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Mattia GM, Villain E, Nemmi F, Le Lann MV, Franceries X, Péran P. Investigating the discrimination ability of 3D convolutional neural networks applied to altered brain MRI parametric maps. Artif Intell Med 2024; 153:102897. [PMID: 38810471 DOI: 10.1016/j.artmed.2024.102897] [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: 06/02/2023] [Revised: 03/05/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
Convolutional neural networks (CNNs) are gradually being recognized in the neuroimaging community as a powerful tool for image analysis. Despite their outstanding performances, some aspects of CNN functioning are still not fully understood by human operators. We postulated that the interpretability of CNNs applied to neuroimaging data could be improved by investigating their behavior when they are fed data with known characteristics. We analyzed the ability of 3D CNNs to discriminate between original and altered whole-brain parametric maps derived from diffusion-weighted magnetic resonance imaging. The alteration consisted in linearly changing the voxel intensity of either one (monoregion) or two (biregion) anatomical regions in each brain volume, but without mimicking any neuropathology. Performing ten-fold cross-validation and using a hold-out set for testing, we assessed the CNNs' discrimination ability according to the intensity of the altered regions, comparing the latter's size and relative position. Monoregion CNNs showed that the larger the modified region, the smaller the intensity increase needed to achieve good performances. Biregion CNNs systematically outperformed monoregion CNNs, but could only detect one of the two target regions when tested on the corresponding monoregion images. Exploiting prior information on training data allowed for a better understanding of CNN behavior, especially when altered regions were combined. This can inform about the complexity of CNN pattern retrieval and elucidate misclassified examples, particularly relevant for pathological data. The proposed analytical approach may serve to gain insights into CNN behavior and guide the design of enhanced detection systems exploiting our prior knowledge.
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Affiliation(s)
- Giulia Maria Mattia
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
| | - Edouard Villain
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France; LAAS CNRS, Université de Toulouse, CNRS, INSA, UPS, Toulouse, France.
| | - Federico Nemmi
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
| | | | - Xavier Franceries
- CRCT, Centre de Recherche en Cancérologie de Toulouse, Inserm, UPS, Toulouse, France.
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
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Liu QY, Yang M, Sheng YJ, Chen XF, Wang CS, Zhang Y, Mao P, Ding CW, Chen R, Zhang YC, Liu CF. Clinical study of transcranial sonography image characteristics in patients with obstructive sleep apnea. Sleep Breath 2023; 27:1325-1332. [PMID: 36272057 DOI: 10.1007/s11325-022-02729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This study aimed to explore the relationship between patients with obstructive sleep apnea (OSA) from subgroups of varying severity and substantia nigra (SN) hyperechogenicity as well as cerebral blood flow detected by transcranial sonography (TCS). The study also explored if there were differences in damage of the SN and in the cerebral blood flow between the bilateral sides. METHODS Right-handed men diagnosed with OSA by polysomnography were recruited from August 2018 to August 2020. The included patients were divided into 3 subgroups (mild, moderate, and severe OSA), and all patients underwent TCS. RESULTS Among the 157 study patients (30 with mild OSA, 25 moderate, and 102 severe), the overall prevalence of SN hyperechogenicity was 15% (23/157). The hyperechogenicity detection rates were 3% (4/157) in the right SN subgroup and 13% (20/157) in the left SN subgroup, which were significantly different. The left side always had reduced blood flow on TCS (P < 0.05). No correlation was observed between the severity of OSA and the detection rates of SN hyperechogenicity (P > 0.05). CONCLUSION Patients with OSA showed a higher detection rate of SN hyperechogenicity on the left compared with the right side. The left middle cerebral arteries had reduced blood flow, which was consistent with the more severe damage of the left SN. No relationship was observed between the severity of OSA and the detection rate of SN hyperechogenicity or hemodynamic parameters.
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Affiliation(s)
- Qing-Yuan Liu
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Min Yang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Yu-Jing Sheng
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Xiao-Fang Chen
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Cai-Shan Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Ying Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Pan Mao
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Chang-Wei Ding
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China
| | - Rui Chen
- Department of Respiratory Medicine, Sleeping Center, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China.
| | - Ying-Chun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China.
| | - Chun-Feng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Imaging the Functional Neuroanatomy of Parkinson's Disease: Clinical Applications and Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052356. [PMID: 33670940 PMCID: PMC7967767 DOI: 10.3390/ijerph18052356] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/11/2021] [Accepted: 02/21/2021] [Indexed: 12/17/2022]
Abstract
The neurobiology of Parkinson’s disease and its progression has been investigated during the last few decades. Braak et al. proposed neuropathological stages of this disease based on the recognizable topographical extent of Lewy body lesions. This pathological process involves specific brain areas with an ascending course from the brain stem to the cortex. Post-mortem studies are of importance to better understand not only the progression of motor symptoms, but also the involvement of other domains, including cognition and behavior. The correlation between the neuropathological expansion of the disease and the clinical phases remains demanding. Neuroimaging, including magnetic resonance imaging (MRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT), could help to bridge this existing gap by providing in vivo evidence of the extension of the disorders. In the last decade, we observed an overabundance of reports regarding the sensitivity of neuroimaging techniques. All these studies were aimed at improving the accuracy of Parkinson’s disease (PD) diagnosis and discriminating it from other causes of parkinsonism. In this review, we look at the recent literature concerning PD and address the new frontier of diagnostic accuracy in terms of identification of early stages of the disease and conventional neuroimaging techniques that, in vivo, are capable of photographing the basal ganglia network and its cerebral connections.
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Pavese N. Atypical Parkinsonian Syndromes and Subtypes of Parkinson's Disease. Will a Single Neuroimaging Modality Ever Be Enough? Mov Disord Clin Pract 2021; 8:172-174. [PMID: 33553486 PMCID: PMC7853187 DOI: 10.1002/mdc3.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography CentreNewcastle UniversityNewcastle Upon TyneUnited Kingdom
- Department of Nuclear Medicine and PET CentreAarhus University HospitalAarhusDenmark
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Lee W. Conventional Magnetic Resonance Imaging in the Diagnosis of Parkinsonian Disorders: A Meta-Analysis. Mov Disord Clin Pract 2020; 8:217-223. [PMID: 33553491 DOI: 10.1002/mdc3.13070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/23/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background Numerous conventional magnetic resonance imaging (cMRI) parameters were previously found to differentiate parkinsonian disorders with statistical significance, but effect size has not been considered. Objectives To quantify effect size of previously identified cMRI parameters that differentiated parkinsonian disorders with statistical significance. Method A PubMed search limited to studies assessing cMRI parameters in at least 2 of Parkinson's disease, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration/syndrome were selected. Either Cohen's d or positive and negative likelihood (LR+/-) as well as diagnostic odds ratios (DORs) were calculated as appropriate. cMRI parameter was considered useful if Cohen's d > 1.94 (<20% overlap) or if LR+ > 10, LR- < 0.1, or DOR > 20. Results Literature search identified 8848 publications and 36 were included for analysis. Putaminal (Cohen's d 2.07; DOR 23-infinity), pontine (DOR 32-infinity), and middle cerebellar peduncle (Cohen's d 2.24; DOR infinity) abnormalities were most useful in differentiating multiple system atrophy while reduced midbrain (Cohen's d 2.33-8.69; DOR infinity) and superior cerebellar peduncle (Cohen's d 2.47; DOR 51-infinity) diameters separated progressive supranuclear palsy. Corticobasal degeneration/syndrome does not have any distinguishing cMRI features, but reduced midbrain diameter may help differentiate corticobasal degeneration/syndrome from Parkinson's disease (DOR infinity). When LR- was calculated, all of these features carried a value of <0.1. Conclusion A number of cMRI features consistently demonstrated large effect size in separating parkinsonian disorders. However, it is the presence and not absence of these cMRI features that is most useful in patients with low to moderate pretest probability.
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Affiliation(s)
- Will Lee
- Department of Neurosciences Box Hill Hospital Box Hill Victoria Australia.,Eastern Health Clinical School Monash University, Eastern Health Box Hill Victoria Australia
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Garcia-Malo C, Wanner V, Miranda C, Romero Peralta S, Agudelo L, Cano-Pumarega I, Granizo JJ, Garcia-Borreguero D. Quantitative transcranial sonography of the substantia nigra as a predictor of therapeutic response to intravenous iron therapy in restless legs syndrome. Sleep Med 2019; 66:123-129. [PMID: 31875533 DOI: 10.1016/j.sleep.2019.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To analyze changes in substantia nigra (SN) iron deposits, assessed by quantitative transcranial sonography (TCS), to obtain and compare substantia nigra echogenicity indices (SNEI) at baseline and after intravenous (IV) iron therapy in patients with restless legs syndrome (RLS)/Willis-Ekbom disease (WED). METHODS A total of 30 consecutive subjects diagnosed with RLS/WED were recruited and underwent IV iron treatment. The SNEI, total daily dose of dopamine equivalents, and International Restless Legs Syndrome Rating Scale (IRLS) scores were obtained at baseline and following IV iron administration. Comparative statistics were performed by means of nonparametric testing. RESULTS The sample was stratified into two groups according to the median baseline SNEI and the grade of SN hypoechogenicity: severely hypoechogenic (HE) (n = 13) and moderately HE (n = 17). Following IV iron, the increase in SNEI among severely HE subjects was 19% (0.038 ± 0.046 cm2; P < 0.01), whereas in moderately HE subjects it was 10% (0.021 ± 0.069 cm2; P = 0.28). Among severely HE subjects, the average reduction in IRLS following IV iron was 10 ± 7.12 points (P < 0.01), in contrast to 1.85 ± 9.85 (not significant) among moderately HE subjects. Finally, we quantified the percentage of patients in each group who were able to reduce by ≥30% their total daily dopaminergic requirements (TDR) after IV iron, with a 57.14% reduction in the severely HE group vs 25% in the moderately HE group (P = 0.1). Three of 30 subjects (17%) were able to completely cease all dopaminergic treatment. CONCLUSION Intravenous iron caused changes in SNEI in both groups of patients, reflecting an increase in brain iron stores. However, the increase in SNEI was greater in patients previously defined as severely HE. Furthermore, RLS/WED symptoms also improved more in severely HE subjects, and there was a greater reduction in TDR. This study highlights the role of TCS in quantifying brain iron deposits and in predicting which patients will likely benefit from IV iron.
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Affiliation(s)
| | | | | | | | | | - Irene Cano-Pumarega
- Sleep Research Institute, Madrid, Spain; Sleep Unit, Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Juan José Granizo
- Unidad de Apoyo a la Investigación, Hospital Universitario Infanta Cristina, Parla, Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Spain
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Nemmi F, Pavy-Le Traon A, Phillips OR, Galitzky M, Meissner WG, Rascol O, Péran P. A totally data-driven whole-brain multimodal pipeline for the discrimination of Parkinson's disease, multiple system atrophy and healthy control. NEUROIMAGE-CLINICAL 2019; 23:101858. [PMID: 31128523 PMCID: PMC6531871 DOI: 10.1016/j.nicl.2019.101858] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/17/2019] [Accepted: 05/11/2019] [Indexed: 01/10/2023]
Abstract
Parkinson's Disease (PD) and Multiple System Atrophy (MSA) are two parkinsonian syndromes that share many symptoms, albeit having very different prognosis. Although previous studies have proposed multimodal MRI protocols combined with multivariate analysis to discriminate between these two populations and healthy controls, studies combining all MRI indexes relevant for these disorders (i.e. grey matter volume, fractional anisotropy, mean diffusivity, iron deposition, brain activity at rest and brain connectivity) with a completely data-driven voxelwise analysis for discrimination are still lacking. In this study, we used such a complete MRI protocol and adapted a fully-data driven analysis pipeline to discriminate between these populations and a healthy controls (HC) group. The pipeline combined several feature selection and reduction steps to obtain interpretable models with a low number of discriminant features that can shed light onto the brain pathology of PD and MSA. Using this pipeline, we could discriminate between PD and HC (best accuracy = 0.78), MSA and HC (best accuracy = 0.94) and PD and MSA (best accuracy = 0.88). Moreover, we showed that indexes derived from resting-state fMRI alone could discriminate between PD and HC, while mean diffusivity in the cerebellum and the putamen alone could discriminate between MSA and HC. On the other hand, a more diverse set of indexes derived by multiple modalities was needed to discriminate between the two disorders. We showed that our pipeline was able to discriminate between distinct pathological populations while delivering sparse model that could be used to better understand the neural underpinning of the pathologies. Structuro-functional MRI can discriminate between parkinsonian syndromes Discriminant MRI modalities vary as a function of the discrimination task fMRI is crucial in discriminating between Parkinson's disease patients and controls Structural MRI discriminate between Multiple System Atrophy patients and controls
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Affiliation(s)
- F Nemmi
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France.
| | - A Pavy-Le Traon
- UMR Institut National de la Santé et de la Recherche Médicale 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France; Department of Neurology and Institute for Neurosciences, University Hospital of Toulouse, Toulouse, France
| | - O R Phillips
- Brain Key, Palo Alto, California, USA; NeuroToul COEN Center, INSERM, CHU de Toulouse, Université de Toulouse 3, Toulouse, France
| | - M Galitzky
- Centre d'Investigation Clinique (CIC), CHU de Toulouse, Toulouse, France
| | - W G Meissner
- French Reference Center for MSA, Department of Neurology, University Hospital Bordeaux, Bordeaux and Institute of Neurodegenerative Disorders, University Bordeaux, CNRS UMR 5293, 33000 Bordeaux, France; Dept. Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - O Rascol
- Departments of Clinical Pharmacology and Neurosciences, Clinical Investigation Center CIC 1436, NS-Park/FCRIN network and NeuroToul COEN Center, INSERM, CHU de Toulouse, Université de Toulouse 3, Toulouse, France
| | - P Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
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Péran P, Barbagallo G, Nemmi F, Sierra M, Galitzky M, Traon APL, Payoux P, Meissner WG, Rascol O. MRI supervised and unsupervised classification of Parkinson's disease and multiple system atrophy. Mov Disord 2018; 33:600-608. [PMID: 29473662 DOI: 10.1002/mds.27307] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/15/2017] [Accepted: 12/22/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multimodal MRI approach is based on a combination of MRI parameters sensitive to different tissue characteristics (eg, volume atrophy, iron deposition, and microstructural damage). The main objective of the present study was to use a multimodal MRI approach to identify brain differences that could discriminate between matched groups of patients with multiple system atrophy, Parkinson's disease, and healthy controls. We assessed the 2 different MSA variants, namely, MSA-P, with predominant parkinsonism, and MSA-C, with more prominent cerebellar symptoms. METHODS Twenty-six PD patients, 29 MSA patients (16 MSA-P, 13 MSA-C), and 26 controls underwent 3-T MRI comprising T2*-weighted, T1-weighted, and diffusion tensor imaging scans. Using whole-brain voxel-based MRI, we combined gray-matter density, T2* relaxation rates, and diffusion tensor imaging scalars to compare and discriminate PD, MSA-P, MSA-C, and healthy controls. RESULTS Our main results showed that this approach reveals multiparametric modifications within the cerebellum and putamen in both MSA-C and MSA-P patients, compared with PD patients. Furthermore, our findings revealed that specific single multimodal MRI markers were sufficient to discriminate MSA-P and MSA-C patients from PD patients. Moreover, the unsupervised analysis based on multimodal MRI data could regroup individuals according to their clinical diagnosis, in most cases. CONCLUSIONS This study demonstrates that multimodal MRI is able to discriminate patients with PD from those with MSA with high accuracy. The combination of different MR biomarkers could be a great tool in early stage of disease to help diagnosis. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | | | - Federico Nemmi
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Maria Sierra
- Neurology Service, University Hospital Marqués de Valdecilla and Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
| | - Monique Galitzky
- Centre d'Investigation Clinique (CIC), CHU de Toulouse, Toulouse, France
| | - Anne Pavy-Le Traon
- UMR Institut National de la Santé et de la Recherche Médicale 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France.,Department of Neurology and Institute for Neurosciences, University Hospital of Toulouse, Toulouse, France
| | - Pierre Payoux
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Wassilios G Meissner
- Service de Neurologie, CHU Bordeaux, Bordeaux, France.,Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Olivier Rascol
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France.,Université de Toulouse 3, CHU de Toulouse, INSERM, Centre de Reference AMS, Service de Neurologie et de Pharmacologie Clinique, Centre d'Investigation Clinique CIC1436, Réseau NS-Park/FCRIN et Centre of excellence for neurodegenerative disorders (COEN) de Toulouse, Toulouse, France
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Oh YS, Kwon DY, Kim JS, Park MH, Berg D. Transcranial sonographic findings may predict prognosis of gastroprokinetic drug-induced parkinsonism. Parkinsonism Relat Disord 2018; 46:36-40. [DOI: 10.1016/j.parkreldis.2017.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/02/2017] [Accepted: 10/18/2017] [Indexed: 12/25/2022]
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Lotankar S, Prabhavalkar KS, Bhatt LK. Biomarkers for Parkinson's Disease: Recent Advancement. Neurosci Bull 2017; 33:585-597. [PMID: 28936761 PMCID: PMC5636742 DOI: 10.1007/s12264-017-0183-5] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/03/2017] [Indexed: 12/12/2022] Open
Abstract
As a multi-factorial degenerative disease, Parkinson's disease (PD) leads to tremor, gait rigidity, and hypokinesia, thus hampering normal living. As this disease is usually detected in the later stages when neurons have degenerated completely, cure is on hold, ultimately leading to death due to the lack of early diagnostic techniques. Thus, biomarkers are required to detect the disease in the early stages when prevention is possible. Various biomarkers providing early diagnosis of the disease include those of imaging, cerebrospinal fluid, oxidative stress, neuroprotection, and inflammation. Also, biomarkers, alone or in combination, are used in the diagnosis and evolution of PD. This review encompasses various biomarkers available for PD and discusses recent advances in their development.
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Affiliation(s)
- Sharvari Lotankar
- Department of Pharmacology, SVKM's Dr Bhanuben Nanavati College of Pharmacy, Vile Parle (W), Mumbai, India
| | - Kedar S Prabhavalkar
- Department of Pharmacology, SVKM's Dr Bhanuben Nanavati College of Pharmacy, Vile Parle (W), Mumbai, India.
| | - Lokesh K Bhatt
- Department of Pharmacology, SVKM's Dr Bhanuben Nanavati College of Pharmacy, Vile Parle (W), Mumbai, India
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Sheng AY, Zhang YC, Sheng YJ, Wang CS, Zhang Y, Hu H, Luo WF, LIu CHF. Transcranial sonography image characteristics in different Parkinson’s disease subtypes. Neurol Sci 2017; 38:1805-1810. [DOI: 10.1007/s10072-017-3059-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/04/2017] [Indexed: 01/18/2023]
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12
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Chen B, Fan G, Sun W, Shang X, Shi S, Wang S, Lv G, Wu C. Usefulness of diffusion-tensor MRI in the diagnosis of Parkinson variant of multiple system atrophy and Parkinson's disease: a valuable tool to differentiate between them? Clin Radiol 2017; 72:610.e9-610.e15. [DOI: 10.1016/j.crad.2017.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/21/2016] [Accepted: 02/03/2017] [Indexed: 11/26/2022]
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Fujita H, Suzuki K, Numao A, Watanabe Y, Uchiyama T, Miyamoto T, Miyamoto M, Hirata K. Usefulness of Cardiac MIBG Scintigraphy, Olfactory Testing and Substantia Nigra Hyperechogenicity as Additional Diagnostic Markers for Distinguishing between Parkinson's Disease and Atypical Parkinsonian Syndromes. PLoS One 2016; 11:e0165869. [PMID: 27812167 PMCID: PMC5094741 DOI: 10.1371/journal.pone.0165869] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/19/2016] [Indexed: 01/02/2023] Open
Abstract
Background We aimed to evaluate the utility of the combined use of cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy, olfactory testing, and substantia nigra (SN) hyperechogenicity on transcranial sonography (TCS) in differentiating Parkinson’s disease (PD) from atypical parkinsonian syndromes (APSs), such as multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). Methods Cardiac MIBG scintigraphy, card-type odor identification testing (Open Essence (OE), Wako, Japan), and TCS were performed with 101 patients with PD and 38 patients with APSs (MSA and PSP). Receiver operating characteristic (ROC) curve analysis was used to assess the sensitivity and specificity of these batteries for diagnosing PD from APSs. The diagnostic accuracy of the three tests was also assessed among patients at the early disease stage (drug-naïve patients with a disease duration of 3 years or less). Results In differentiating PD from APSs, the area under the ROC curve was 0.74 (95% CI, 0.65–0.83), 0.8 (95% CI, 0.73–0.87), and 0.75 (95% CI, 0.67–0.82) for TCS, cardiac MIBG scintigraphy, and olfactory testing, respectively. The diagnostic sensitivity and specificity were 53.1% and 91.7%, respectively, for TCS, 70.3% and 86.8%, respectively, for cardiac MIBG scintigraphy, 58.4% and 76.3%, respectively, for OE. Among early-stage patients, sensitivity and specificity were 50.0% and 93.8%, respectively, for TCS, 57.1% and 87.5%, respectively, for cardiac MIBG scintigraphy, and 54.8% and 79.2%, respectively, for OE. At least one positive result from 3 tests improved sensitivity (86.1%) but decreased specificity (63.2%). In contrast, at least 2 positive results from 3 tests had good discrimination for both early-stage patients (50.0% sensitivity and 93.8% specificity) and patients overall (57.8% sensitivity and 95.8% specificity). Positive results for all 3 tests yielded 100% specificity but low sensitivity (25%). Conclusions At least 2 positive results from among TCS, cardiac MIBG scintigraphy, and olfactory testing can support clinical diagnosis in distinguishing PD from APSs.
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Affiliation(s)
- Hiroaki Fujita
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
- * E-mail:
| | - Ayaka Numao
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Yuji Watanabe
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Tomoyuki Uchiyama
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
- Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Tomoyuki Miyamoto
- Department of Neurology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Masayuki Miyamoto
- Department of Clinical Medicine for Nursing, Dokkyo Medical University School of Nursing, Tochigi, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
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López-Sendón Moreno JL, Alonso-Cánovas A, Buisán Catevilla J, García Barragán N, Corral Corral I, de Felipe Mimbrera A, Matute Lozano MC, Masjuan Vallejo J, Martínez-Castrillo JC. Substantia Nigra Echogenicity Predicts Response to Drug Withdrawal in Suspected Drug-Induced Parkinsonism. Mov Disord Clin Pract 2015; 3:268-274. [PMID: 30363526 DOI: 10.1002/mdc3.12281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 09/04/2015] [Accepted: 09/16/2015] [Indexed: 12/28/2022] Open
Abstract
Introduction Response to drug withdrawal in patients with suspected drug-induced parkinsonism (DIP) is of prognostic and therapeutic importance, but cannot be predicted solely on clinical information. The aim of this study was to validate SN hyperechogenicity (SN+) assessed by transcranial sonography as a predictor of response to drug withdrawal in this group of patients. Methods Patients were diagnosed according to previously published criteria and prospectively included in the study. All patients were followed until complete recovery of parkinsonian symptoms or at least for 6 months after discontinuation of the offending drug and then diagnosed as DIP or parkinsonism following neuroleptic exposure (PFNE). Transcranial sonography (TCS) findings were compared with the clinical diagnosis. Results Sixty patients comprised the group for the final analysis. Sixteen patients were classified as PFNE and 44 as DIP. The area of SN echogenicity was significantly increased in the PFNE group (0.23 cm2; standard deviation [SD]: 0.04), compared to the DIP group (0.14 cm2; SD, 0.05; one-way analysis of variance; P < 0.001). Normal SN was significantly associated with complete recovery after withdrawal of the parkinsonism-inducing drug (P < 0.0005). Accuracy of SN+ to distinguish PFNE from DIP was: sensitivity 81.2%; specificity 84.1%; positive predictive value 47.4%; and negative predictive value 96.2%. Conclusions We believe that SN+ assessed with TCS is a valid prognostic marker in the setting of suspected DIP. It is a nonexpensive, feasible technique that can be implemented for proper counseling and guidance of treatment decisions.
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Affiliation(s)
- Jose L López-Sendón Moreno
- Movement Disorders Center Department of Neurology Hospital Universitario Ramón y Cajal Madrid Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Madrid Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Madrid Spain
| | - Araceli Alonso-Cánovas
- Movement Disorders Center Department of Neurology Hospital Universitario Ramón y Cajal Madrid Spain.,Department of Medicine Universidad de Alcalá de Henares Madrid Spain
| | | | | | | | | | | | - Jaime Masjuan Vallejo
- Department of Medicine Universidad de Alcalá de Henares Madrid Spain.,Department of Neurology Hospital Universitario Ramón y Cajal Madrid Spain
| | - Juan Carlos Martínez-Castrillo
- Movement Disorders Center Department of Neurology Hospital Universitario Ramón y Cajal Madrid Spain.,Department of Neurology Hospital Universitario Ramón y Cajal Madrid Spain
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15
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Dąbrowska M, Schinwelski M, Sitek EJ, Muraszko-Klaudel A, Brockhuis B, Jamrozik Z, Sławek J. The role of neuroimaging in the diagnosis of the atypical parkinsonian syndromes in clinical practice. Neurol Neurochir Pol 2015; 49:421-31. [PMID: 26652877 DOI: 10.1016/j.pjnns.2015.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 11/18/2022]
Abstract
Atypical parkinsonian disorders (APD) are a heterogenous group of neurodegenerative diseases such as: progressive supranuclear palsy (PSP), multiple system atrophy (MSA), cortico-basal degeneration (CBD) and dementia with Lewy bodies (DLB). In all of them core symptoms of parkinsonian syndrome are accompanied by many additional clinical features not typical for idiopathic Parkinson's disease (PD) like rapid progression, gaze palsy, apraxia, ataxia, early cognitive decline, dysautonomia and usually poor response to levodopa therapy. In the absence of reliably validated biomarkers the diagnosis is still challenging and mainly based on clinical criteria. However, robust data emerging from routine magnetic resonance imaging (MRI) as well as from many advanced MRI techniques such as: diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), voxel-based morphometry (VBM), susceptibility-weighted imaging (SWI) may help in differential diagnosis. The main aim of this review is to summarize briefly the most important and acknowledged radiological findings of conventional MRI due to its availability in standard clinical settings. Nevertheless, we present shortly other methods of structural (like TCS - transcranial sonography) and functional imaging (like SPECT - single photon emission computed tomography or PET - positron emission tomography) as well as some selected advanced MRI techniques and their potential future applications in supportive role in distinguishing APD.
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Affiliation(s)
- Magda Dąbrowska
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdańsk, Poland.
| | - Michał Schinwelski
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdańsk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdańsk, Gdańsk, Poland
| | - Emilia J Sitek
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdańsk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Muraszko-Klaudel
- Radiology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdańsk, Poland
| | - Bogna Brockhuis
- Nuclear Medicine Department, Medical University of Gdańsk, Gdańsk, Poland
| | - Zygmunt Jamrozik
- Neurology Department, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Sławek
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdańsk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdańsk, Gdańsk, Poland
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16
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Yoo SW, Park HE, Lee KS, Kim JS. Hairdresser dystonia: an unusual substantia nigra hyperechogenicity. J Neurol Sci 2015; 357:314-6. [PMID: 26227828 DOI: 10.1016/j.jns.2015.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/30/2015] [Accepted: 07/21/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Sang-Won Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyung-Eun Park
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwang-Soo Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Yu F, Barron DS, Tantiwongkosi B, Fox P. Patterns of gray matter atrophy in atypical parkinsonism syndromes: a VBM meta-analysis. Brain Behav 2015; 5:e00329. [PMID: 26085961 PMCID: PMC4467770 DOI: 10.1002/brb3.329] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND PURPOSE Accurate diagnosis of Atypical Parkinsonian Syndromes (APS) is important due to differences in prognosis and management, but remains a challenge in the clinical setting. The purpose of our meta-analysis was to identify characteristic patterns of gray matter atrophy in Corticobasal Degeneration (CBD), Progressive Supranuclear Palsy (PSP), Multisystem-Atrophy Parkinsonian type (MSA-P), and Idiopathic Parkinson's Disease (IPD). MATERIALS AND METHODS Whole-brain meta-analysis was performed on 39 published voxel-based morphometry (VBM) articles (consisting of 404 IPD, 87 MSA-P, 165 CBD, and 176 PSP subjects) using the modified Anatomic Likelihood Estimation method. Based on these results, contrast analyses were then utilized to determine areas of atrophy shared by as well as unique to each disorder. RESULTS CBD was characterized by asymmetric gray matter atrophy in multiple cortical regions, while the thalamus-midbrain and insula were predominantly involved in PSP. The striatum and superior cerebellum were affected in MSA-P, while IPD demonstrated an anterior cerebral pattern. Although there was a mild overlap among PSP, CBD, and MSA-P, significant regions of atrophy unique to each disorder were identified, including (1) the superior parietal lobule in CBD (2) putamen in MSA-P (3) insula and medial dorsal nucleus in PSP. CONCLUSION Our results suggest that there are characteristic patterns of atrophy in APS. Guided by these findings, future studies on the individual subject level may lead to the development of robust imaging biomarkers.
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Affiliation(s)
- Fang Yu
- Department of Radiology, University of Texas Health Science Center San Antonio, Texas ; Research Imaging Institute San Antonio, Texas
| | - Daniel S Barron
- Department of Radiology, University of Texas Health Science Center San Antonio, Texas ; Research Imaging Institute San Antonio, Texas
| | - Bundhit Tantiwongkosi
- Department of Radiology, University of Texas Health Science Center San Antonio, Texas ; Research Imaging Institute San Antonio, Texas
| | - Peter Fox
- Department of Radiology, University of Texas Health Science Center San Antonio, Texas ; Research Imaging Institute San Antonio, Texas
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Schwarz ST, Abaei M, Gontu V, Morgan PS, Bajaj N, Auer DP. Diffusion tensor imaging of nigral degeneration in Parkinson's disease: A region-of-interest and voxel-based study at 3 T and systematic review with meta-analysis. NEUROIMAGE-CLINICAL 2013; 3:481-8. [PMID: 24273730 PMCID: PMC3830065 DOI: 10.1016/j.nicl.2013.10.006] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/04/2013] [Accepted: 10/04/2013] [Indexed: 12/27/2022]
Abstract
There is increasing interest in developing a reliable, affordable and accessible disease biomarker of Parkinson's disease (PD) to facilitate disease modifying PD-trials. Imaging biomarkers using magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) can describe parameters such as fractional anisotropy (FA), mean diffusivity (MD) or apparent diffusion coefficient (ADC). These parameters, when measured in the substantia nigra (SN), have not only shown promising but also varying and controversial results. To clarify the potential diagnostic value of nigral DTI in PD and its dependency on selection of region-of-interest, we undertook a high resolution DTI study at 3 T. 59 subjects (32 PD patients, 27 age and sex matched healthy controls) were analysed using manual outlining of SN and substructures, and voxel-based analysis (VBA). We also performed a systematic literature review and meta-analysis to estimate the effect size (DES) of disease related nigral DTI changes. We found a regional increase in nigral mean diffusivity in PD (mean ± SD, PD 0.80 ± 0.10 vs. controls 0.73 ± 0.06 · 10− 3 mm2/s, p = 0.002), but no difference using a voxel based approach. No significant disease effect was seen using meta-analysis of nigral MD changes (10 studies, DES = + 0.26, p = 0.17, I2 = 30%). None of the nigral regional or voxel based analyses of this study showed altered fractional anisotropy. Meta-analysis of 11 studies on nigral FA changes revealed a significant PD induced FA decrease. There was, however, a very large variation in results (I2 = 86%) comparing all studies. After exclusion of five studies with unusual high values of nigral FA in the control group, an acceptable heterogeneity was reached, but there was non-significant disease effect (DES = − 0.5, p = 0.22, I2 = 28%). The small PD related nigral MD changes in conjunction with the negative findings on VBA and meta-analysis limit the usefulness of nigral MD measures as biomarker of Parkinson's disease. The negative results of nigral FA measurements at regional, sub-regional and voxel level in conjunction with the results of the meta-analysis of nigral FA changes question the stability and validity of this measure as a PD biomarker. Investigating diagnostic accuracy of nigral diffusion MRI to diagnose Parkinson's There is small, inconsistent increase of mean diffusivity of the substantia nigra. There is no change in nigral fractional anisotropy (FA) in the case–control study. Meta-analysis revealed nigral FA change is dependent on high FA in controls. This questions the usefulness of nigral diffusion MRI as biomarker in Parkinson's.
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Key Words
- ACE, Addenbrooke's cognitive examination test battery
- ADC, Apparent diffusion coefficient
- DES, Effect size of disease related nigral changes
- DTI, Diffusion tensor imaging
- Diffusion weighted imaging
- EPI, Echo planar imaging
- Fractional anisotropy
- ICC, Intraclass correlation coefficient
- MD, Mean diffusivity
- MRI, Magnetic resonance imaging
- Magnetic resonance imaging
- PD, Parkinson's disease
- Parkinson's disease
- Parkinsonism
- ROI, Region/regions of interest
- SN, Substantia nigra
- SNc, Substantia nigra pars compacta
- Substantia nigra
- TCS, Transcranial sonography
- UPDRS, Unified Parkinson's disease rating scale
- VBA, Voxel based analysis
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Affiliation(s)
- Stefan T. Schwarz
- Radiological and Imaging Sciences, University of Nottingham, Queen's Medical Centre, Derby Rd, Nottingham, NG7 2UH, United Kingdom
- Corresponding author. Tel.: + 44 115823 1177; fax: + 44 115 8231180.
| | - Maryam Abaei
- Radiological and Imaging Sciences, University of Nottingham, Queen's Medical Centre, Derby Rd, Nottingham, NG7 2UH, United Kingdom
| | - Vamsi Gontu
- Department of Radiology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Rd, Nottingham, NG7 2UH, United Kingdom
| | - Paul S. Morgan
- Medical Physics, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Rd, Nottingham, NG7 2UH, United Kingdom
| | - Nin Bajaj
- Department of Neurology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Rd, Nottingham, NG7 2UH, United Kingdom
| | - Dorothee P. Auer
- Radiological and Imaging Sciences, University of Nottingham, Queen's Medical Centre, Derby Rd, Nottingham, NG7 2UH, United Kingdom
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Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review. Aging Clin Exp Res 2013; 25:265-74. [PMID: 23784725 DOI: 10.1007/s40520-013-0039-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. METHODS To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years. RESULTS The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. CONCLUSION The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.
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Poewe W, Seppi K. Diagnosis of drug-induced parkinsonism: can transcranial sonography make the difference? Eur J Neurol 2013; 20:1429-30. [PMID: 23678988 DOI: 10.1111/ene.12189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- W Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
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21
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Sahuquillo P, Tembl JI, Parkhutik V, Vázquez JF, Sastre I, Lago A. The study of deep brain structures by transcranial duplex sonography and imaging resonance correlation. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:226-232. [PMID: 23257352 DOI: 10.1016/j.ultrasmedbio.2012.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 09/10/2012] [Accepted: 09/11/2012] [Indexed: 06/01/2023]
Abstract
Transcranial duplex sonography (TCS) currently provides us with images of deep brain structures with sufficient resolution. We chose 2 sonographic quantitative parameters: the diameter of the third ventricle and a measurement not used by TCS to date, the midbrain area. Their reliability and reproducibility were assessed using magnetic resonance imaging (MRI) as the reference. A total of 99 patients free from neurodegenerative disorders were examined using TCS, and both parameters were measured by 2 independent explorers. Measurements of third-ventricle diameter by TCS showed very good correlation (r = 0.80) and agreement (ICC = 0.89) with measurements obtained by MRI. Measurements of the midbrain area by TCS also provided acceptable values with moderate correlation (r = 0.36) and agreement (ICC = 0.53). Interexplorer correlation values were good (ICC = 0.98 and 0.79 for the third ventricle and midbrain areas, respectively). Further studies will be required to determine the potential diagnostic usefulness of these parameters.
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22
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Nicoletti G, Rizzo G, Barbagallo G, Tonon C, Condino F, Manners D, Messina D, Testa C, Arabia G, Gambardella A, Lodi R, Quattrone A. Diffusivity of cerebellar hemispheres enables discrimination of cerebellar or parkinsonian multiple system atrophy from progressive supranuclear palsy-Richardson syndrome and Parkinson disease. Radiology 2013; 267:843-50. [PMID: 23329659 DOI: 10.1148/radiol.12120364] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To explore the usefulness of histogram analysis of mean diffusivity (MD) derived from diffusion-weighted imaging of large infratentorial structures to distinguish parkinsonian syndromes. MATERIALS AND METHODS Local research ethics committee approval and informed consent were obtained. Ten patients with Parkinson disease (PD), nine with the parkinsonian variant of multiple system atrophy (MSA-P), seven with the cerebellar variant of MSA (MSA-C), 17 with progressive supranuclear palsy-Richardson syndrome (PSP-RS), and 10 healthy subjects were recruited. Histograms of MD values were generated for all pixels in the whole infratentorial compartment and separately for the whole brainstem, vermis, and cerebellar hemispheres. To assess the differences in MD values among groups, the Kruskal-Wallis test was used, followed by the Mann-Whitney U test for pairwise comparisons. All P values resulting from pairwise comparisons were corrected with the Bonferroni method. RESULTS MSA-P and MSA-C groups had higher median MD values (P < .01) in the brainstem and cerebellum when compared with other groups; this finding was in line with the known consistent neurodegenerative damage in posterior cranial fossa structures in these diseases. Median MD values from cerebellar hemispheres were used to discriminate patients with MSA-C and those with MSA-P from patients with PD and those with PSP-RS (P < .01; sensitivity, specificity, and positive predictive value equaled 100%). Furthermore, patients with PSP-RS had significantly higher MD values in the vermis than did healthy subjects (P < .05) and patients with PD (P < .001). CONCLUSION These findings support the clinical usefulness of diffusion imaging in the differential diagnosis of parkinsonism, suggesting that the minimally operator-dependent histogram analysis of the infratentorial structures and particularly of the whole cerebellar hemispheres can be used to distinguish patients with MSA-P and those with MSA-C from patients with PSP-RS and those with PD.
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Affiliation(s)
- Giuseppe Nicoletti
- Institute of Neurologic Sciences, National Research Council, Piano Lago di Mangone, Cosenza, Italy
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Rizzo G, Tonon C, Lodi R. Looking into the brain: How can conventional, morphometric and functional MRI help in diagnosing and understanding PD? ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.baga.2012.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Sonthalia N, Ray S. The Hummingbird sign: a diagnostic clue for Steele-Richardson-Olszweski syndrome. BMJ Case Rep 2012; 2012:bcr-2012-006263. [PMID: 22987902 DOI: 10.1136/bcr-2012-006263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Nikhil Sonthalia
- Department of General Medicine, Medical College and Hospital, Kolkata, West Bengal, India.
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Feature analysis for Parkinson's disease detection based on transcranial sonography image. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2012; 15:272-9. [PMID: 23286140 DOI: 10.1007/978-3-642-33454-2_34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Transcranial sonography (TCS) is a new tool for the diagnosis of Parkinson's disease (PD) according to a distinct hyperechogenic pattern in the substantia nigra (SN) region. However a procedure including rating scale of SN hyperechogenicity was required for a standard clinical setting with increased use. We applied the feature analysis method to a large TCS dataset that is relevant for clinical practice and includes the variability that is present under real conditions. In order to decrease the influence to the image properties from the different settings of ultrasound machine, we propose a local image analysis method using an invariant scale blob detection for the hyperechogenicity estimation. The local features are extracted from the detected blobs and the watershed regions in half of mesencephalon area. The performance of these features is evaluated by a feature-selection method. The cross validation results show that the local features could be used for PD detection.
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