, Spain
| | - Pau Pastor
- Unit of Neurodegenerative diseases, Department of Neurology, University Hospital Germans Trias i Pujol, Badalona, Spain.
- Neurosciences, The Germans Trias i Pujol Research Institute (IGTP) Badalona, Badalona, Catalonia, Spain.
| | | | - Maria A Pastor
- Neuroimaging Laboratory, University of Navarra, School of Medicine, Pamplona, Spain.
- Neurosciences, School of Medicine, University of Navarra, Pamplona, Spain.
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9
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Abstract
The midbrain dopamine (mDA) system is composed of molecularly and functionally distinct neuron subtypes that mediate specific behaviours and are linked to various brain diseases. Considerable progress has been made in identifying mDA neuron subtypes, and recent work has begun to unveil how these neuronal subtypes develop and organize into functional brain structures. This progress is important for further understanding the disparate physiological functions of mDA neurons and their selective vulnerability in disease, and will ultimately accelerate therapy development. This Review discusses recent advances in our understanding of molecularly defined mDA neuron subtypes and their circuits, ranging from early developmental events, such as neuron migration and axon guidance, to their wiring and function, and future implications for therapeutic strategies.
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10
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Jokar M, Jin Z, Huang P, Wang Y, Zhang Y, Li Y, Cheng Z, Liu Y, Tang R, Shi X, Min J, Liu F, Chen S, He N, Haacke EM, Yan F. Diagnosing Parkinson's disease by combining neuromelanin and iron imaging features using an automated midbrain template approach. Neuroimage 2023; 266:119814. [PMID: 36528314 DOI: 10.1016/j.neuroimage.2022.119814] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 12/01/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Early diagnosis of Parkinson's disease (PD) is still a clinical challenge. Most previous studies using manual or semi-automated methods for segmenting the substantia nigra (SN) are time-consuming and, despite raters being well-trained, individual variation can be significant. In this study, we used a template-based, automatic, SN subregion segmentation pipeline to detect the neuromelanin (NM) and iron features in the SN and SN pars compacta (SNpc) derived from a single 3D magnetization transfer contrast (MTC) gradient echo (GRE) sequence in an attempt to develop a comprehensive imaging biomarker that could be used to diagnose PD. MATERIALS AND METHODS A total of 100 PD patients and 100 age- and sex-matched healthy controls (HCs) were imaged on a 3T scanner. NM-based SN (SNNM) boundaries and iron-based SN (SNQSM) boundaries and their overlap region (representing the SNpc) were delineated automatically using a template-based SN subregion segmentation approach based on quantitative susceptibility mapping (QSM) and NM images derived from the same MTC-GRE sequence. All PD and HC subjects were evaluated for the nigrosome-1 (N1) sign by two raters independently. Receiver Operating Characteristic (ROC) analyses were performed to evaluate the utility of SNNM volume, SNQSM volume, SNpc volume and iron content with a variety of thresholds as well as the N1 sign in diagnosing PD. Correlation analyses were performed to study the relationship between these imaging measures and the clinical scales in PD. RESULTS In this study, we verified the value of the fully automatic template based midbrain deep gray matter mapping approach in differentiating PD patients from HCs. The automatic segmentation of the SN in PD patients led to satisfactory DICE similarity coefficients and volume ratio (VR) values of 0.81 and 1.17 for the SNNM, and 0.87 and 1.05 for the SNQSM, respectively. For the HC group, the average DICE similarity coefficients and VR values were 0.85 and 0.94 for the SNNM, and 0.87 and 0.96 for the SNQSM, respectively. The SNQSM volume tended to decrease with age for both the PD and HC groups but was more severe for the PD group. For diagnosing PD, the N1 sign performed reasonably well by itself (Area Under the Curve (AUC) = 0.783). However, combining the N1 sign with the other quantitative measures (SNNM volume, SNQSM volume, SNpc volume and iron content) resulted in an improved diagnosis of PD with an AUC as high as 0.947 (using an SN threshold of 50ppb and an NM threshold of 0.15). Finally, the SNQSM volume showed a negative correlation with the MDS-UPDRS III (R2 = 0.1, p = 0.036) and the Hoehn and Yahr scale (R2 = 0.04, p = 0.013) in PD patients. CONCLUSION In summary, this fully automatic template based deep gray matter mapping approach performs well in the segmentation of the SN and its subregions for not only HCs but also PD patients with SN degeneration. The combination of the N1 sign with other quantitative measures (SNNM volume, SNQSM volume, SNpc volume and iron content) resulted in an AUC of 0.947 and provided a comprehensive set of imaging biomarkers that, potentially, could be used to diagnose PD clinically.
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Affiliation(s)
| | - Zhijia Jin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China
| | - Pei Huang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China
| | - Ying Wang
- SpinTech MRI, Inc., Bingham Farms, MI, USA; Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Youmin Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China
| | - Yan Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China
| | - Zenghui Cheng
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China
| | - Yu Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China
| | - Rongbiao Tang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China
| | - Xiaofeng Shi
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China
| | - Jihua Min
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China
| | - Fangtao Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China
| | - Shengdi Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
| | - E Mark Haacke
- SpinTech MRI, Inc., Bingham Farms, MI, USA; Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China; Department of Radiology, Wayne State University, Detroit, MI, USA; Department of Neurology, Wayne State University, Detroit, MI, USA.
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
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11
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He N, Chen Y, LeWitt PA, Yan F, Haacke EM. Application of Neuromelanin MR Imaging in Parkinson Disease. J Magn Reson Imaging 2023; 57:337-352. [PMID: 36017746 PMCID: PMC10086789 DOI: 10.1002/jmri.28414] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 01/20/2023] Open
Abstract
MRI has been used to develop biomarkers for movement disorders such as Parkinson disease (PD) and other neurodegenerative disorders with parkinsonism such as progressive supranuclear palsy and multiple system atrophy. One of these imaging biomarkers is neuromelanin (NM), whose integrity can be assessed from its contrast and volume. NM is found mainly in certain brain stem structures, namely, the substantia nigra pars compacta (SNpc), the ventral tegmental area, and the locus coeruleus. Another major biomarker is brain iron, which often increases in concert with NM degeneration. These biomarkers have the potential to improve diagnostic certainty in differentiating between PD and other neurodegenerative disorders similar to PD, as well as provide a better understanding of pathophysiology. Mapping NM in vivo has clinical importance for gauging the premotor phase of PD when there is a greater than 50% loss of dopaminergic SNpc melanized neurons. As a metal ion chelator, NM can absorb iron. When NM is released from neurons, it deposits iron into the intracellular tissues of the SNpc; the result is iron that can be imaged and measured using quantitative susceptibility mapping. An increase of iron also leads to the disappearance of the nigrosome-1 sign, another neuroimage biomarker for PD. Therefore, mapping NM and iron changes in the SNpc are a practical means for improving early diagnosis of PD and in monitoring disease progression. In this review, we discuss the functions and location of NM, how NM-MRI is performed, the automatic mapping of NM and iron content, how NM-related imaging biomarkers can be used to enhance PD diagnosis and differentiate it from other neurodegenerative disorders, and potential advances in NM imaging methods. With major advances currently evolving for rapid imaging and artificial intelligence, NM-related biomarkers are likely to have increasingly important roles for enhancing diagnostic capabilities in PD. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Yongsheng Chen
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Peter A LeWitt
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Neurology, Henry Ford Hospital, Parkinson's Disease and Movement Disorders Program, Detroit, Michigan, USA
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - E Mark Haacke
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China.,Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Radiology, Wayne State University School of Medicine, Detroit, Michigan, USA.,SpinTech, Inc, Bingham Farms, Michigan, USA
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12
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Hwang KS, Langley J, Tripathi R, Hu XP, Huddleston DE. In vivo detection of substantia nigra and locus coeruleus volume loss in Parkinson's disease using neuromelanin-sensitive MRI: Replication in two cohorts. PLoS One 2023; 18:e0282684. [PMID: 37053195 PMCID: PMC10101455 DOI: 10.1371/journal.pone.0282684] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/20/2023] [Indexed: 04/14/2023] Open
Abstract
Patients with Parkinson's disease undergo a loss of melanized neurons in substantia nigra pars compacta and locus coeruleus. Very few studies have assessed substantia nigra pars compacta and locus coeruleus pathology in Parkinson's disease simultaneously with magnetic resonance imaging (MRI). Neuromelanin-sensitive MRI measures of substantia nigra pars compacta and locus coeruleus volume based on explicit magnetization transfer contrast have been shown to have high scan-rescan reproducibility in controls, but no study has replicated detection of Parkinson's disease-associated volume loss in substantia nigra pars compacta and locus coeruleus in multiple cohorts with the same methodology. Two separate cohorts of Parkinson's disease patients and controls were recruited from the Emory Movement Disorders Clinic and scanned on two different MRI scanners. In cohort 1, imaging data from 19 controls and 22 Parkinson's disease patients were acquired with a Siemens Trio 3 Tesla scanner using a 2D gradient echo sequence with magnetization transfer preparation pulse. Cohort 2 consisted of 33 controls and 39 Parkinson's disease patients who were scanned on a Siemens Prisma 3 Tesla scanner with a similar imaging protocol. Locus coeruleus and substantia nigra pars compacta volumes were segmented in both cohorts. Substantia nigra pars compacta volume (Cohort 1: p = 0.0148; Cohort 2: p = 0.0011) and locus coeruleus volume (Cohort 1: p = 0.0412; Cohort 2: p = 0.0056) were significantly reduced in the Parkinson's disease group as compared to controls in both cohorts. This imaging approach robustly detects Parkinson's disease effects on these structures, indicating that it is a promising marker for neurodegenerative neuromelanin loss.
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Affiliation(s)
- Kristy S Hwang
- Department of Neurosciences, University of California San Diego, San Diego, California, United States of America
| | - Jason Langley
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, California, United States of America
| | - Richa Tripathi
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States of America
| | - Xiaoping P Hu
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, California, United States of America
- Department of Bioengineering, University of California Riverside, Riverside, California, United States of America
| | - Daniel E Huddleston
- Department of Neurology, Emory University,Atlanta, Georgia, United States of America
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13
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Ji S, Choi EJ, Sohn B, Baik K, Shin NY, Moon WJ, Park S, Song S, Lee PH, Shin DH, Oh SH, Kim EY, Lee J. Sandwich spatial saturation for neuromelanin-sensitive MRI: Development and multi-center trial. Neuroimage 2022; 264:119706. [PMID: 36349597 DOI: 10.1016/j.neuroimage.2022.119706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/09/2022] [Accepted: 10/20/2022] [Indexed: 11/08/2022] Open
Abstract
Neuromelanin (NM)-sensitive MRI using a magnetization transfer (MT)-prepared T1-weighted sequence has been suggested as a tool to visualize NM contents in the brain. In this study, a new NM-sensitive imaging method, sandwichNM, is proposed by utilizing the incidental MT effects of spatial saturation RF pulses in order to generate consistent high-quality NM images using product sequences. The spatial saturation pulses are located both superior and inferior to the imaging volume, increasing MT weighting while avoiding asymmetric MT effects. When the parameters of the spatial saturation were optimized, sandwichNM reported a higher NM contrast ratio than those of conventional NM-sensitive imaging methods with matched parameters for comparability with sandwichNM (SandwichNM: 23.6 ± 5.4%; MT-prepared TSE: 20.6 ± 7.4%; MT-prepared GRE: 17.4 ± 6.0%). In a multi-vendor experiment, the sandwichNM images displayed higher means and lower standard deviations of the NM contrast ratio across subjects in all three vendors (SandwichNM vs. MT-prepared GRE; Vendor A: 28.4 ± 1.5% vs. 24.4 ± 2.8%; Vendor B: 27.2 ± 1.0% vs. 13.3 ± 1.3%; Vendor C: 27.3 ± 0.7% vs. 20.1 ± 0.9%). For each subject, the standard deviations of the NM contrast ratio across the vendors were substantially lower in SandwichNM (SandwichNM vs. MT-prepared GRE; subject 1: 1.5% vs. 8.1%, subject 2: 1.1 % vs. 5.1%, subject 3: 0.9% vs. 4.0%, subject 4: 1.1% vs. 5.3%), demonstrating consistent contrasts across the vendors. The proposed method utilizes product sequences, requiring no alteration of a sequence and, therefore, may have a wide practical utility in exploring the NM imaging.
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Affiliation(s)
- Sooyeon Ji
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea
| | - Eun-Jung Choi
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea
| | - Beomseok Sohn
- Department of Radiology, Severance Hospital, Seoul, Republic of Korea
| | - Kyoungwon Baik
- Department of Radiology, Severance Hospital, Seoul, Republic of Korea
| | - Na-Young Shin
- Department of Radiology, Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | | | | | - Phil Hyu Lee
- Department of Neurology, Severance Hospital, Seoul, Republic of Korea
| | | | - Se-Hong Oh
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Gyeonggi-do, Republic of Korea
| | - Eung Yeop Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
| | - Jongho Lee
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea.
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14
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Langley J, Hwang KS, Hu XP, Huddleston DE. Nigral volumetric and microstructural measures in individuals with scans without evidence of dopaminergic deficit. Front Neurosci 2022; 16:1048945. [PMID: 36507343 PMCID: PMC9731284 DOI: 10.3389/fnins.2022.1048945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/28/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Striatal dopamine transporter (DAT) imaging using 123I-ioflupane single photon positron emitted computed tomography (SPECT) (DaTScan, GE) identifies 5-20% of newly diagnosed Parkinson's disease (PD) subjects enrolling in clinical studies to have scans without evidence of dopaminergic deficit (SWEDD). These individuals meet diagnostic criteria for PD, but do not clinically progress as expected, and they are not believed to have neurodegenerative Parkinsonism. Inclusion of SWEDD participants in PD biomarker studies or therapeutic trials may therefore cause them to fail. DaTScan can identify SWEDD individuals, but it is expensive and not widely available; an alternative imaging approach is needed. Here, we evaluate the use of neuromelanin-sensitive, iron-sensitive, and diffusion contrasts in substantia nigra pars compacta (SNpc) to differentiate SWEDD from PD individuals. Methods Neuromelanin-sensitive, iron-sensitive, and diffusion imaging data for SWEDD, PD, and control subjects were downloaded from the Parkinson's progression markers initiative (PPMI) database. SNpc volume, SNpc iron (R 2), and SNpc free water (FW) were measured for each participant. Results Significantly smaller SNpc volume was seen in PD as compared to SWEDD (P < 10-3) and control (P < 10-3) subjects. SNpc FW was elevated in the PD group relative to controls (P = 0.017). No group difference was observed in SNpc R 2. Conclusion In conclusion, nigral volume and FW in the SWEDD group were similar to that of controls, while a reduction in nigral volume and increased FW were observed in the PD group relative to SWEDD and control participants. These results suggest that these MRI measures should be explored as a cost-effective alternative to DaTScan for evaluation of the nigrostriatal system.
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Affiliation(s)
- Jason Langley
- Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, United States
| | - Kristy S. Hwang
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Xiaoping P. Hu
- Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, United States,Department of Bioengineering, University of California, Riverside, Riverside, CA, United States,*Correspondence: Xiaoping P. Hu,
| | - Daniel E. Huddleston
- Department of Neurology, Emory University, Atlanta, GA, United States,Daniel E. Huddleston,
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15
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Padilla-Godínez FJ, Ruiz-Ortega LI, Guerra-Crespo M. Nanomedicine in the Face of Parkinson's Disease: From Drug Delivery Systems to Nanozymes. Cells 2022; 11:3445. [PMID: 36359841 PMCID: PMC9657131 DOI: 10.3390/cells11213445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 01/02/2024] Open
Abstract
The complexity and overall burden of Parkinson's disease (PD) require new pharmacological approaches to counteract the symptomatology while reducing the progressive neurodegeneration of affected dopaminergic neurons. Since the pathophysiological signature of PD is characterized by the loss of physiological levels of dopamine (DA) and the misfolding and aggregation of the alpha-synuclein (α-syn) protein, new proposals seek to restore the lost DA and inhibit the progressive damage derived from pathological α-syn and its impact in terms of oxidative stress. In this line, nanomedicine (the medical application of nanotechnology) has achieved significant advances in the development of nanocarriers capable of transporting and delivering basal state DA in a controlled manner in the tissues of interest, as well as highly selective catalytic nanostructures with enzyme-like properties for the elimination of reactive oxygen species (responsible for oxidative stress) and the proteolysis of misfolded proteins. Although some of these proposals remain in their early stages, the deepening of our knowledge concerning the pathological processes of PD and the advances in nanomedicine could endow for the development of potential treatments for this still incurable condition. Therefore, in this paper, we offer: (i) a brief summary of the most recent findings concerning the physiology of motor regulation and (ii) the molecular neuropathological processes associated with PD, together with (iii) a recapitulation of the current progress in controlled DA release by nanocarriers and (iv) the design of nanozymes, catalytic nanostructures with oxidoreductase-, chaperon, and protease-like properties. Finally, we conclude by describing the prospects and knowledge gaps to overcome and consider as research into nanotherapies for PD continues, especially when clinical translations take place.
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Affiliation(s)
- Francisco J. Padilla-Godínez
- Neurosciences Division, Cell Physiology Institute, National Autonomous University of Mexico, Coyoacan, Mexico City 04510, Mexico
- Regenerative Medicine Laboratory, Department of Physiology, Faculty of Medicine, National Autonomous University of Mexico, Coyoacan, Mexico City 04510, Mexico
| | - Leonardo I. Ruiz-Ortega
- Institute for Physical Sciences, National Autonomous University of Mexico, Cuernavaca 62210, Mexico
- Department of Biological Sciences, Columbia University, New York, NY 10027, USA
| | - Magdalena Guerra-Crespo
- Neurosciences Division, Cell Physiology Institute, National Autonomous University of Mexico, Coyoacan, Mexico City 04510, Mexico
- Regenerative Medicine Laboratory, Department of Physiology, Faculty of Medicine, National Autonomous University of Mexico, Coyoacan, Mexico City 04510, Mexico
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16
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Furukawa K, Shima A, Kambe D, Nishida A, Wada I, Sakamaki H, Yoshimura K, Terada Y, Sakato Y, Mitsuhashi M, Sawamura M, Nakanishi E, Taruno Y, Yamakado H, Fushimi Y, Okada T, Nakamoto Y, Takahashi R, Sawamoto N. Motor progression and nigrostriatal neurodegeneration in Parkinson’s disease. Ann Neurol 2022; 92:110-121. [DOI: 10.1002/ana.26373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/03/2022] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Koji Furukawa
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Atsushi Shima
- Human Brain Research Center Kyoto University Graduate School of Medicine Kyoto Japan
| | - Daisuke Kambe
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Akira Nishida
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Ikko Wada
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Haruhi Sakamaki
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Kenji Yoshimura
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yuta Terada
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yusuke Sakato
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Masahiro Mitsuhashi
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Masanori Sawamura
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Etsuro Nakanishi
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yosuke Taruno
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Hodaka Yamakado
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Tomohisa Okada
- Human Brain Research Center Kyoto University Graduate School of Medicine Kyoto Japan
- Department of Diagnostic Imaging and Nuclear Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Ryosuke Takahashi
- Department of Neurology Kyoto University Graduate School of Medicine Kyoto Japan
| | - Nobukatsu Sawamoto
- Department of Human Health Sciences Kyoto University Graduate School of Medicine Kyoto Japan
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17
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Xing Y, Sapuan AH, Martín-Bastida A, Naidu S, Tench C, Evans J, Sare G, Schwarz ST, Al-Bachari S, Parkes LM, Kanavou S, Raw J, Silverdale M, Bajaj N, Pavese N, Burn D, Piccini P, Grosset DG, Auer DP. Neuromelanin-MRI to Quantify and Track Nigral Depigmentation in Parkinson's Disease: A Multicenter Longitudinal Study Using Template-Based Standardized Analysis. Mov Disord 2022; 37:1028-1039. [PMID: 35165920 PMCID: PMC9303322 DOI: 10.1002/mds.28934] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 11/24/2021] [Accepted: 01/09/2022] [Indexed: 12/15/2022] Open
Abstract
Background Clinical diagnosis and monitoring of Parkinson's disease (PD) remain challenging because of the lack of an established biomarker. Neuromelanin‐magnetic resonance imaging (NM‐MRI) is an emerging biomarker of nigral depigmentation indexing the loss of melanized neurons but has unknown prospective diagnostic and tracking performance in multicenter settings. Objectives The aim was to investigate the diagnostic accuracy of NM‐MRI in early PD in a multiprotocol setting and to determine and compare serial NM‐MRI changes in PD and controls. Methods In this longitudinal case–control 3 T MRI study, 148 patients and 97 controls were included from six UK clinical centers, of whom 140 underwent a second scan after 1.5 to 3 years. An automated template‐based analysis was applied for subregional substantia nigra NM‐MRI contrast and volume assessment. A point estimate of the period of prediagnostic depigmentation was computed. Results All NM metrics performed well to discriminate patients from controls, with receiver operating characteristic showing 85% accuracy for ventral NM contrast and 83% for volume. Generalizability using a priori volume cutoff was good (79% accuracy). Serial MRI demonstrated accelerated NM loss in patients compared to controls. Ventral NM contrast loss was point estimated to start 5 to 6 years before clinical diagnosis. Ventral nigral depigmentation was greater in the most affected side, more severe cases, and nigral NM volume change correlated with change in motor severity. Conclusions We demonstrate that NM‐MRI provides clinically useful diagnostic information in early PD across protocols, platforms, and sites. It provides methods and estimated depigmentation rates that highlight the potential to detect preclinical PD and track progression for biomarker‐enabled clinical trials. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Yue Xing
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Abdul Halim Sapuan
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Antonio Martín-Bastida
- Division of Neurology, Imperial College London, London, United Kingdom.,Department of Neurology and Neurosciences, Clínica Universidad de Navarra, Pamplona-Madrid, Spain
| | - Saadnah Naidu
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,Neurology, Nottingham University Hospital Trust, Nottingham, United Kingdom
| | - Christopher Tench
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Jonathan Evans
- Neurology, Nottingham University Hospital Trust, Nottingham, United Kingdom
| | - Gillian Sare
- Neurology, Nottingham University Hospital Trust, Nottingham, United Kingdom
| | - Stefan T Schwarz
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,Department of Radiology, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Sarah Al-Bachari
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Lancaster Medical School, Lancaster University, Lancaster, United Kingdom.,Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Laura M Parkes
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sofia Kanavou
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jason Raw
- Pennine Acute Hospitals NHS Trust, Oldham, United Kingdom
| | - Monty Silverdale
- Division of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Nin Bajaj
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Spire Nottingham Hospital, Nottingham, United Kingdom
| | - Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography Centre and Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David Burn
- Faculty of Medical Sciences, The Medical School, Framlington Place, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paola Piccini
- Division of Neurology, Imperial College London, London, United Kingdom.,Department of Brain Science, Imperial College London, London, United Kingdom
| | - Donald G Grosset
- Institute for Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Dorothee P Auer
- School of Medicine, Mental Health & Clinical Neurosciences, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
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18
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Jin Z, Wang Y, Jokar M, Li Y, Cheng Z, Liu Y, Tang R, Shi X, Zhang Y, Min J, Liu F, He N, Yan F, Haacke EM. Automatic detection of neuromelanin and iron in the midbrain nuclei using a
magnetic resonance imaging
‐based brain template. Hum Brain Mapp 2022; 43:2011-2025. [PMID: 35072301 PMCID: PMC8933249 DOI: 10.1002/hbm.25770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/01/2021] [Accepted: 12/22/2021] [Indexed: 12/17/2022] Open
Abstract
Parkinson disease (PD) is a chronic progressive neurodegenerative disorder characterized pathologically by early loss of neuromelanin (NM) in the substantia nigra pars compacta (SNpc) and increased iron deposition in the substantia nigra (SN). Degeneration of the SN presents as a 50 to 70% loss of pigmented neurons in the ventral lateral tier of the SNpc at the onset of symptoms. Also, using magnetic resonance imaging (MRI), iron deposition and volume changes of the red nucleus (RN), and subthalamic nucleus (STN) have been reported to be associated with disease status and rate of progression. Further, the STN serves as an important target for deep brain stimulation treatment in advanced PD patients. Therefore, an accurate in‐vivo delineation of the SN, its subregions and other midbrain structures such as the RN and STN could be useful to better study iron and NM changes in PD. Our goal was to use an MRI template to create an automatic midbrain deep gray matter nuclei segmentation approach based on iron and NM contrast derived from a single, multiecho magnetization transfer contrast gradient echo (MTC‐GRE) imaging sequence. The short echo TE = 7.5 ms data from a 3D MTC‐GRE sequence was used to find the NM‐rich region, while the second echo TE = 15 ms was used to calculate the quantitative susceptibility map for 87 healthy subjects (mean age ± SD: 63.4 ± 6.2 years old, range: 45–81 years). From these data, we created both NM and iron templates and calculated the boundaries of each midbrain nucleus in template space, mapped these boundaries back to the original space and then fine‐tuned the boundaries in the original space using a dynamic programming algorithm to match the details of each individual's NM and iron features. A dual mapping approach was used to improve the performance of the morphological mapping of the midbrain of any given individual to the template space. A threshold approach was used in the NM‐rich region and susceptibility maps to optimize the DICE similarity coefficients and the volume ratios. The results for the NM of the SN as well as the iron containing SN, STN, and RN all indicate a strong agreement with manually drawn structures. The DICE similarity coefficients and volume ratios for these structures were 0.85, 0.87, 0.75, and 0.92 and 0.93, 0.95, 0.89, 1.05, respectively, before applying any threshold on the data. Using this fully automatic template‐based deep gray matter mapping approach, it is possible to accurately measure the tissue properties such as volumes, iron content, and NM content of the midbrain nuclei.
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Affiliation(s)
- Zhijia Jin
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Ying Wang
- SpinTech MRI, Inc. Detroit Michigan USA
- Department of Radiology Wayne State University Detroit Michigan USA
| | | | - Yan Li
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Zenghui Cheng
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yu Liu
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Rongbiao Tang
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Xiaofeng Shi
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Youmin Zhang
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Jihua Min
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Fangtao Liu
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Naying He
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Ewart Mark Haacke
- Department of Radiology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- SpinTech MRI, Inc. Detroit Michigan USA
- Department of Radiology Wayne State University Detroit Michigan USA
- Department of Biomedical Engineering Wayne State University Detroit Michigan USA
- Department of Neurology Wayne State University Detroit Michigan USA
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19
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Langley J, Huddleston DE, Hu X. Nigral diffusivity, but not free water, correlates with iron content in Parkinson's disease. Brain Commun 2021; 3:fcab251. [PMID: 34805996 PMCID: PMC8599079 DOI: 10.1093/braincomms/fcab251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/18/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
The loss of melanized neurons in the substantia nigra pars compacta is a primary feature in Parkinson's disease. Iron deposition occurs in conjunction with this loss. Loss of nigral neurons should remove barriers for diffusion and increase diffusivity of water molecules in regions undergoing this loss. In metrics from single-compartment diffusion tensor imaging models, these changes should manifest as increases in mean diffusivity and reductions in fractional anisotropy as well as increases in the free water compartment in metrics derived from bi-compartment models. However, studies examining nigral diffusivity changes from Parkinson's disease with single-compartment models have yielded inconclusive results and emerging evidence in control subjects indicates that iron corrupts diffusivity metrics derived from single-compartment models. We aimed to examine Parkinson's disease-related changes in nigral iron and diffusion measures from single- and bi-compartment models as well as assess the effect of iron on these diffusion measures in two separate Parkinson's cohorts. Iron-sensitive data and diffusion data were analysed in two cohorts: First, a discovery cohort consisting of 71 participants (32 control participants and 39 Parkinson's disease participants) was examined. Second, an external validation cohort, obtained from the Parkinson's Progression Marker's Initiative, consisting of 110 participants (58 control participants and 52 Parkinson's disease participants) was examined. The effect of iron on diffusion measures from single- and bi-compartment models was assessed in both cohorts. Measures sensitive to the free water compartment (discovery cohort: P = 0.006; external cohort: P = 0.01) and iron content (discovery cohort: P < 0.001; validation cohort: P = 0.02) were found to increase in substantia nigra of the Parkinson's disease group in both cohorts. However, diffusion markers derived from the single-compartment model (i.e. mean diffusivity and fractional anisotropy) were not replicated across cohorts. Correlations were seen between single-compartment diffusion measures and iron markers in the discovery cohort (iron-mean diffusivity: r = -0.400, P = 0.006) and validation cohort (iron-mean diffusivity: r = -0.387, P = 0.003) but no correlation was observed between a measure from the bi-compartment model related to the free water compartment and iron markers in either cohort. In conclusion, the variability of nigral diffusion metrics derived from the single-compartment model in Parkinson's disease may be attributed to competing influences of increased iron content, which tends to drive diffusivity down, and increases in the free water compartment, which tends to drive diffusivity up. In contrast to diffusion metrics derived from the single-compartment model, no relationship was seen between iron and the free water compartment in substantia nigra.
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Affiliation(s)
- Jason Langley
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, CA 92521, USA
| | | | - Xiaoping Hu
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, CA 92521, USA.,Department of Bioengineering, University of California Riverside, Riverside, CA 92521, USA
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20
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He N, Ghassaban K, Huang P, Jokar M, Wang Y, Cheng Z, Jin Z, Li Y, Sethi SK, He Y, Chen Y, Gharabaghi S, Chen S, Yan F, Haacke EM. Imaging iron and neuromelanin simultaneously using a single 3D gradient echo magnetization transfer sequence: Combining neuromelanin, iron and the nigrosome-1 sign as complementary imaging biomarkers in early stage Parkinson's disease. Neuroimage 2021; 230:117810. [PMID: 33524572 DOI: 10.1016/j.neuroimage.2021.117810] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 10/22/2022] Open
Abstract
Diagnosing early stage Parkinson's disease (PD) is still a clinical challenge. Previous studies using iron, neuromelanin (NM) or the Nigrosome-1 (N1) sign in the substantia nigra (SN) by themselves have been unable to provide sufficiently high diagnostic performance for these methods to be adopted clinically. Our goal in this study was to extract the NM complex volume, iron content and volume representing the entire SN, and the N1 sign as potential complementary imaging biomarkers using a single 3D magnetization transfer contrast (MTC) gradient echo sequence and to evaluate their diagnostic performance and clinical correlations in early stage PD. A total of 40 early stage idiopathic PD subjects and 40 age- and sex-matched healthy controls (HCs) were imaged at 3T. NM boundaries (representing the SN pars compacta (SNpc) and parabrachial pigmented nucleus) and iron boundaries representing the total SN (SNpc and SN pars reticulata) were determined semi-automatically using a dynamic programming (DP) boundary detection algorithm. Receiver operating characteristic analyses were performed to evaluate the utility of these imaging biomarkers in diagnosing early stage PD. A correlation analysis was used to study the relationship between these imaging measures and the clinical scales. We also introduced the concept of NM and total iron overlap volumes to demonstrate the loss of NM relative to the iron containing SN. Furthermore, all 80 cases were evaluated for the N1 sign independently. The NM and SN volumes were lower while the iron content was higher in the SN for PD subjects compared to HCs. Interestingly, the PD subjects with bilateral loss of the N1 sign had the highest iron content. The area under the curve (AUC) values for the average of both hemispheres for single measures were: .960 for NM complex volume; .788 for total SN volume; .740 for SN iron content and .891 for the N1 sign. Combining NM complex volume with each of the following measures through binary logistic regression led to AUC values for the averaged right and left sides of: .976 for total iron content; .969 for total SN volume, .965 for overlap volume and .983 for the N1 sign. We found a negative correlation between SN volume and UPDRS-III (R2 = .22, p = .002). While the N1 sign performed well, it does not contain any information about iron content or NM quantitatively, therefore, marrying this sign with the NM and iron measures provides a better physiological explanation of what is happening when the N1 sign disappears in PD subjects. In summary, the combination of NM complex volume, SN volume, iron content and the N1 sign as derived from a single MTC sequence provides complementary information for understanding and diagnosing early stage PD.
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Affiliation(s)
- Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China.
| | - Kiarash Ghassaban
- Department of Radiology, Wayne State University, 3990 John R, Detroit, Michigan 48201, USA; Department of Biomedical Engineering, Wayne State University, 3990 John R, Detroit, Michigan 48201, USA
| | - Pei Huang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Ying Wang
- Department of Radiology, Wayne State University, 3990 John R, Detroit, Michigan 48201, USA; SpinTech, Inc., Bingham Farms, Michigan 48025, USA
| | - Zenghui Cheng
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Zhijia Jin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Yan Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Sean K Sethi
- Department of Radiology, Wayne State University, 3990 John R, Detroit, Michigan 48201, USA; SpinTech, Inc., Bingham Farms, Michigan 48025, USA
| | - Yixi He
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongsheng Chen
- Department of Neurology, Wayne State University, 4201 St. Antoine, Detroit, Michigan 48201, USA
| | | | - Shengdi Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China.
| | - E Mark Haacke
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China; Department of Radiology, Wayne State University, 3990 John R, Detroit, Michigan 48201, USA; Department of Biomedical Engineering, Wayne State University, 3990 John R, Detroit, Michigan 48201, USA; SpinTech, Inc., Bingham Farms, Michigan 48025, USA; Department of Neurology, Wayne State University, 4201 St. Antoine, Detroit, Michigan 48201, USA
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21
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Hackney ME, Bay AA, Jackson JM, Nocera JR, Krishnamurthy V, Crosson B, Evatt ML, Langley J, Cui X, McKay JL, Huddleston DE. Rationale and Design of the PAIRED Trial: Partnered Dance Aerobic Exercise as a Neuroprotective, Motor, and Cognitive Intervention in Parkinson's Disease. Front Neurol 2020; 11:943. [PMID: 33162925 PMCID: PMC7581698 DOI: 10.3389/fneur.2020.00943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson's disease (PD), an intractable condition impairing motor and cognitive function, is imperfectly treated by drugs and surgery. Two priority issues for many people with PD are OFF-time and cognitive impairment. Even under best medical management, three-fourths of people with PD experience “OFF-time” related to medication-related motor fluctuations, which severely impacts both quality of life and cognition. Cognitive deficits are found even in newly diagnosed people with PD and are often intractable. Our data suggest that partnered dance aerobic exercise (PDAE) reduces OFF-time on the Movement Disorders Society Unified Parkinson Disease Rating Scale-IV (MDS-UPDRS-IV) and ameliorates other disease features, which motivate the PAIRED trial. PDAE provides AE during an improvisational, cognitively engaging rehabilitative physical activity. Although exercise benefits motor and cognitive symptoms and may be neuroprotective for PD, studies using robust biomarkers of neuroprotection in humans are rare. We propose to perform a randomized, controlled trial in individuals with diagnosed mild–moderate PD to compare the efficacy of PDAE vs. walking aerobic exercise (WALK) for OFF-time, cognition, and neuroprotection. We will assess neuroprotection with neuromelanin-sensitive MRI (NM-MRI) and iron-sensitive (R2*) MRI sequences to quantify neuromelanin loss and iron accumulation in substantia nigra pars compacta (SNc). We will use these biomarkers, neuromelanin loss, and iron accumulation, as tools to chart the course of neurodegeneration in patients with PD who have undergone long-term (16 months) intervention. We will randomly assign 102 individuals with mild–moderate PD to 16 months of PDAE or WALK. The 16-month intervention period will consist of Training (3 months of biweekly sessions) and Maintenance (13 months of weekly sessions) phases. We will assess participants at baseline, 3 months (immediately post-Training), and 16 months (immediately post-Maintenance) for OFF-time and behaviorally and physiologically measured cognition. We will acquire NM-MRI and R2* imaging data at baseline and 16 months to assess neuroprotection. We will (1) examine effects of Training and Maintenance phases of PDAE vs. WALK on OFF-time, (2) compare PDAE vs. WALK at 3 and 16 months on behavioral and functional MRI (fMRI) measures of spatial cognition, and (3) compare PDAE vs. WALK for effects on rates of neurodegeneration.
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Affiliation(s)
- Madeleine E Hackney
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Emory University School of Nursing, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States
| | - Allison A Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Jordan M Jackson
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Joe R Nocera
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Bruce Crosson
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States.,Georgia State University Department of Psychology, Atlanta, GA, United States.,Health and Rehabilitation Science, University of Queensland, Brisbane, QLD, Australia
| | - Marian L Evatt
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Jason Langley
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States.,Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, United States
| | - Xiangqin Cui
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - J Lucas McKay
- Department of Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel E Huddleston
- Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
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22
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van der Pluijm M, Cassidy C, Zandstra M, Wallert E, de Bruin K, Booij J, de Haan L, Horga G, van de Giessen E. Reliability and Reproducibility of Neuromelanin-Sensitive Imaging of the Substantia Nigra: A Comparison of Three Different Sequences. J Magn Reson Imaging 2020; 53:712-721. [PMID: 33037730 PMCID: PMC7891576 DOI: 10.1002/jmri.27384] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neuromelanin-sensitive MRI (NM-MRI) of the substantia nigra provides a noninvasive way to acquire an indirect measure of dopamine functioning. Despite the potential of NM-MRI as a candidate biomarker for dopaminergic pathology, studies about its reproducibility are sparse. PURPOSE To assess the test-retest reproducibility of three commonly used NM-MRI sequences and evaluate three analysis methods. STUDY TYPE Prospective study. POPULATION A total of 11 healthy participants age between 20-27 years. FIELD STRENGTH/SEQUENCE 3.0T; NM-MRI gradient recalled echo (GRE) with magnetization transfer (MT) pulse; NM-MRI turbo spin echo (TSE) with MT pulse; NM-MRI TSE without MT pulse. ASSESSMENT Participants were scanned twice with a 3-week interval. Manual analysis, threshold analysis, and voxelwise analysis were performed for volume and contrast ratio (CR) measurements. STATISTICAL TESTS Intraclass correlation coefficients (ICCs) were calculated for test-retest and inter- and intrarater variability. RESULTS The GRE sequence achieved the highest contrast and lowest variability (4.9-5.7%) and showed substantial to almost perfect test-retest ICC (0.72-0.90) for CR measurements. For volume measurements, the manual analysis showed a higher variability (10.7-17.9%) and scored lower test-retest ICCs (-0.13-0.73) than the other analysis methods. The threshold analysis showed higher test-retest ICC (0.77) than the manual analysis for the volume measurements. DATA CONCLUSION NM-MRI is a highly reproducible measure, especially when using the GRE sequence and CR measurements. Volume measurements appear to be more sensitive to inter/intrarater variability and variability in placement and orientation of the NM-MRI slab. The threshold analysis appears to be the best alternative for volume analysis. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Marieke van der Pluijm
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Clifford Cassidy
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa, Ontario, Canada
| | - Melissa Zandstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Elon Wallert
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kora de Bruin
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Guillermo Horga
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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23
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Langley J, Huddleston DE, Crosson B, Song DD, Factor SA, Hu X. Multimodal assessment of nigrosomal degeneration in Parkinson's disease. Parkinsonism Relat Disord 2020; 80:102-107. [PMID: 32979784 DOI: 10.1016/j.parkreldis.2020.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately forty percent of all dopaminergic neurons in SNpc are located in five dense neuronal clusters, named nigrosomes. T2- or T2*-weighted images are used to delineate the largest nigrosome, named nigrosome-1. In these images, nigrosome-1 is a hyperintense region in the caudal and dorsal portion of the T2- or T2*-weighted substantia nigra. In PD, nigrosome-1 experiences iron accumulation, which leads to a reduction in T2-weighted hyperintensity. Here, we examine neuromelanin-depletion and iron deposition in regions of interest (ROIs) derived from quantitative-voxel based morphometry (qVBM) on neuromelanin-sensitive images and compare the ROIs with nigrosome-1 identified in T2*-weighted images. METHODS Neuromelanin-sensitive and multi-echo gradient echo imaging data were obtained. R2* was calculated from multi-echo gradient echo imaging data. qVBM analysis was performed on neuromelanin-sensitive images and restricted to SNpc. Mean neuromelanin-sensitive contrast and R2* was measured from the resulting qVBM clusters. Nigrosome-1 was segmented in T2*-weighted images of control subjects and its location was compared to the spatial location of the qVBM clusters. RESULTS Two bilateral clusters emerged from the qVBM analysis. These clusters showed reduced neuromelanin-sensitive contrast and increased mean R2* in PD as compared to controls. Cluster-1 from the qVBM analysis was in a similar spatial location as nigrosome-1, as seen in T2*-weighted images. CONCLUSION qVBM cluster-1 shows reduced neuromelanin-sensitive contrast and is in a similar spatial position as nigrosome-1. This region likely corresponds to nigrosome-1 while the second cluster may correspond to nigrosome-2.
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Affiliation(s)
- Jason Langley
- Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, USA
| | | | - Bruce Crosson
- Department of Neurology, Emory University, Atlanta, GA, USA; Department of Veterans Affairs Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA; Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - David D Song
- Department of Neurosciences, University of California, Riverside, Riverside, CA, USA
| | | | - Xiaoping Hu
- Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, USA; Department of Bioengineering, University of California, Riverside, Riverside, CA, USA.
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24
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Biondetti E, Gaurav R, Yahia-Cherif L, Mangone G, Pyatigorskaya N, Valabrègue R, Ewenczyk C, Hutchison M, François C, Arnulf I, Corvol JC, Vidailhet M, Lehéricy S. Spatiotemporal changes in substantia nigra neuromelanin content in Parkinson’s disease. Brain 2020; 143:2757-2770. [DOI: 10.1093/brain/awaa216] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/11/2020] [Accepted: 05/08/2020] [Indexed: 02/03/2023] Open
Abstract
Abstract
This study aimed to investigate the spatiotemporal changes in neuromelanin-sensitive MRI signal in the substantia nigra and their relation to clinical scores of disease severity in patients with early or progressing Parkinson’s disease and patients with idiopathic rapid eye movement sleep behaviour disorder (iRBD) exempt of Parkinsonian signs compared to healthy control subjects. Longitudinal T1-weighted anatomical and neuromelanin-sensitive MRI was performed in two cohorts, including patients with iRBD, patients with early or progressing Parkinson’s disease, and control subjects. Based on the aligned substantia nigra segmentations using a study-specific brain anatomical template, parametric maps of the probability of a voxel belonging to the substantia nigra were calculated for patients with various degrees of disease severity and controls. For each voxel in the substantia nigra, probability map of controls, correlations between signal-to-noise ratios on neuromelanin-sensitive MRI in patients with iRBD and Parkinson’s disease and clinical scores of motor disability, cognition and mood/behaviour were calculated. Our results showed that in patients, compared to the healthy control subjects, the volume of the substantia nigra was progressively reduced for increasing disease severity. The neuromelanin signal changes appeared to start in the posterolateral motor areas of the substantia nigra and then progressed to more medial areas of this region. The ratio between the volume of the substantia nigra in patients with Parkinson’s disease relative to the controls was best fitted by a mono-exponential decay. Based on this model, the pre-symptomatic phase of the disease started at 5.3 years before disease diagnosis, and 23.1% of the substantia nigra volume was lost at the time of diagnosis, which was in line with previous findings using post-mortem histology of the human substantia nigra and radiotracer studies of the human striatum. Voxel-wise patterns of correlation between neuromelanin-sensitive MRI signal-to-noise ratio and motor, cognitive and mood/behavioural clinical scores were localized in distinct regions of the substantia nigra. This localization reflected the functional organization of the nigrostriatal system observed in histological and electrophysiological studies in non-human primates (motor, cognitive and mood/behavioural domains). In conclusion, neuromelanin-sensitive MRI enabled us to assess voxel-wise modifications of substantia nigra’s morphology in vivo in humans, including healthy controls, patients with iRBD and patients with Parkinson’s disease, and identify their correlation with nigral function across all motor, cognitive and behavioural domains. This insight could help assess disease progression in drug trials of disease modification.
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Affiliation(s)
- Emma Biondetti
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- ICM, Centre de NeuroImagerie de Recherche – CENIR, Paris, France
- ICM, Team “Movement Investigations and Therapeutics” (MOV’IT), Paris, France
| | - Rahul Gaurav
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- ICM, Centre de NeuroImagerie de Recherche – CENIR, Paris, France
- ICM, Team “Movement Investigations and Therapeutics” (MOV’IT), Paris, France
| | - Lydia Yahia-Cherif
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- ICM, Centre de NeuroImagerie de Recherche – CENIR, Paris, France
| | - Graziella Mangone
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- National Institute of Health and Medical Research - INSERM, Clinical Investigation Centre, Pitié-Salpêtrière Hospital, Paris, France
| | - Nadya Pyatigorskaya
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- ICM, Team “Movement Investigations and Therapeutics” (MOV’IT), Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Public Assistance - Paris Hospitals (AP-HP), Paris, France
| | - Romain Valabrègue
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- ICM, Centre de NeuroImagerie de Recherche – CENIR, Paris, France
| | - Claire Ewenczyk
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- ICM, Team “Movement Investigations and Therapeutics” (MOV’IT), Paris, France
- Department of Neurology, Pitié-Salpêtrière Hospital, Public Assistance - Paris Hospitals (AP-HP), Paris, France
| | | | - Chantal François
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Isabelle Arnulf
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- ICM, Team “Movement Investigations and Therapeutics” (MOV’IT), Paris, France
- Sleep Disorders Unit, Pitié-Salpêtrière Hospital, Public Assistance – Paris Hospitals (AP-HP), Paris, France
| | - Jean-Christophe Corvol
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- National Institute of Health and Medical Research - INSERM, Clinical Investigation Centre, Pitié-Salpêtrière Hospital, Paris, France
- Department of Neurology, Pitié-Salpêtrière Hospital, Public Assistance - Paris Hospitals (AP-HP), Paris, France
| | - Marie Vidailhet
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- ICM, Team “Movement Investigations and Therapeutics” (MOV’IT), Paris, France
- Department of Neurology, Pitié-Salpêtrière Hospital, Public Assistance - Paris Hospitals (AP-HP), Paris, France
| | - Stéphane Lehéricy
- Institut du Cerveau – ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- ICM, Centre de NeuroImagerie de Recherche – CENIR, Paris, France
- ICM, Team “Movement Investigations and Therapeutics” (MOV’IT), Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Public Assistance - Paris Hospitals (AP-HP), Paris, France
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25
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He N, Langley J, Huddleston DE, Chen S, Huang P, Ling H, Yan F, Hu X. Increased iron-deposition in lateral-ventral substantia nigra pars compacta: A promising neuroimaging marker for Parkinson's disease. Neuroimage Clin 2020; 28:102391. [PMID: 32889398 PMCID: PMC7479276 DOI: 10.1016/j.nicl.2020.102391] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/09/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND To date there are no validated MRI biomarkers to assist diagnosis of Parkinson's disease (PD). Our aim was to investigate PD related iron changes in the substantia nigra pars compacta (SNpc) as defined by neuromelanin-sensitive MR contrast. METHODS Thirty-nine PD participants and 33 healthy controls were scanned at 3.0-T using a 16-echo gradient echo sequence to create R2* maps for the evaluation of iron content to find the overlap with a neuromelanin based SNpc mask. The SNpc overlap percentage with the R2* map, and the R2* values in both the whole SNpc and the overlap volume were compared between PD and control groups, and correlated with clinical features for PD participants. Finally, the diagnostic performance of the SNpc overlap percentage was evaluated using ROC analysis. RESULTS PD related iron changes mostly occur in the lateral-ventral part of the neuromelanin SNpc. The R2* values in the whole SNpc and the SNpc overlap volume, and the SNpc overlap percentage were larger in PD participants than in controls. Furthermore, the SNpc overlap percentage was positively correlated with the disease duration in PD. The SNpc overlap percentage provided excellent diagnostic accuracy for discriminating PD participants from controls (AUC = 0.93), while the R2* values in the whole SNpc or the overlap volume were less effective. CONCLUSION The overlap between the iron content as determined by R2* mapping and neuromelanin in the substantia nigra pars compacta has the potential to be a neuroimaging biomarker for diagnosing Parkinson's disease.
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Affiliation(s)
- Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jason Langley
- Center for Advanced Neuroimaging, University of California, Riverside, CA, USA
| | - Daniel E Huddleston
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Pei Huang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Huawei Ling
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Xiaoping Hu
- Center for Advanced Neuroimaging, University of California, Riverside, CA, USA; Department of Bioengineering, University of California, Riverside, CA, USA.
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26
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Devos D, Cabantchik ZI, Moreau C, Danel V, Mahoney-Sanchez L, Bouchaoui H, Gouel F, Rolland AS, Duce JA, Devedjian JC. Conservative iron chelation for neurodegenerative diseases such as Parkinson's disease and amyotrophic lateral sclerosis. J Neural Transm (Vienna) 2020; 127:189-203. [PMID: 31912279 DOI: 10.1007/s00702-019-02138-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/28/2019] [Indexed: 12/12/2022]
Abstract
Focal iron accumulation associated with brain iron dyshomeostasis is a pathological hallmark of various neurodegenerative diseases (NDD). The application of iron-sensitive sequences in magnetic resonance imaging has provided a useful tool to identify the underlying NDD pathology. In the three major NDD, degeneration occurs in central nervous system (CNS) regions associated with memory (Alzheimer's disease, AD), automaticity (Parkinson's disease, PD) and motor function (amyotrophic lateral sclerosis, ALS), all of which require a high oxygen demand for harnessing neuronal energy. In PD, a progressive degeneration of the substantia nigra pars compacta (SNc) is associated with the appearance of siderotic foci, largely caused by increased labile iron levels resulting from an imbalance between cell iron import, storage and export. At a molecular level, α-synuclein regulates dopamine and iron transport with PD-associated mutations in this protein causing functional disruption to these processes. Equally, in ALS, an early iron accumulation is present in neurons of the cortico-spinal motor pathway before neuropathology and secondary iron accumulation in microglia. High serum ferritin is an indicator of poor prognosis in ALS and the application of iron-sensitive sequences in magnetic resonance imaging has become a useful tool in identifying pathology. The molecular pathways that cascade down from such dyshomeostasis still remain to be fully elucidated but strong inroads have been made in recent years. Far from being a simple cause or consequence, it has recently been discovered that these alterations can trigger susceptibility to an iron-dependent cell-death pathway with unique lipoperoxidation signatures called ferroptosis. In turn, this has now provided insight into some key modulators of this cell-death pathway that could be therapeutic targets for the NDD. Interestingly, iron accumulation and ferroptosis are highly sensitive to iron chelation. However, whilst chelators that strongly scavenge intracellular iron protect against oxidative neuronal damage in mammalian models and are proven to be effective in treating systemic siderosis, these compounds are not clinically suitable due to the high risk of developing iatrogenic iron depletion and ensuing anaemia. Instead, a moderate iron chelation modality that conserves systemic iron offers a novel therapeutic strategy for neuroprotection. As demonstrated with the prototype chelator deferiprone, iron can be scavenged from labile iron complexes in the brain and transferred (conservatively) either to higher affinity acceptors in cells or extracellular transferrin. Promising preclinical and clinical proof of concept trials has led to several current large randomized clinical trials that aim to demonstrate the efficacy and safety of conservative iron chelation for NDD, notably in a long-term treatment regimen.
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Affiliation(s)
- David Devos
- Service de Pharmacologie Clinique et Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center Lille, Université de Lille, CHU de Lille, INSERM, UMRS_1171, Lille, France.
- Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center Lille, Université de Lille, CHU de Lille, INSERM, UMRS_1171, Lille, France.
- Département de Pharmacologie Médicale, Université Lille INSERM 1171, CHU de Lille, 59037, Lille, France.
| | - Z Ioav Cabantchik
- Della Pergola Chair, Alexander Silberman Institute of Life Sciences, Hebrew University, 91904, Jerusalem, Israel
| | - Caroline Moreau
- Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center Lille, Université de Lille, CHU de Lille, INSERM, UMRS_1171, Lille, France
| | - Véronique Danel
- Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center Lille, Université de Lille, CHU de Lille, INSERM, UMRS_1171, Lille, France
| | - Laura Mahoney-Sanchez
- Service de Pharmacologie Clinique et Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center Lille, Université de Lille, CHU de Lille, INSERM, UMRS_1171, Lille, France
| | - Hind Bouchaoui
- Service de Pharmacologie Clinique et Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center Lille, Université de Lille, CHU de Lille, INSERM, UMRS_1171, Lille, France
| | - Flore Gouel
- Service de Pharmacologie Clinique et Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center Lille, Université de Lille, CHU de Lille, INSERM, UMRS_1171, Lille, France
| | - Anne-Sophie Rolland
- Service de Pharmacologie Clinique et Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center Lille, Université de Lille, CHU de Lille, INSERM, UMRS_1171, Lille, France
| | - James A Duce
- The ALBORADA Drug Discovery Institute, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, UK
- Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jean-Christophe Devedjian
- Service de Pharmacologie Clinique et Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center Lille, Université de Lille, CHU de Lille, INSERM, UMRS_1171, Lille, France
- Université du Littoral Côte d'Opale-1, place de l'Yser, BP 72033, 59375, Dunkerque Cedex, France
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Wengler K, He X, Abi-Dargham A, Horga G. Reproducibility assessment of neuromelanin-sensitive magnetic resonance imaging protocols for region-of-interest and voxelwise analyses. Neuroimage 2019; 208:116457. [PMID: 31841683 PMCID: PMC7118586 DOI: 10.1016/j.neuroimage.2019.116457] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 01/02/2023] Open
Abstract
Neuromelanin-sensitive MRI (NM-MRI) provides a noninvasive measure of the content of neuromelanin (NM), a product of dopamine metabolism that accumulates with age in dopamine neurons of the substantia nigra (SN). NM-MRI has been validated as a measure of both dopamine neuron loss, with applications in neurodegenerative disease, and dopamine function, with applications in psychiatric disease. Furthermore, a voxelwise-analysis approach has been validated to resolve substructures, such as the ventral tegmental area (VTA), within midbrain dopaminergic nuclei thought to have distinct anatomical targets and functional roles. NM-MRI is thus a promising tool that could have diverse research and clinical applications to noninvasively interrogate in vivo the dopamine system in neuropsychiatric illness. Although a test-retest reliability study by Langley et al. using the standard NM-MRI protocol recently reported high reliability, a systematic and comprehensive investigation of the performance of the method for various acquisition parameters and preprocessing methods has not been conducted. In particular, most previous studies used relatively thick MRI slices (~3 mm), compared to the typical in-plane resolution (~0.5 mm) and to the height of the SN (~15 mm), to overcome technical limitations such as specific absorption rate and signal-to-noise ratio, at the cost of partial-volume effects. Here, we evaluated the effect of various acquisition and preprocessing parameters on the strength and test-retest reliability of the NM-MRI signal to determine optimized protocols for both region-of-interest (including whole SN-VTA complex and atlas-defined dopaminergic nuclei) and voxelwise measures. Namely, we determined a combination of parameters that optimizes the strength and reliability of the NM-MRI signal, including acquisition time, slice-thickness, spatial-normalization software, and degree of spatial smoothing. Using a newly developed, detailed acquisition protocol, across two scans separated by 13 days on average, we obtained intra-class correlation values indicating excellent reliability and high contrast, which could be achieved with a different set of parameters depending on the measures of interest and experimental constraints such as acquisition time. Based on this, we provide detailed guidelines covering acquisition through analysis and recommendations for performing NM-MRI experiments with high quality and reproducibility. This work provides a foundation for the optimization and standardization of NM-MRI, a promising MRI approach with growing applications throughout clinical and basic neuroscience.
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Affiliation(s)
- Kenneth Wengler
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY, USA; Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.
| | - Xiang He
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA
| | - Anissa Abi-Dargham
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA; Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Guillermo Horga
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY, USA
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28
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Bergsland N, Zivadinov R, Schweser F, Hagemeier J, Lichter D, Guttuso T. Ventral posterior substantia nigra iron increases over 3 years in Parkinson's disease. Mov Disord 2019; 34:1006-1013. [PMID: 31180615 DOI: 10.1002/mds.27730] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is characterized in part by the progressive accumulation of iron within the substantia nigra (SN); however, its spatial and temporal dynamics remain relatively poorly understood. OBJECTIVES The objective of this study was to investigate spatial patterns and temporal evolution of SN iron accumulation in PD. METHODS A total of 18 PD patients (mean disease duration = 6.2 years) receiving dopaminergic therapy and 16 healthy controls were scanned with 3T MRI at baseline and 3 years later using quantitative susceptibility mapping, an indirect marker of iron content. Iron was assessed separately in the posterior SN and anterior SN at the ventral and dorsal levels of the SN. The results were corrected for the false discovery rate. RESULTS A significant group effect was found for the ventral posterior SN (P < .001) and anterior SN (P = .042) quantitative susceptibility mapping as well as significant group x time interaction effects (P = .02 and P = .043, respectively). In addition, a significant intragroup change during 3 years of follow-up was found only in the ventral posterior SN of PD (P = .012), but not healthy controls. No significant effects were detected for any dorsal SN measures. No associations were identified with clinical measures. CONCLUSIONS We found both cross-sectional and longitudinal SN iron changes to be confined to its more ventral location in PD. Because pathology studies also show the ventral SN to degenerate early and to the greatest extent in PD, the assessment of iron levels by quantitative susceptibility mapping in this area may potentially represent a disease progression biomarker in PD. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.,Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.,Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - David Lichter
- Movement Disorder Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Thomas Guttuso
- Movement Disorder Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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29
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Ghassaban K, He N, Sethi SK, Huang P, Chen S, Yan F, Haacke EM. Regional High Iron in the Substantia Nigra Differentiates Parkinson's Disease Patients From Healthy Controls. Front Aging Neurosci 2019; 11:106. [PMID: 31191294 PMCID: PMC6546029 DOI: 10.3389/fnagi.2019.00106] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Iron is important in the pathophysiology of Parkinson’s disease (PD) specifically related to degeneration of the substantia nigra (SN). Magnetic resonance imaging (MRI) can be used to measure brain iron in the entire structure but this approach is insensitive to regional changes in iron content. Objective: The goal of this work was to use quantitative susceptibility mapping (QSM) and R2∗ to quantify both global and regional brain iron in PD patients and healthy controls (HC) to ascertain if regional changes correlate with clinical conditions and can be used to discriminate patients from controls. Methods: Susceptibility and R2∗ maps of 25 PD and 24 HC subjects were reconstructed from data collected on a 3T GE scanner. For the susceptibility maps, three-dimensional regions-of-interest (ROIs) were traced on eight deep gray matter (DGM) structures and an age-based threshold was applied to define regions of high iron content. The same multi-slice ROIs were duplicated on the R2∗ maps as well. Mean susceptibility values of both global and regional high iron (RII) content along with global R2∗ values were measured and compared not only between the two cohorts, but also to susceptibility and R2∗ baselines as a function of age. Finally, clinical features were compared for those PD patients lying above and below the upper 95% regional susceptibility-age prediction intervals. Results: The SN was the only structure showing significantly higher susceptibility in PD patients compared to controls globally (p < 0.01) and regionally (p < 0.001). The R2∗ values were also higher only in the SN of PD patients compared to the healthy cohort (p < 0.05). Furthermore, those patients with abnormal susceptibility values lying above the upper 95% prediction intervals had significantly higher united Parkinson’s diagnostic rating scores. R2∗ values had larger errors and showed larger dispersion as a function of age than QSM data for global analysis while the dispersion was significantly less for QSM using the RII iron content. Conclusion: Abnormal iron deposition in the SN, especially in RII areas, could serve as a biomarker to distinguish PD patients from HC and to assess disease severity.
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Affiliation(s)
- Kiarash Ghassaban
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sean Kumar Sethi
- Magnetic Resonance Innovations, Inc., Bingham Farms, MI, United States
| | - Pei Huang
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengdi Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ewart Mark Haacke
- Department of Radiology, Wayne State University, Detroit, MI, United States.,Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Magnetic Resonance Innovations, Inc., Bingham Farms, MI, United States
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30
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Langley J, He N, Huddleston DE, Chen S, Yan F, Crosson B, Factor S, Hu X. Reproducible detection of nigral iron deposition in 2 Parkinson's disease cohorts. Mov Disord 2019; 34:416-419. [PMID: 30597635 PMCID: PMC6608731 DOI: 10.1002/mds.27608] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Previous studies investigating nigral iron accumulation used T2 or T2 *-weighted contrasts to define the regions of interest (ROIs) in the substantia nigra with mixed results. Because these contrasts are not sensitive to neuromelanin, ROIs may have inadvertently missed the SNpc. An approach sensitive to neuromelanin should yield consistent results. We examine iron deposition in ROIs derived from neuromelanin-sensitive and T2 *-weighted contrasts, respectively. METHODS T1 -weighted and multiecho gradient echo imaging data were obtained in 2 cohorts. Multiecho gradient echo imaging data were analyzed using neuromelanin-sensitive SNpc ROIs as well as T2 *-weighted SNr ROIs. RESULTS When compared with controls, significantly larger R2 * values were seen in the SNpc of PD patients in both cohorts. Mean R2 * values in the SNr of PD patients showed no consistency, with 1 cohort showing a small, statistically significant increase, whereas the other cohort exhibited no statistical difference. CONCLUSION Mean R2 * in the SNpc defined by neuromelanin-sensitive MRI is significantly increased in PD. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jason Langley
- Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bruce Crosson
- Department of Neurology, Emory University, Atlanta, GA
- Department of Veterans Affairs Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Xiaoping Hu
- Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA
- Department of Bioengineering, University of California, Riverside, Riverside, CA
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31
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Xing Y, Sapuan A, Dineen RA, Auer DP. Life span pigmentation changes of the substantia nigra detected by neuromelanin-sensitive MRI. Mov Disord 2018; 33:1792-1799. [PMID: 30423212 PMCID: PMC6659388 DOI: 10.1002/mds.27502] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/12/2018] [Accepted: 08/08/2018] [Indexed: 12/28/2022] Open
Abstract
Background: Neuromelanin is a pigment with strong iron‐chelating properties preferentially found in dopaminergic neurons of the substantia nigra pars compacta (SNpc). Parkinson's disease is characterized by pronounced, MRI‐detectable neuromelanin loss, but the neuroprotective or neurotoxic role of neuromelanin remains debated. Histological studies have demonstrated neuromelanin increases with age, but this has not been confirmed in vivo, and there is uncertainty whether neuromelanin declines, stabilizes, or increases from middle age. Methods: This study aimed to establish physiological changes of pigmentation of the SNpc using a pooled data set of neuromelanin‐sensitive 3T MRI from 134 healthy individuals aged 5‐83 years. Neuromelanin‐related brightness (regional contrast to ratio) and calibrated hyperintense volumes were analyzed using linear and nonlinear regression models to characterize age effects. Laterality, sex, and subregional effects were also assessed. Results: For brightness, age effects were best described as a quadratic trajectory explaining 81.5% of the observed variance in the SNpc showing a strong increase from childhood to adolescence, with plateauing in middle age and a decline in older age. Similar but less pronounced effects were seen in hyperintense volumes. We also show an anterior‐posterior gradient in SNpc contrast, larger normalized neuromelanin‐rich volume in women > 47 years old, but no laterality effect. Conclusions: Using optimized neuromelanin MRI in a life span sample, we demonstrate a strong age effect with inverted U‐shaped SNpc pigmentation‐related contrast from childhood to old age. This age trajectory of physiological SNpc pigmentation needs to be taken into account for diagnostic applications of depigmentation. The study also paves the way for systematic investigations of the mechanisms of neuromelanin in healthy and pathological brain development and aging. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Yue Xing
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Abdul Sapuan
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Rob A Dineen
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre, Nottingham, UK
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre, Nottingham, UK
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32
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Prasad S, Saini J, Yadav R, Pal PK. Motor asymmetry and neuromelanin imaging: Concordance in Parkinson's disease. Parkinsonism Relat Disord 2018; 53:28-32. [DOI: 10.1016/j.parkreldis.2018.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
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33
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Sulzer D, Cassidy C, Horga G, Kang UJ, Fahn S, Casella L, Pezzoli G, Langley J, Hu XP, Zucca FA, Isaias IU, Zecca L. Neuromelanin detection by magnetic resonance imaging (MRI) and its promise as a biomarker for Parkinson's disease. NPJ PARKINSONS DISEASE 2018; 4:11. [PMID: 29644335 PMCID: PMC5893576 DOI: 10.1038/s41531-018-0047-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 11/10/2022]
Abstract
The diagnosis of Parkinson’s disease (PD) occurs after pathogenesis is advanced and many substantia nigra (SN) dopamine neurons have already died. Now that therapies to block this neuronal loss are under development, it is imperative that the disease be diagnosed at earlier stages and that the response to therapies is monitored. Recent studies suggest this can be accomplished by magnetic resonance imaging (MRI) detection of neuromelanin (NM), the characteristic pigment of SN dopaminergic, and locus coeruleus (LC) noradrenergic neurons. NM is an autophagic product synthesized via oxidation of catecholamines and subsequent reactions, and in the SN and LC it increases linearly during normal aging. In PD, however, the pigment is lost when SN and LC neurons die. As shown nearly 25 years ago by Zecca and colleagues, NM’s avid binding of iron provides a paramagnetic source to enable electron and nuclear magnetic resonance detection, and thus a means for safe and noninvasive measure in living human brain. Recent technical improvements now provide a means for MRI to differentiate between PD patients and age-matched healthy controls, and should be able to identify changes in SN NM with age in individuals. We discuss how MRI detects NM and how this approach might be improved. We suggest that MRI of NM can be used to confirm PD diagnosis and monitor disease progression. We recommend that for subjects at risk for PD, and perhaps generally for older people, that MRI sequences performed at regular intervals can provide a pre-clinical means to detect presymptomatic PD.
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Affiliation(s)
- David Sulzer
- 1Department of Psychiatry, Columbia University Medical Center , New York State Psychiatric Institute, New York, NY USA.,2Department of Neurology, Columbia University Medical Center, New York, NY USA.,3Department of Pharmacology, Columbia University Medical Center, New York, NY USA
| | - Clifford Cassidy
- 4The Royal's Institute of Mental Health Research, Affiliated with the University of Ottawa, Ottawa, ON Canada
| | - Guillermo Horga
- 1Department of Psychiatry, Columbia University Medical Center , New York State Psychiatric Institute, New York, NY USA
| | - Un Jung Kang
- 2Department of Neurology, Columbia University Medical Center, New York, NY USA
| | - Stanley Fahn
- 2Department of Neurology, Columbia University Medical Center, New York, NY USA
| | - Luigi Casella
- 5Department of Chemistry, University of Pavia, Pavia, Italy
| | - Gianni Pezzoli
- Parkinson Institute, ASST "Gaetano Pini-CTO", Milan, Italy
| | - Jason Langley
- 7Center for Advanced NeuroImaging, University of California Riverside, Riverside, CA USA
| | - Xiaoping P Hu
- 8Department of Bioengineering, University of California Riverside, Riverside, CA USA
| | - Fabio A Zucca
- 9Institute of Biomedical Technologies, National Research Council of Italy, Milan, Italy
| | - Ioannis U Isaias
- Department of Neurology, University Hospital and Julius-Maximillian-University, Wuerzburg, Germany
| | - Luigi Zecca
- 9Institute of Biomedical Technologies, National Research Council of Italy, Milan, Italy
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Prasad S, Stezin A, Lenka A, George L, Saini J, Yadav R, Pal PK. Three-dimensional neuromelanin-sensitive magnetic resonance imaging of the substantia nigra in Parkinson's disease. Eur J Neurol 2018; 25:680-686. [PMID: 29341412 DOI: 10.1111/ene.13573] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 01/11/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to investigate the diagnostic utility of signal intensity measurement of the substantia nigra pars compacta (SNc) using three-dimensional (3D) neuromelanin-sensitive magnetic resonance imaging (MRI), for discrimination of patients with Parkinson's disease (PD) from healthy controls. METHODS T1-weighted neuromelanin-sensitive images of 16 patients with PD and 15 controls were quantitatively analyzed by placing circular 10 mm2 regions of interest over the central and lateral parts of the bilateral SNc and anterior to the cerebral aqueduct at three levels of the midbrain. Signal intensities and contrast ratios (CRs) were calculated, after which significant differences, correlations, sensitivity and specificity were calculated. RESULTS The CRs of the central and lateral SNc were significantly lower in patients with PD. Lateral CRs were lower than the central CRs in both groups and significantly correlated with duration of illness. CRs of central and lateral parts of the SNc also correlated with the Unified Parkinson's Disease Rating Scale III OFF state scores. Receiver operating characteristic analysis revealed lateral CRs to be more sensitive and central CRs to be more specific for the discrimination of patients with PD from controls. CONCLUSIONS Contrast ratio analysis of the SNc using 3D neuromelanin-sensitive MRI may serve as a quick and accurate tool to discern between patients with PD and healthy controls.
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Affiliation(s)
- S Prasad
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.,Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - A Stezin
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.,Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - A Lenka
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.,Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - L George
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - J Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - R Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - P K Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Moreau C, Duce JA, Rascol O, Devedjian JC, Berg D, Dexter D, Cabantchik ZI, Bush AI, Devos D. Iron as a therapeutic target for Parkinson's disease. Mov Disord 2018; 33:568-574. [PMID: 29380903 DOI: 10.1002/mds.27275] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Caroline Moreau
- Université de Lille, CHU de Lille, INSERM UMRS_1171, Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center, Lille, France
| | - James A Duce
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, West Yorkshire, UK, and Oxidation Biology Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Olivier Rascol
- Université de Toulouse, UPS, CHU de Toulouse, INSERM; Centre d'Investigation Clinique CIC1436, Services de Neurologie et de Pharmacologie Clinique, UMR TONIC, NS-Park/FCRIN Network, NeuroToul COEN Center, Toulouse, France
| | - Jean-Christophe Devedjian
- University de Lille, CHU de Lille, INSERM UMRS_1171, NS-Park/FCRIN Network LICEND COEN Center, Lille, France
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany and Hertie-Institute of Clinical Brain Research, Department of Neurodegeneration, Tübingen, Germany
| | | | - Z Ioav Cabantchik
- Della Pergola Chair, Alexander Silberman Institute of Life Sciences, Hebrew University, Jerusalem, Israel
| | - Ashley I Bush
- Oxidation Biology Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - David Devos
- Université de Lille, CHU de Lille, INSERM UMRS_1171, Service de Pharmacologie Clinique et Service de Neurologie NS-Park/FCRIN Network LICEND COEN Center, Lille, France
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Xu H, Wang Y, Song N, Wang J, Jiang H, Xie J. New Progress on the Role of Glia in Iron Metabolism and Iron-Induced Degeneration of Dopamine Neurons in Parkinson's Disease. Front Mol Neurosci 2018; 10:455. [PMID: 29403352 PMCID: PMC5780449 DOI: 10.3389/fnmol.2017.00455] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/26/2017] [Indexed: 12/26/2022] Open
Abstract
It is now increasingly appreciated that glial cells play a critical role in the regulation of iron homeostasis. Impairment of these properties might lead to dysfunction of iron metabolism and neurodegeneration of neurons. We have previously shown that dysfunction of glia could cause iron deposit and enhance iron-induced degeneration of dopamine (DA) neurons in Parkinson’s disease (PD). There also has been a substantial growth of knowledge regarding the iron metabolism of glia and their effects on iron accumulation and degeneration of DA neurons in PD in recent years. Here, we attempt to describe the role of iron metabolism of glia and the effect of glia on iron accumulation and degeneration of DA neurons in the substantia nigra of PD. This could provide evidence to reveal the mechanisms underlying nigral iron accumulation of DA neurons in PD and provide the basis for discovering new potential therapeutic targets for PD.
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Affiliation(s)
- Huamin Xu
- Collaborative Innovation Center for Brain Science, Department of Physiology, Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
| | - Youcui Wang
- Collaborative Innovation Center for Brain Science, Department of Physiology, Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
| | - Ning Song
- Collaborative Innovation Center for Brain Science, Department of Physiology, Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
| | - Jun Wang
- Collaborative Innovation Center for Brain Science, Department of Physiology, Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
| | - Hong Jiang
- Collaborative Innovation Center for Brain Science, Department of Physiology, Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
| | - Junxia Xie
- Collaborative Innovation Center for Brain Science, Department of Physiology, Shandong Provincial Collaborative Innovation Center for Neurodegenerative Disorders, Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
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Pool size ratio of the substantia nigra in Parkinson's disease derived from two different quantitative magnetization transfer approaches. Neuroradiology 2017; 59:1251-1263. [PMID: 28986653 DOI: 10.1007/s00234-017-1911-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/22/2017] [Indexed: 12/27/2022]
Abstract
PURPOSE We sought to measure quantitative magnetization transfer (qMT) properties of the substantia nigra pars compacta (SNc) in patients with Parkinson's disease (PD) and healthy controls (HCs) using a full qMT analysis and determine whether a rapid single-point measurement yields equivalent results for pool size ratio (PSR). METHODS Sixteen different MT-prepared MRI scans were obtained at 3 T from 16 PD patients and eight HCs, along with B1, B0, and relaxation time maps. Maps of PSR, free and macromolecular pool transverse relaxation times ([Formula: see text], [Formula: see text]) and rate of MT exchange between pools (k mf ) were generated using a full qMT model. PSR maps were also generated using a single-point qMT model requiring just two MT-prepared images. qMT parameter values of the SNc, red nucleus, cerebral crus, and gray matter were compared between groups and methods. RESULTS PSR of the SNc was the only qMT parameter to differ significantly between groups (p < 0.05). PSR measured via single-point analysis was less variable than with the full MT model, provided slightly better differentiation of PD patients from HCs (area under curve 0.77 vs. 0.75) with sensitivity of 0.75 and specificity of 0.87, and was better than transverse relaxation time in distinguishing PD patients from HCs (area under curve 0.71, sensitivity 0.87, and specificity 0.50). CONCLUSION The increased PSR observed in the SNc of PD patients may provide a novel biomarker of PD, possibly associated with an increased macromolecular content. Single-point PSR mapping with reduced variability and shorter scan times relative to the full qMT model appears clinically feasible.
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