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Angelini L, Paparella G, Bologna M. Distinguishing essential tremor from Parkinson's disease: clinical and experimental tools. Expert Rev Neurother 2024; 24:799-814. [PMID: 39016323 DOI: 10.1080/14737175.2024.2372339] [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: 04/25/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Essential tremor (ET) and Parkinson's disease (PD) are the most common causes of tremor and the most prevalent movement disorders, with overlapping clinical features that can lead to diagnostic challenges, especially in the early stages. AREAS COVERED In the present paper, the authors review the clinical and experimental studies and emphasized the major aspects to differentiate between ET and PD, with particular attention to cardinal phenomenological features of these two conditions. Ancillary and experimental techniques, including neurophysiology, neuroimaging, fluid biomarker evaluation, and innovative methods, are also discussed for their role in differential diagnosis between ET and PD. Special attention is given to investigations and tools applicable in the early stages of the diseases, when the differential diagnosis between the two conditions is more challenging. Furthermore, the authors discuss knowledge gaps and unsolved issues in the field. EXPERT OPINION Distinguishing ET and PD is crucial for prognostic purposes and appropriate treatment. Additionally, accurate diagnosis is critical for optimizing clinical and experimental research on pathophysiology and innovative therapies. In a few years, integrated technologies could enable accurate, reliable diagnosis from early disease stages or prodromal stages in at-risk populations, but further research combining different techniques is needed.
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Affiliation(s)
| | - Giulia Paparella
- IRCCS Neuromed, Pozzilli, (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Shi D, Wu S, Zhuang C, Mao Y, Wang Q, Zhai H, Zhao N, Yan G, Wu R. Multimodal data fusion reveals functional and neurochemical correlates of Parkinson's disease. Neurobiol Dis 2024; 197:106527. [PMID: 38740347 DOI: 10.1016/j.nbd.2024.106527] [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: 04/16/2024] [Accepted: 05/09/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Neurotransmitter deficits and spatial associations among neurotransmitter distribution, brain activity, and clinical features in Parkinson's disease (PD) remain unclear. Better understanding of neurotransmitter impairments in PD may provide potential therapeutic targets. Therefore, we aimed to investigate the spatial relationship between PD-related patterns and neurotransmitter deficits. METHODS We included 59 patients with PD and 41 age- and sex-matched healthy controls (HCs). The voxel-wise mean amplitude of the low-frequency fluctuation (mALFF) was calculated and compared between the two groups. The JuSpace toolbox was used to test whether spatial patterns of mALFF alterations in patients with PD were associated with specific neurotransmitter receptor/transporter densities. RESULTS Compared to HCs, patients with PD showed reduced mALFF in the sensorimotor- and visual-related regions. In addition, mALFF alteration patterns were significantly associated with the spatial distribution of the serotonergic, dopaminergic, noradrenergic, glutamatergic, cannabinoid, and acetylcholinergic neurotransmitter systems (p < 0.05, false discovery rate-corrected). CONCLUSIONS Our results revealed abnormal brain activity patterns and specific neurotransmitter deficits in patients with PD, which may provide new insights into the mechanisms and potential targets for pharmacotherapy.
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Affiliation(s)
- Dafa Shi
- Department of Radiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China.
| | - Shuohua Wu
- Department of Radiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Caiyu Zhuang
- Department of Radiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yumeng Mao
- Department of Radiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Qianqi Wang
- Department of Basic Medical Sciences, School of Medicine, Xiamen University, Xiamen, China
| | - Huige Zhai
- Center of Morphological Experiment, Medical College of Yanbian University, Yanji, China
| | - Nannan Zhao
- Center of Morphological Experiment, Medical College of Yanbian University, Yanji, China
| | - Gen Yan
- Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China.
| | - Renhua Wu
- Department of Radiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China.
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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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Lakhani DA, Zhou X, Tao S, Patel V, Wen S, Okromelidze L, Greco E, Lin C, Westerhold EM, Straub S, Wszolek ZK, Tipton PW, Uitti RJ, Grewal SS, Middlebrooks EH. Diagnostic utility of 7T neuromelanin imaging of the substantia nigra in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:13. [PMID: 38191546 PMCID: PMC10774294 DOI: 10.1038/s41531-024-00631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024] Open
Abstract
Parkinson's disease (PD) is a prevalent neurodegenerative disorder that presents a diagnostic challenge due to symptom overlap with other disorders. Neuromelanin (NM) imaging is a promising biomarker for PD, but adoption has been limited, in part due to subpar performance at standard MRI field strengths. We aimed to evaluate the diagnostic utility of ultra-high field 7T NM-sensitive imaging in the diagnosis of PD versus controls and essential tremor (ET), as well as NM differences among PD subtypes. A retrospective case-control study was conducted including PD patients, ET patients, and controls. 7T NM-sensitive 3D-GRE was acquired, and substantia nigra pars compacta (SNpc) volumes, contrast ratios, and asymmetry indices were calculated. Statistical analyses, including general linear models and ROC curves, were employed. Twenty-one PD patients, 13 ET patients, and 18 controls were assessed. PD patients exhibited significantly lower SNpc volumes compared to non-PD subjects. SNpc total volume showed 100% sensitivity and 96.8% specificity (AUC = 0.998) for differentiating PD from non-PD and 100% sensitivity and 95.2% specificity (AUC = 0.996) in differentiating PD from ET. Contrast ratio was not significantly different between PD and non-PD groups (p = 0.07). There was also significantly higher asymmetry index in SNpc volume in PD compared to non-PD cohorts (p < 0.001). NM signal loss in PD predominantly involved the inferior, posterior, and lateral aspects of SNpc. Akinetic-rigid subtype showed more significant NM signal loss compared to tremor dominant subtype (p < 0.001). 7T NM imaging demonstrates potential as a diagnostic tool for PD, including potential distinction between subtypes, allowing improved understanding of disease progression and subtype-related characteristics.
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Affiliation(s)
- Dhairya A Lakhani
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Xiangzhi Zhou
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Shengzhen Tao
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Vishal Patel
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Sijin Wen
- Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | | | - Elena Greco
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Sina Straub
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA.
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
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Lee DH, Heo H, Suh CH, Shim WH, Kim E, Jo S, Chung SJ, Lee CS, Kim HS, Kim SJ. Improved diagnostic performance of susceptibility-weighted imaging with compressed sensing-sensitivity encoding and neuromelanin-sensitive MRI for Parkinson's disease and atypical Parkinsonism. Clin Radiol 2024; 79:e102-e111. [PMID: 37863747 DOI: 10.1016/j.crad.2023.09.019] [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: 02/07/2023] [Revised: 08/08/2023] [Accepted: 09/18/2023] [Indexed: 10/22/2023]
Abstract
AIM To verify the diagnostic performance of the loss of nigrosome-1 on susceptibility-weighted imaging (SWI) with compressed sensing-sensitivity encoding (CS-SENSE) and neuromelanin on neuromelanin-sensitive (NM) magnetic resonance imaging (MRI) for the diagnosis of Parkinson's disease (PD) and atypical Parkinsonism. MATERIALS AND METHODS A total of 195 patients who underwent MRI between October 2019 and February 2020, including SWI, with or without CS-SENSE, and NM-MRI, were reviewed retrospectively. Two neuroradiologists assessed the loss of nigrosome-1 on SWI and neuromelanin on the NM-MRI. The result of N-3-fluoropropyl-2-beta-carbomethoxy-3-beta-(4-iodophenyl) nortropane positron-emission tomography (PET) was set as the reference standard. RESULTS When CS-SENSE was applied for nigrosome-1 imaging on SWI, the non-diagnostic scan rate was lowered significantly from 19.3% (17/88) to 5.6% (6/107; p=0.004). Diagnosis of PD and atypical Parkinsonism based on the loss of nigrosome-1 on SWI and based on NM-MRI showed good diagnostic value (area under the curve [AUC] 0.821, 95% confidence interval [CI] = 0.755-0.875: AUC 0.832, 95% CI = 0.771-0.882, respectively) with a substantial inter-reader agreement (κ = 0.791 and 0.681, respectively). Combined SWI and neuromelanin had a similar discriminatory ability (AUC 0.830, 95% CI = 0.770-0.880). Similarly, the diagnosis of PD was excellent. CONCLUSIONS CS-SENSE may add value to the diagnostic capability of nigrosome-1 on SWI to reduce the nondiagnostic scan rates. Furthermore, loss of nigrosome-1 on SWI or volume loss of neuromelanin on NM-MRI may be helpful for diagnosing PD.
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Affiliation(s)
- D H Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - H Heo
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - C H Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - W H Shim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - E Kim
- Philips Healthcare Korea, Seoul, Republic of Korea
| | - S Jo
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - S J Chung
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - C S Lee
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - H S Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - S J Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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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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Seong M, Park S, Sung YH, Kim EY. Diagnostic performance of a high-spatial-resolution voxelwise analysis of neuromelanin-sensitive imaging in early-stage idiopathic Parkinson's disease. BMC Med Imaging 2023; 23:64. [PMID: 37202720 DOI: 10.1186/s12880-023-01018-1] [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: 07/27/2022] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Quantitative assessments of neuromelanin (NM) of the substantia nigra pars compacta (SNpc) in neuromelanin-sensitive MRI (NM-MRI) to determine its abnormality have been conducted by measuring either the volume or contrast ratio (CR) of the SNpc. A recent study determined the regions in the SNpc that are significantly different between early-stage idiopathic Parkinson's disease (IPD) patients and healthy controls (HCs) using a high spatial-resolution NM-MRI template, which enables a template-based voxelwise analysis to overcome the susceptibility of CR measurement to inter-rater discrepancy. We aimed to assess the diagnostic performance, which has not been reported, of the CRs between early-stage IPD patients and HCs using a NM-MRI template. METHODS We retrospectively enrolled early-stage IPD patients (n = 50) and HCs (n = 50) who underwent 0.8-mm isovoxel NM-MRI and dopamine-transporter PET as the standard of reference. A template-based voxelwise analysis revealed two regions in nigrosomes 1 and 2 (N1 and N2, respectively), with significant differences in each substantia nigra (SNpc) between IPD and HCs. The mean CR values of N1, N2, volume-weighted mean of N1 and N2 (N1 + N2), and whole SNpc on each side were compared between IPD and HC using the independent t-test or the Mann-Whitney U test. The diagnostic performance was compared in each region using receiver operating characteristic curves. RESULTS The mean CR values in the right N1 (0.149459 vs. 0.194505), left N1 (0.133328 vs. 0.169160), right N2 (0.230245 vs. 0.278181), left N2 (0.235784 vs. 0.314169), right N1 + N2 (0.155322 vs. 0.278143), left N1 + N2 (0.140991 vs. 0.276755), right whole SNpc (0.131397 vs. 0.141422), and left whole SNpc (0.127099 vs. 0.137873) significantly differed between IPD patients and HCs (all p < 0.001). The areas under the curve of the left N1 + N2, right N1 + N2, left N1, right N1, left N2, right N2, left whole SNpc, and right whole SNpc were 0.994 (sensitivity, 98.0%; specificity, 94.0%), 0.985, 0.804, 0.802, 0.777, 0.766, 0.632, and 0.606, respectively. CONCLUSION Our NM-MRI template-based CR measurements revealed significant differences between early-stage IPD patients and HCs. The CR values of the left N1 + N2 demonstrated the highest diagnostic performance.
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Affiliation(s)
- Minjung Seong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | | | - Young Hee Sung
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eung Yeop Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Wang X, Huang P, Haacke EM, Liu Y, Zhang Y, Jin Z, Li Y, Xu Q, Liu P, Chen S, He N, Yan F. Locus coeruleus and substantia nigra neuromelanin magnetic resonance imaging differentiates Parkinson's disease and essential tremor. Neuroimage Clin 2023; 38:103420. [PMID: 37141646 PMCID: PMC10176060 DOI: 10.1016/j.nicl.2023.103420] [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: 12/07/2022] [Revised: 04/04/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Differential diagnosis of essential tremor (ET) and Parkinson's disease (PD) can still be a challenge in clinical practice. These two tremor disorders may have different pathogenesis related to the substantia nigra (SN) and locus coeruleus (LC). Characterizing neuromelanin (NM) in these structures may help improve the differential diagnosis. METHODS Forty-three subjects with tremor-dominant PD (PDTD), 31 subjects with ET, and 30 age- and sex-matched healthy controls were included. All subjects were scanned with NM magnetic resonance imaging (NM-MRI). NM volume and contrast measures for the SN and contrast for the LC were evaluated. Logistic regression was used to calculate predicted probabilities by using the combination of SN and LC NM measures. The discriminative power of the NM measures in detecting subjects with PDTD from ET was assessed with a receiver operative characteristic curve, and the area under the curve (AUC) was calculated. RESULTS The NM contrast-to-noise ratio (CNR) of the LC, the NM volume, and CNR of the SN on the right and left sides were significantly lower in PDTD subjects than in ET subjects or healthy controls (all P < 0.05). Furthermore, when combining the best model constructed from the NM measures, the AUC reached 0.92 in differentiating PDTD from ET. CONCLUSION The NM volume and contrast measures of the SN and contrast for the LC provided a new perspective on the differential diagnosis of PDTD and ET, and the investigation of the underlying pathophysiology.
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Affiliation(s)
- Xinhui Wang
- From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Pei Huang
- From the Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Ewart Mark Haacke
- From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China; Department of Biomedical Engineering, Wayne State University, 3990 John R, Detroit, MI, USA; Department of Radiology, Wayne State University, 3990 John R, Detroit, MI, USA; Department of Neurology, Wayne State University, 3990 John R, Detroit, MI, USA
| | - Yu Liu
- From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Youmin Zhang
- From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Zhijia Jin
- From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Yan Li
- From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Qiuyun Xu
- Department of Biomedical Engineering, Wayne State University, 3990 John R, Detroit, MI, USA
| | - Peng Liu
- From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China
| | - Shengdi Chen
- From the Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China.
| | - Naying He
- From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China.
| | - Fuhua Yan
- From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Er Road, Shanghai 200025, China.
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Wang S, Wu T, Cai Y, Yu Y, Chen X, Wang L. Neuromelanin magnetic resonance imaging of substantia nigra and locus coeruleus in Parkinson's disease with freezing of gait. Front Aging Neurosci 2023; 15:1060935. [PMID: 36819729 PMCID: PMC9932285 DOI: 10.3389/fnagi.2023.1060935] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background The downregulation of monoamines, especially dopamine in substantia nigra (SN) and norepinephrine in locus coeruleus (LC), may be responsible for freezing of gait (FOG) pathological basis in Parkinson's disease (PD). Methods Thirty-two Parkinson's disease patients with freezing of gait (PD-FOG), 32 Parkinson's disease patients without freezing of gait (PD-NFOG) and 32 healthy controls (HC) underwent neuromelanin magnetic resonance imaging (NM-MRI). The volume, surface area and contrast to noise ratio (CNR) of SN and LC were measured and compared. The correlation analyses were conducted between the measurements of SN and LC with clinical symptoms. We plotted the receiver operating characteristic (ROC) curve and determined the sensitivity and specificity of the CNR of SN and LC for discriminating the PD-FOG from the PD-NFOG. Results Both PD-FOG and PD-NFOG showed decreased volume, surface area and CNR of SN compared with HC. The PD-FOG exhibited decreased volume and surface area of LC compared with both PD-NFOG and HC groups, and decreased CNR of LC compared with HC group. The volume, surface area and CNR of SN were negatively correlated with the Unified Parkinson's Disease Rating Scale part III scores. The illness durations in PD patients were negatively correlated with the volume, surface area of SN, while not the CNR. And the volume and surface area of LC were negatively correlated with new freezing of gait questionnaire scores. ROC analyses indicated that the area under the curve (AUC) was 0.865 and 0.713 in the CNR of SN and LC, respectively, in PD versus HC, whereas it was 0.494 and 0.637 respectively, in PD-FOG versus PD-NFOG. Among these, for discriminating the PD from the HC, the sensitivity and specificity in the CNR of the SN was 90.6 and 71.9%, respectively, when the cut-off value was set at 2.101; the sensitivity and specificity in the CNR of the LC was 90.6 and 50.0%, respectively, when the cut-off value for CNR was set at 1.411. Conclusion The dopaminergic changes in the SN were found across both PD-FOG and PD-NFOG, whilst LC noradrenergic neuron reduction was more evident in PD-FOG.
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Affiliation(s)
- Shangpei Wang
- Department of Radiology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tong Wu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yajie Cai
- Department of Radiology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,*Correspondence: Yongqiang Yu, ✉
| | - Xianwen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,Xianwen Chen, ✉
| | - Longsheng Wang
- Department of Radiology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China,Longsheng Wang, ✉
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Pizarro-Galleguillos BM, Kunert L, Brüggemann N, Prasuhn J. Iron- and Neuromelanin-Weighted Neuroimaging to Study Mitochondrial Dysfunction in Patients with Parkinson's Disease. Int J Mol Sci 2022; 23:ijms232213678. [PMID: 36430157 PMCID: PMC9696602 DOI: 10.3390/ijms232213678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
The underlying causes of Parkinson's disease are complex, and besides recent advances in elucidating relevant disease mechanisms, no disease-modifying treatments are currently available. One proposed pathophysiological hallmark is mitochondrial dysfunction, and a plethora of evidence points toward the interconnected nature of mitochondria in neuronal homeostasis. This also extends to iron and neuromelanin metabolism, two biochemical processes highly relevant to individual disease manifestation and progression. Modern neuroimaging methods help to gain in vivo insights into these intertwined pathways and may pave the road to individualized medicine in this debilitating disorder. In this narrative review, we will highlight the biological rationale for studying these pathways, how distinct neuroimaging methods can be applied in patients, their respective limitations, and which challenges need to be overcome for successful implementation in clinical studies.
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Affiliation(s)
- Benjamin Matis Pizarro-Galleguillos
- Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
- Institute of Neurogenetics, University of Lübeck, 23588 Lübeck, Germany
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Center for Brain, Behavior, and Metabolism, University of Lübeck, 23562 Lübeck, Germany
| | - Liesa Kunert
- Institute of Neurogenetics, University of Lübeck, 23588 Lübeck, Germany
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Center for Brain, Behavior, and Metabolism, University of Lübeck, 23562 Lübeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, 23588 Lübeck, Germany
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Center for Brain, Behavior, and Metabolism, University of Lübeck, 23562 Lübeck, Germany
- Correspondence: ; Tel.: +49-451-500-43420; Fax: +49-451-500-43424
| | - Jannik Prasuhn
- Institute of Neurogenetics, University of Lübeck, 23588 Lübeck, Germany
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Center for Brain, Behavior, and Metabolism, University of Lübeck, 23562 Lübeck, Germany
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11
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Gaurav R, Valabrègue R, Yahia-Chérif L, Mangone G, Narayanan S, Arnulf I, Vidailhet M, Corvol JC, Lehéricy S. NigraNet: An automatic framework to assess nigral neuromelanin content in early Parkinson's disease using convolutional neural network. Neuroimage Clin 2022; 36:103250. [PMID: 36451356 PMCID: PMC9668659 DOI: 10.1016/j.nicl.2022.103250] [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: 05/23/2022] [Revised: 10/15/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Parkinson's disease (PD) demonstrates neurodegenerative changes in the substantia nigra pars compacta (SNc) using neuromelanin-sensitive (NM)-MRI. As SNc manual segmentation is prone to substantial inter-individual variability across raters, development of a robust automatic segmentation framework is necessary to facilitate nigral neuromelanin quantification. Artificial intelligence (AI) is gaining traction in the neuroimaging community for automated brain region segmentation tasks using MRI. OBJECTIVE Developing and validating AI-based NigraNet, a fully automatic SNc segmentation framework allowing nigral neuromelanin quantification in patients with PD using NM-MRI. METHODS We prospectively included 199 participants comprising 144 early-stage idiopathic PD patients (disease duration = 1.5 ± 1.0 years) and 55 healthy volunteers (HV) scanned using a 3 Tesla MRI including whole brain T1-weighted anatomical imaging and NM-MRI. The regions of interest (ROI) were delineated in all participants automatically using NigraNet, a modified U-net, and compared to manual segmentations performed by two experienced raters. The SNc volumes (Vol), volumes corrected by total intracranial volume (Cvol), normalized signal intensity (NSI) and contrast-to-noise ratio (CNR) were computed. One-way GLM-ANCOVA was performed while adjusting for age and sex as covariates. Diagnostic performance measurement was assessed using the receiver operating characteristic (ROC) analysis. Inter and intra-observer variability were estimated using Dice similarity coefficient (DSC). The agreements between methods were tested using intraclass correlation coefficient (ICC) based on a mean-rating, two-way, mixed-effects model estimates for absolute agreement. Cronbach's alpha and Bland-Altman plots were estimated to assess inter-method consistency. RESULTS Using both methods, Vol, Cvol, NSI and CNR measurements differed between PD and HV with an effect of sex for Cvol and CNR. ICC values between the methods demonstrated optimal agreement for Cvol and CNR (ICC > 0.9) and high reproducibility (DSC: 0.80) was also obtained. The SNc measurements also showed good to excellent consistency values (Cronbach's alpha > 0.87). Bland-Altman plots of agreement demonstrated no association of SNc ROI measurement differences between the methods and ROI average measurements while confirming that 95 % of the data points were ranging between the limits of mean difference (d ± 1.96xSD). Percentage changes between PD and HV were -27.4 % and -17.7 % for Vol, -30.0 % and -22.2 % for Cvol, -15.8 % and -14.4 % for NSI, -17.1 % and -16.0 % for CNR for automatic and manual measurements respectively. Using automatic method, in the entire dataset, we obtained the areas under the ROC curve (AUC) of 0.83 for Vol, 0.85 for Cvol, 0.79 for NSI and 0.77 for CNR whereas in the training dataset of 0.96 for Vol, 0.95 for Cvol, 0.85 for NSI and 0.85 for CNR. Disease duration correlated negatively with NSI of the patients for both the automatic and manual measurements. CONCLUSIONS We presented an AI-based NigraNet framework that utilizes a small MRI training dataset to fully automatize the SNc segmentation procedure with an increased precision and more reproducible results. Considering the consistency, accuracy and speed of our approach, this study could be a crucial step towards the implementation of a time-saving non-rater dependent fully automatic method for studying neuromelanin changes in clinical settings and large-scale neuroimaging studies.
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Affiliation(s)
- Rahul Gaurav
- Paris Brain Institute – ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France,Movement Investigations and Therapeutics Team (MOV’IT), ICM, Paris, France,Center for NeuroImaging Research – CENIR, ICM, Paris, France,Corresponding author at: Centre de NeuroImagerie de Recherche – CENIR, Institut du Cerveau – ICM, Hôpital Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75013 Paris, France.
| | - Romain Valabrègue
- Paris Brain Institute – ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France,Center for NeuroImaging Research – CENIR, ICM, Paris, France
| | - Lydia Yahia-Chérif
- Paris Brain Institute – ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France,Center for NeuroImaging Research – CENIR, ICM, Paris, France
| | - Graziella Mangone
- Paris Brain Institute – ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France,INSERM, Clinical Investigation Center for Neurosciences (CIC), Pitié-Salpêtrière Hospital, Paris, France
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec, H3A 2B4, Canada
| | - Isabelle Arnulf
- Paris Brain Institute – ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France,Movement Investigations and Therapeutics Team (MOV’IT), ICM, Paris, France,Sleep Disorders Unit, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Marie Vidailhet
- Paris Brain Institute – ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France,Movement Investigations and Therapeutics Team (MOV’IT), ICM, Paris, France,Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Jean-Christophe Corvol
- Paris Brain Institute – ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France,INSERM, Clinical Investigation Center for Neurosciences (CIC), Pitié-Salpêtrière Hospital, Paris, France,Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Stéphane Lehéricy
- Paris Brain Institute – ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France,Movement Investigations and Therapeutics Team (MOV’IT), ICM, Paris, France,Center for NeuroImaging Research – CENIR, ICM, Paris, France,Department of Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
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12
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Classification of Parkinson's disease using a region-of-interest- and resting-state functional magnetic resonance imaging-based radiomics approach. Brain Imaging Behav 2022; 16:2150-2163. [PMID: 35650376 DOI: 10.1007/s11682-022-00685-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/02/2022]
Abstract
To investigate the value of combining amplitude of low-frequency fluctuations-based radiomics and the support vector machine classifier method in distinguishing patients with Parkinson's disease from healthy controls. A total of 123 patients with Parkinson's disease and 90 healthy controls from three centers with functional and structural MRI images were included in this study. We extracted radiomics features using the Brainnetome 246 atlas from the mean amplitude of low-frequency fluctuations maps. Two-sample t-tests and recursive feature elimination combined with support vector machine method were applied for feature selection and dimensionality reduction. We used support vector machine classifier to construct model and identify the discriminative features. The automated anatomical labeling 90 atlas and fivefold cross-validation were used to evaluate the robustness and generalization of the classifier. We found our model obtained a high classification performance with an accuracy of 78.07%, and AUC, sensitivity, and specificity of 0.8597, 78.80%, and 76.08%, respectively. We detected 7 discriminative brain subregions. The fivefold cross-validation and automated anatomical labeling 90 atlas also got high classification accuracy, and we found Brainnetome 246 atlas achieved a higher classification performance than the automated anatomical labeling 90 atlas both with tenfold and fivefold cross-validation. Our findings may help the early diagnosis of Parkinson's disease and provide support for research on Parkinson's disease mechanisms and clinical evaluation.
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13
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Gaurav R, Pyatigorskaya N, Biondetti E, Valabrègue R, Yahia-Cherif L, Mangone G, Leu-Semenescu S, Corvol JC, Vidailhet M, Arnulf I, Lehéricy S. Deep Learning-Based Neuromelanin MRI Changes of Isolated REM Sleep Behavior Disorder. Mov Disord 2022; 37:1064-1069. [PMID: 35102604 PMCID: PMC9302679 DOI: 10.1002/mds.28933] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background Isolated REM sleep behavior disorder (iRBD) is considered a prodromal stage of parkinsonism. Neurodegenerative changes in the substantia nigra pars compacta (SNc) in parkinsonism can be detected using neuromelanin‐sensitive MRI. Objective To investigate SNc neuromelanin changes in iRBD patients using fully automatic segmentation. Methods We included 47 iRBD patients, 134 early Parkinson's disease (PD) patients and 55 healthy volunteers (HVs) scanned at 3 Tesla. SNc regions‐of‐interest were delineated automatically using convolutional neural network. SNc volumes, volumes corrected by total intracranial volume, signal‐to‐noise ratio (SNR) and contrast‐to‐noise ratio were computed. One‐way general linear models (GLM) analysis of covariance (ANCOVA) was conducted while adjusting for age and sex. Results All SNc measurements differed significantly between the three groups (except SNR in iRBD). Changes in iRBD were intermediate between those in PD and HVs. Conclusions Using fully automated SNc segmentation method and neuromelanin‐sensitive imaging, iRBD patients showed neurodegenerative changes in the SNc at a lower level than in PD patients. © 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)
- Rahul Gaurav
- Center for NeuroImaging Research (CENIR), Paris Brain Institute-ICM, Paris, France.,Sorbonne Université, Paris Brain Institute-ICM, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France.,Movement Investigations and Therapeutics - MOV'IT Team, Paris Brain Institute-ICM, Paris, France
| | - Nadya Pyatigorskaya
- Center for NeuroImaging Research (CENIR), Paris Brain Institute-ICM, Paris, France.,Sorbonne Université, Paris Brain Institute-ICM, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France.,Movement Investigations and Therapeutics - MOV'IT Team, Paris Brain Institute-ICM, Paris, France.,Department of Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Emma Biondetti
- Center for NeuroImaging Research (CENIR), Paris Brain Institute-ICM, Paris, France.,Sorbonne Université, Paris Brain Institute-ICM, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France.,Movement Investigations and Therapeutics - MOV'IT Team, Paris Brain Institute-ICM, Paris, France
| | - Romain Valabrègue
- Center for NeuroImaging Research (CENIR), Paris Brain Institute-ICM, Paris, France.,Sorbonne Université, Paris Brain Institute-ICM, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France
| | - Lydia Yahia-Cherif
- Center for NeuroImaging Research (CENIR), Paris Brain Institute-ICM, Paris, France.,Sorbonne Université, Paris Brain Institute-ICM, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France
| | - Graziella Mangone
- Sorbonne Université, Paris Brain Institute-ICM, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France.,INSERM, Clinical Investigation Center for Neurosciences (CIC), Pitié-Salpêtrière Hospital, Paris, France
| | | | - Jean-Christophe Corvol
- Sorbonne Université, Paris Brain Institute-ICM, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France.,Department of Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Marie Vidailhet
- Sorbonne Université, Paris Brain Institute-ICM, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France.,Movement Investigations and Therapeutics - MOV'IT Team, Paris Brain Institute-ICM, Paris, France.,Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Isabelle Arnulf
- Center for NeuroImaging Research (CENIR), Paris Brain Institute-ICM, Paris, France.,Movement Investigations and Therapeutics - MOV'IT Team, Paris Brain Institute-ICM, Paris, France.,Sleep Disorders Unit, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Stéphane Lehéricy
- Center for NeuroImaging Research (CENIR), Paris Brain Institute-ICM, Paris, France.,Sorbonne Université, Paris Brain Institute-ICM, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France.,Movement Investigations and Therapeutics - MOV'IT Team, Paris Brain Institute-ICM, Paris, France.,INSERM, Clinical Investigation Center for Neurosciences (CIC), Pitié-Salpêtrière Hospital, Paris, France
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14
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Zhou C, Guo T, Wu J, Wang L, Bai X, Gao T, Guan X, Gu L, Huang P, Xuan M, Gu Q, Xu X, Zhang B, Cheng W, Feng J, Zhang M. Locus Coeruleus Degeneration Correlated with Levodopa Resistance in Parkinson's Disease: A Retrospective Analysis. JOURNAL OF PARKINSONS DISEASE 2021; 11:1631-1640. [PMID: 34366373 PMCID: PMC8609680 DOI: 10.3233/jpd-212720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The widely divergent responsiveness of Parkinson’s disease (PD) patients to levodopa is an important clinical issue because of its relationship with quality of life and disease prognosis. Preliminary animal experiments have suggested that degeneration of the locus coeruleus (LC) attenuates the efficacy of levodopa treatment. Objective: To explore the relationship between LC degeneration and levodopa responsiveness in PD patients in vivo. Methods: Neuromelanin-sensitive magnetic resonance imaging (NM-MRI), a good indicator of LC and substantia nigra (SN) degeneration, and levodopa challenge tests were conducted in 57 PD patients. Responsiveness to levodopa was evaluated by the rates of change of the Unified Parkinson’s Disease Rating Scale Part III score and somatomotor network synchronization calculated from resting-state functional MRI before and after levodopa administration. Next, we assessed the relationship between the contrast-to-noise ratio of LC (CNRLC) and levodopa responsiveness. Multiple linear regression analysis was conducted to rule out the potential influence of SN degeneration on levodopa responsiveness. Results: A significant positive correlation was found between CNRLC and the motor improvement after levodopa administration (R = 0.421, p = 0.004). CNRLC also correlated with improvement in somatomotor network synchronization (R = –0.323, p = 0.029). Furthermore, the relationship between CNRLC and levodopa responsiveness was independent of SN degeneration. Conclusion: LC degeneration might be an essential factor for levodopa resistance. LC evaluation using NM-MRI might be an alternative tool for predicting levodopa responsiveness and for helping to stratify patients into clinical trials aimed at improving the efficacy of levodopa.
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Affiliation(s)
- Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - JingJing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linbo Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luyan Gu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Xuan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Quanquan Gu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.,Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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15
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Comparative morphometric evaluation of the brainstem in neurodegenerative diseases with healthy individuals using magnetic resonance imaging. J Taibah Univ Med Sci 2021; 17:87-95. [PMID: 35140570 PMCID: PMC8802845 DOI: 10.1016/j.jtumed.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022] Open
Abstract
Objective Measurement of a component within the reference value is a widely used parameter in Biomedical Science. This study highlights the value of morphometric changes in healthy individuals’ brainstem structure and their application in the detection and diagnosis of neurodegenerative disorders. Methods This retrospective study included magnetic resonance (MR) images of 50 healthy individuals without neurological diseases, 35 clinically diagnosed individuals with Parkinson's disease (PD), and 12 individuals with Progressive Supranuclear Palsy (PSP). Measurements of midbrain area, pons area, ratio of midbrain to pons area, superior profile of midbrain, thickness of substantia nigra (SN), cerebral crus width, interpeduncular distance, and concavity of the crus were analysed as per the standard protocol. Results Patients with PD had mean anteroposterior diameter of 1.11 ± 0.1 cm, which was more than the control group and PSP patients. Additionally, PSP patients showed the least midbrain and pons area of 1.06 ± 0.34 and 4.01 ± 1.2 sq.cm, respectively, compared to other groups. The ratio of midbrain to pons area was the least among PSP patients (0.21 ± 0.06 cm). Mean thickness of the right and left middle cerebellar peduncles (1.25 ± 0.19 and 1.24 ± 0.17 cm) was less in the PD group. The width of the SN gradually reduced in PD and more so in PSP patients. The convex superior profile of the midbrain was a consistent feature in all groups. Conclusion This study highlights the value of morphometrics of the brainstem profile in differentiating neurodegenerative diseases among aged, healthy individuals when combined with their clinical data.
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Parkinson's disease multimodal imaging: F-DOPA PET, neuromelanin-sensitive and quantitative iron-sensitive MRI. NPJ Parkinsons Dis 2021; 7:57. [PMID: 34238927 PMCID: PMC8266835 DOI: 10.1038/s41531-021-00199-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/16/2021] [Indexed: 11/08/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative synucleinopathy characterized by the degeneration of neuromelanin (NM)-containing dopaminergic neurons and deposition of iron in the substantia nigra (SN). How regional NM loss and iron accumulation within specific areas of SN relate to nigro-striatal dysfunction needs to be clarified. We measured dopaminergic function in pre- and postcommissural putamen by [18F]DOPA PET in 23 Parkinson's disease patients and 23 healthy control (HC) participants in whom NM content and iron load were assessed in medial and lateral SN, respectively, by NM-sensitive and quantitative R2* MRI. Data analysis consisted of voxelwise regressions testing the group effect and its interaction with NM or iron signals. In PD patients, R2* was selectively increased in left lateral SN as compared to healthy participants, suggesting a local accumulation of iron in Parkinson's disease. By contrast, NM signal differed between PD and HC, without specific regional specificity within SN. Dopaminergic function in posterior putamen decreased as R2* increased in lateral SN, indicating that dopaminergic function impairment progresses with iron accumulation in the SN. Dopaminergic function was also positively correlated with NM signal in lateral SN, indicating that dopaminergic function impairment progresses with depigmentation in the SN. A complex relationship was detected between R2* in the lateral SN and NM signal in the medial SN. In conclusion, multimodal imaging reveals regionally specific relationships between iron accumulation and depigmentation within the SN of Parkinson's disease and provides in vivo insights in its neuropathology.
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Gaurav R, Yahia‐Cherif L, Pyatigorskaya N, Mangone G, Biondetti E, Valabrègue R, Ewenczyk C, Hutchison RM, Cedarbaum JM, Corvol J, Vidailhet M, Lehéricy S. Longitudinal Changes in Neuromelanin MRI Signal in Parkinson's Disease: A Progression Marker. Mov Disord 2021; 36:1592-1602. [PMID: 33751655 PMCID: PMC8359265 DOI: 10.1002/mds.28531] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/07/2021] [Accepted: 01/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Development of reliable and accurate imaging biomarkers of dopaminergic cell neurodegeneration is necessary to facilitate therapeutic drug trials in Parkinson's disease (PD). Neuromelanin-sensitive MRI techniques have been effective in detecting neurodegeneration in the substantia nigra pars compacta (SNpc). The objective of the current study was to investigate longitudinal neuromelanin signal changes in the SNpc in PD patients. METHODS In this prospective, longitudinal, observational case-control study, we included 140 PD patients and 64 healthy volunteers divided into 2 cohorts. Cohort I included 99 early PD patients (disease duration, 1.5 ± 1.0 years) and 41 healthy volunteers analyzed at baseline (V1), where 79 PD patients and 32 healthy volunteers were rescanned after 2.0 ± 0.2 years of follow-up (V2). Cohort II included 41 progressing PD patients (disease duration, 9.3 ± 3.7 years) and 23 healthy volunteers at V1, where 30 PD patients were rescanned after 2.4 ± 0.5 years of follow-up. Subjects were scanned at 3 T MRI using 3-dimensional T1-weighted and neuromelanin-sensitive imaging. Regions of interest were delineated manually to calculate SN volumes, volumes corrected by total intracranial volume, signal-to-noise ratio, and contrast-to-noise ratio. RESULTS Results showed (1) significant reduction in volume and volume corrected by total intracranial volume between visits, greater in progressing PD than nonsignificant changes in healthy volunteers; (2) no significant effects of visit for signal intensity (signal-to-noise ratio); (3) significant interaction in volume between group and visit; (4) greater volume corrected by total intracranial volume at baseline in female patients and greater decrease in volume and increase in the contrast-to-noise ratio in progressing female PD patients compared with male patients; and (5) correlations between neuromelanin SN changes and disease severity and duration. CONCLUSIONS We observed a progressive and measurable decrease in neuromelanin-based SN signal and volume in PD, which might allow a direct noninvasive assessment of progression of SN loss and could represent a target biomarker for disease-modifying treatments. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rahul Gaurav
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
| | - Lydia Yahia‐Cherif
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
| | - Nadya Pyatigorskaya
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
- Department of NeuroradiologyPitié‐Salpêtrière Hospital, AP‐HPParisFrance
| | - Graziella Mangone
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- INSERM, Clinical Investigation Center for Neurosciences, Pitié‐Salpêtrière HospitalParisFrance
| | - Emma Biondetti
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
| | - Romain Valabrègue
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
| | - Claire Ewenczyk
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
- Department of NeurologyPitié‐Salpêtrière Hospital, AP‐HPParisFrance
| | | | | | - Jean‐Christophe Corvol
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- INSERM, Clinical Investigation Center for Neurosciences, Pitié‐Salpêtrière HospitalParisFrance
- Department of NeurologyPitié‐Salpêtrière Hospital, AP‐HPParisFrance
| | - Marie Vidailhet
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
- Department of NeurologyPitié‐Salpêtrière Hospital, AP‐HPParisFrance
| | - Stéphane Lehéricy
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
- Department of NeuroradiologyPitié‐Salpêtrière Hospital, AP‐HPParisFrance
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18
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Holtbernd F, Shah NJ. Imaging the Pathophysiology of Essential Tremor-A Systematic Review. Front Neurol 2021; 12:680254. [PMID: 34220687 PMCID: PMC8244929 DOI: 10.3389/fneur.2021.680254] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background: The pathophysiology underlying essential tremor (ET) still is poorly understood. Recent research suggests a pivotal role of the cerebellum in tremor genesis, and an ongoing controversy remains as to whether ET constitutes a neurodegenerative disorder. In addition, mounting evidence indicates that alterations in the gamma-aminobutyric acid neurotransmitter system are involved in ET pathophysiology. Here, we systematically review structural, functional, and metabolic neuroimaging studies and discuss current concepts of ET pathophysiology from an imaging perspective. Methods: We conducted a PubMed and Scopus search from 1966 up to December 2020, entering essential tremor in combination with any of the following search terms and their corresponding abbreviations: positron emission tomography (PET), single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and gamma-aminobutyric acid (GABA). Results: Altered functional connectivity in the cerebellum and cerebello-thalamico-cortical circuitry is a prevalent finding in functional imaging studies. Reports from structural imaging studies are less consistent, and there is no clear evidence for cerebellar neurodegeneration. However, diffusion tensor imaging robustly points toward microstructural cerebellar changes. Radiotracer imaging suggests that the dopaminergic axis is largely preserved in ET. Similarly, measurements of nigral iron content and neuromelanin are unremarkable in most studies; this is in contrast to Parkinson's disease (PD). PET and MRS studies provide limited evidence for cerebellar and thalamic GABAergic dysfunction. Conclusions: There is robust evidence indicating that the cerebellum plays a key role within a multiple oscillator tremor network which underlies tremor genesis. However, whether cerebellar dysfunction relies on a neurodegenerative process remains unclear. Dopaminergic and iron imaging do not suggest a substantial overlap of ET with PD pathophysiology. There is limited evidence for alterations of the GABAergic neurotransmitter system in ET. The clinical, demographical, and genetic heterogeneity of ET translates into neuroimaging and likely explains the various inconsistencies reported.
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Affiliation(s)
- Florian Holtbernd
- Institute of Neuroscience and Medicine (INM-4/INM-11), Forschungszentrum Juelich GmbH, Juelich, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Juelich GmbH, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
- Department of Neurology, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
| | - N. Jon Shah
- Institute of Neuroscience and Medicine (INM-4/INM-11), Forschungszentrum Juelich GmbH, Juelich, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Juelich GmbH, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
- Department of Neurology, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
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19
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Feraco P, Gagliardo C, La Tona G, Bruno E, D’angelo C, Marrale M, Del Poggio A, Malaguti MC, Geraci L, Baschi R, Petralia B, Midiri M, Monastero R. Imaging of Substantia Nigra in Parkinson's Disease: A Narrative Review. Brain Sci 2021; 11:brainsci11060769. [PMID: 34207681 PMCID: PMC8230134 DOI: 10.3390/brainsci11060769] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 12/15/2022] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder, characterized by motor and non-motor symptoms due to the degeneration of the pars compacta of the substantia nigra (SNc) with dopaminergic denervation of the striatum. Although the diagnosis of PD is principally based on a clinical assessment, great efforts have been expended over the past two decades to evaluate reliable biomarkers for PD. Among these biomarkers, magnetic resonance imaging (MRI)-based biomarkers may play a key role. Conventional MRI sequences are considered by many in the field to have low sensitivity, while advanced pulse sequences and ultra-high-field MRI techniques have brought many advantages, particularly regarding the study of brainstem and subcortical structures. Nowadays, nigrosome imaging, neuromelanine-sensitive sequences, iron-sensitive sequences, and advanced diffusion weighted imaging techniques afford new insights to the non-invasive study of the SNc. The use of these imaging methods, alone or in combination, may also help to discriminate PD patients from control patients, in addition to discriminating atypical parkinsonian syndromes (PS). A total of 92 articles were identified from an extensive review of the literature on PubMed in order to ascertain the-state-of-the-art of MRI techniques, as applied to the study of SNc in PD patients, as well as their potential future applications as imaging biomarkers of disease. Whilst none of these MRI-imaging biomarkers could be successfully validated for routine clinical practice, in achieving high levels of accuracy and reproducibility in the diagnosis of PD, a multimodal MRI-PD protocol may assist neuroradiologists and clinicians in the early and differential diagnosis of a wide spectrum of neurodegenerative disorders.
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Affiliation(s)
- Paola Feraco
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Via S. Giacomo 14, 40138 Bologna, Italy;
- Neuroradiology Unit, S. Chiara Hospital, 38122 Trento, Italy;
| | - Cesare Gagliardo
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.L.T.); (E.B.); (C.D.); (M.M.)
- Correspondence:
| | - Giuseppe La Tona
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.L.T.); (E.B.); (C.D.); (M.M.)
| | - Eleonora Bruno
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.L.T.); (E.B.); (C.D.); (M.M.)
| | - Costanza D’angelo
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.L.T.); (E.B.); (C.D.); (M.M.)
| | - Maurizio Marrale
- Department of Physics and Chemistry, University of Palermo, 90128 Palermo, Italy;
| | - Anna Del Poggio
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, San Raffaele Vita-Salute University, 20132 Milan, Italy;
| | | | - Laura Geraci
- Diagnostic and Interventional Neuroradiology Unit, A.R.N.A.S. Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy;
| | - Roberta Baschi
- Section of Neurology, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (R.B.); (R.M.)
| | | | - Massimo Midiri
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.L.T.); (E.B.); (C.D.); (M.M.)
| | - Roberto Monastero
- Section of Neurology, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (R.B.); (R.M.)
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20
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Su D, Zhang F, Liu Z, Yang S, Wang Y, Ma H, Manor B, Hausdorff JM, Lipsitz LA, Pan H, Feng T, Zhou J. Different effects of essential tremor and Parkinsonian tremor on multiscale dynamics of hand tremor. Clin Neurophysiol 2021; 132:2282-2289. [PMID: 34148777 DOI: 10.1016/j.clinph.2021.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/23/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Essential tremor (ET) and Parkinsonian tremor (PT) are often clinically misdiagnosed due to the overlapping characteristics of their hand tremor. We aim to examine if ET and PT influence the multiscale dynamics of hand tremor, as quantified using complexity, differently, and if such complexity metric is of promise to help identify ET from PT. METHODS Forty-eight participants with PT and 48 with ET performed two 30-second tests within each of the following conditions: sitting while resting arms or outstretching arms horizontally. The hand tremor was captured by accelerometers secured to the dorsum of each hand. The complexity was quantified using multiscale entropy. RESULTS Compared to PT group, ET group had lower complexity of both hands across conditions (F > 34.2, p < 0.001). Lower complexity was associated with longer disease duration (r2 > 0.15, p < 0.009) in both PT and ET, and within PT, greater Unified Parkinson's Disease Rating Scale-III UPDRS-III scores (r2 > 0.18, p < 0.009). Receiver-operating-characteristic curves revealed that the complexity metric can distinguish ET from PT (area-under-the-curve > 0.77, cut-off value = 48 (postural), 49 (resting)), which was confirmed in a separate dataset with ET and PT that were clearly diagnosed in prior work. CONCLUSIONS The PT and ET have different effects on hand tremor complexity, and this metric is promising to help the identification of ET and PT, which still needs to be confirmed in future studies. SIGNIFICANCE The characteristics of multiscale dynamics of the hand tremor, as quantified by complexity, provides novel insights into the different pathophysiology between ET and PT.
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Affiliation(s)
- Dongning Su
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | | | - Zhu Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ying Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huizi Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center; Chicago, IL, USA
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Hua Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA
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21
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Leitão R, Guerreiro C, Nunes RG, Gonçalves N, Galati G, Rosário M, Guedes LC, Ferreira JJ, Reimão S. Neuromelanin Magnetic Resonance Imaging of the Substantia Nigra in Huntington's Disease. J Huntingtons Dis 2021; 9:143-148. [PMID: 32065802 DOI: 10.3233/jhd-190388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Huntington's disease (HD) is an autosomal-dominant neurodegenerative disorder inducing motor, psychiatric changes and cognitive decline, characterized pathologically by striatal atrophy. Pathological changes in the extra-striatal structures, such as the substantia nigra (SN), and abnormalities in pre-synaptic striatal dopamine neurotransmission are also known to occur. Neuromelanin (NM)-sensitive magnetic resonance imaging (NM-MRI) is an innovative technique that was recently developed allowing the in vivo study of pathological changes in the dopaminergic neurons of the SN. OBJECTIVE To investigate the SN MR signal in HD patients. METHODS We performed a cross-sectional study using a specific T1-weighted MR sequence to visualize NM. The areas and signal intensity contrast ratios of the T1 hyperintense SN regions were obtained using a semi-automatic segmentation method. RESULTS A total of 8 HD patients and 12 healthy subjects were evaluated. The SN area was markedly reduced in the HD group compared with the control group (p = 0.02), even after normalization of the SN area with the midbrain area and age correction (p = 0.01). There was a significant reduction in the intensity contrast ratio of the hyperintense SN areas to crus cerebri in HD patients comparing with controls (p = 0.04) after correction for age. CONCLUSIONS NM-sensitive MR techniques were used for the first time to study the SN in HD patients, showing loss of NM in this region, supporting the implication of dopaminergic neuronal changes in disease pathology. Future research needs to be conducted to evaluate the potential of SN area and intensity contrast as biomarkers for HD.
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Affiliation(s)
- Ricardo Leitão
- ISR-Lisboa/LARSyS and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Carla Guerreiro
- Neurological Imaging Department, Hospital de Santa Maria - CHULN, Lisbon, Portugal
| | - Rita G Nunes
- ISR-Lisboa/LARSyS and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Nilza Gonçalves
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Giulia Galati
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Madalena Rosário
- Department of Neuroscience and Mental Health, Neurology, Hospital de Santa Maria - CHULN, Lisbon, Portugal
| | - Leonor Correia Guedes
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Department of Neuroscience and Mental Health, Neurology, Hospital de Santa Maria - CHULN, Lisbon, Portugal
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Reimão
- Neurological Imaging Department, Hospital de Santa Maria - CHULN, Lisbon, Portugal.,Imaging University Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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22
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Brooks DJ. Imaging Familial and Sporadic Neurodegenerative Disorders Associated with Parkinsonism. Neurotherapeutics 2021; 18:753-771. [PMID: 33432494 PMCID: PMC8423977 DOI: 10.1007/s13311-020-00994-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
In this paper, the structural and functional imaging changes associated with sporadic and genetic Parkinson's disease and atypical Parkinsonian variants are reviewed. The role of imaging for supporting diagnosis and detecting subclinical disease is discussed, and the potential use and drawbacks of using imaging biomarkers for monitoring disease progression is debated. Imaging changes associated with nonmotor complications of PD are presented. The similarities and differences in imaging findings in Lewy body dementia, Parkinson's disease dementia, and Alzheimer's disease are discussed.
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Affiliation(s)
- David J Brooks
- Department of Nuclear Medicine, Aarhus University, Aarhus N, 8200, Denmark.
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
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23
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Pietracupa S, Bologna M, Tommasin S, Elifani F, Vasselli F, Paparella G, Petsas N, Berardelli A, Pantano P. No evidence of iron deposition in essential tremor: a susceptibility-weighted imaging study. Neurol Sci 2021; 42:4667-4672. [PMID: 33721138 DOI: 10.1007/s10072-021-05173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 03/06/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the role of iron deposition in subcortical nuclei of patients with essential tremor (ET). METHODS Twenty-three patients with ET underwent a standardized 3T-MRI protocol. We specifically assessed iron deposition using susceptibility-weighted angiography (SWAN) images in seven specific regions of interest (ROIs): the thalamus, putamen, globus pallidus, caudate nucleus, substantia nigra, red nucleus, and dentate nucleus. Tremor in ET patients was clinically assessed using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). ET patient data were compared with data obtained from 23 Parkinson's disease (PD) patients and 14 healthy subjects (HS). RESULTS No differences in iron deposition in the seven ROIs were found between ET patients and HS. Conversely, PD patients showed increased iron deposition in the substantia nigra in comparison with both ET patients and HS. CONCLUSIONS Our results indicate the absence of iron deposition in subcortical nuclei of ET patients, which is generally considered a marker of neurodegeneration.
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Affiliation(s)
- Sara Pietracupa
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.
| | - Matteo Bologna
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Elifani
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Federica Vasselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Paparella
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Nikolaos Petsas
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Alfredo Berardelli
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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24
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Sung YH, Noh Y, Kim EY. Early-stage Parkinson's disease: Abnormal nigrosome 1 and 2 revealed by a voxelwise analysis of neuromelanin-sensitive MRI. Hum Brain Mapp 2021; 42:2823-2832. [PMID: 33751680 PMCID: PMC8127157 DOI: 10.1002/hbm.25406] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/17/2021] [Accepted: 02/27/2021] [Indexed: 12/11/2022] Open
Abstract
Previous pathologic studies evaluated the substantia nigra pars compacta (SNpc) of a limited number of idiopathic Parkinson's disease (IPD) patients with relatively longer disease durations. Therefore, it remains unknown which region of the SNpc is most significantly affected in early‐stage IPD. We hypothesized that a voxelwise analysis of thin‐section neuromelanin‐sensitive MRI (NM‐MRI) may help determine the significantly affected regions of the SNpc in early‐stage IPD and localize these areas in each nigrosome on high‐spatial‐resolution susceptibility map‐weighted imaging (SMwI). Ninety‐six healthy subjects and 50 early‐stage IPD patients underwent both a 0.8 × 0.8 × 0.8 mm3 NM‐MRI and a 0.5 × 0.5 × 1.0 mm3 multi‐echo gradient‐recalled echo imaging for SMwI. Both NM‐MRI and SMwI templates were created by using image data from the 96 healthy subjects. Permutation‐based nonparametric tests were conducted to investigate spatial differences between the two groups in NM‐MRI, and the results were displayed on both NM‐MRI and SMwI templates. The posterolateral and anteromedial regions of the SNpc in NM‐MRI were significantly different between the two groups, corresponding to the nigrosome 1 and nigrosome 2 regions, respectively, on the SMwI template. There were the areas of significant spatial difference in the hypointense SN on SMwI between early‐stage IPD patients and healthy subjects. These areas on SMwI were slightly greater than those on NM‐MRI, including the areas showing group difference on NM‐MRI. Our voxelwise analysis of NM‐MRI suggests that two regions (nigrosome 1 and nigrosome 2) of the SNpc are separately affected in early‐stage IPD.
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Affiliation(s)
- Young Hee Sung
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Young Noh
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eung Yeop Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
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25
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Wang L, Yan Y, Zhang L, Liu Y, Luo R, Chang Y. Substantia nigra neuromelanin magnetic resonance imaging in patients with different subtypes of Parkinson disease. J Neural Transm (Vienna) 2021; 128:171-179. [PMID: 33559725 PMCID: PMC7914244 DOI: 10.1007/s00702-020-02295-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/19/2020] [Indexed: 01/18/2023]
Abstract
Neuromelanin (NM) is a dark pigment that mainly exists in neurons of the substantia nigra pars compacta (SNc). In Parkinson disease (PD) patients, NM concentration decreases gradually with degeneration and necrosis of dopamine neurons, suggesting potential use as a PD biomarker. We aimed to evaluate associations between NM concentration in in vivo SN and PD progression and different motor subtypes using NM magnetic resonance imaging (NM-MRI). Fifty-four patients with idiopathic PD were enrolled. Patients were divided into groups by subtypes with different clinical symptoms: tremor dominant (TD) group and postural instability and gait difficulty (PIGD) group. Fifteen healthy age-matched volunteers were enrolled as controls. All subjects underwent clinical assessment and NM-MRI examination. PD patients showed significantly decreased contrast-to-noise ratio (CNR) values in medial and lateral SN (P < 0.05) compared to controls. CNR values in lateral SN region decreased linearly with PD progression (P = 0.001). PIGD patients showed significant decreases in CNR mean values in lateral SN compared to TD patients (P = 0.004). Diagnostic accuracy of using lateral substantia nigra (SN) in TD and PIGD groups was 79% (sensitivity 76.5%, specificity 78.6%). NM concentration in PD patients decreases gradually during disease progression and differs significantly between PD subtypes. NM may be a reliable biomarker for PD severity and subtype identification.
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Affiliation(s)
- Lu Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Xiantai street 126, Changchun, 130033, Jilin Province, China
| | - Yayun Yan
- Department of Neurology, China-Japan Union Hospital of Jilin University, Xiantai street 126, Changchun, 130033, Jilin Province, China
| | - Liyao Zhang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Xiantai street 126, Changchun, 130033, Jilin Province, China
| | - Yan Liu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Xiantai street 126, Changchun, 130033, Jilin Province, China
| | - Ruirui Luo
- Department of Neurology, China-Japan Union Hospital of Jilin University, Xiantai street 126, Changchun, 130033, Jilin Province, China
| | - Ying Chang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Xiantai street 126, Changchun, 130033, Jilin Province, China.
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26
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Simões RM, Castro Caldas A, Grilo J, Correia D, Guerreiro C, Pita Lobo P, Valadas A, Fabbri M, Correia Guedes L, Coelho M, Rosa MM, Ferreira JJ, Reimão S. A distinct neuromelanin magnetic resonance imaging pattern in parkinsonian multiple system atrophy. BMC Neurol 2020; 20:432. [PMID: 33243166 PMCID: PMC7694430 DOI: 10.1186/s12883-020-02007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022] Open
Abstract
Background Parkinsonian variant of multiple system atrophy is a neurodegenerative disorder frequently misdiagnosed as Parkinson’s disease. No early imaging biomarkers currently differentiate these disorders. Methods Simple visual imaging analysis of the substantia nigra and locus coeruleus in neuromelanin-sensitive magnetic resonance imaging and nigrosome 1 in susceptibility-weighted sequences was performed in thirty patients with parkinsonian variant of multiple system atrophy fulfilling possible/probable second consensus diagnostic criteria. The neuromelanin visual pattern was compared to patients with Parkinson’s disease with the same disease duration (n = 10) and healthy controls (n = 10). Substantia nigra semi-automated neuromelanin area/signal intensity was compared to the visual data. Results Groups were similar in age, sex, disease duration, and levodopa equivalent dose. Hoehn & Yahr stage was higher in parkinsonian multiple system atrophy patients, 69% of whom had normal neuromelanin size/signal, significantly different from Parkinson’s disease patients, and similar to controls. Nigrosome 1 signal was lost in 74% of parkinsonian multiple system atrophy patients. Semi-automated neuromelanin substantia nigra signal, but not area, measurements were able to differentiate groups. Conclusions In patients with parkinsonism, simple visual magnetic resonance imaging analysis showing normal neuromelanin substantia nigra and locus coeruleus, combined with nigrosome 1 loss, allowed the distinction of the parkinsonian variant of multiple system atrophy from Parkinson’s disease and healthy controls. This easy and widely available method was superior to semi-automated measurements in identifying specific imaging changes in substantia nigra and locus coeruleus. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-020-02007-5.
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Affiliation(s)
- Rita Moiron Simões
- Neurology Department, Hospital Beatriz Ângelo, Loures, Portugal.,CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Ana Castro Caldas
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Joana Grilo
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Institute for Systems and Robotics (LARSyS), Department of Bioengineering, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | - Daisy Correia
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carla Guerreiro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.,Department of Neurological Imaging, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Imaging University Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Patrícia Pita Lobo
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Serviço de Neurologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Anabela Valadas
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Serviço de Neurologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Marguerita Fabbri
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.,Department of Neurosciences, clinical investigation center CIC 1436, Parkinson Toulouse expert center, NS-Park/FCRIN network and NeuroToul COEN center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | - Leonor Correia Guedes
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Serviço de Neurologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Miguel Coelho
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Serviço de Neurologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Mario Miguel Rosa
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Serviço de Neurologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Joaquim J Ferreira
- CNS-Campus Neurológico Sénior, Torres Vedras, Portugal. .,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal. .,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Sofia Reimão
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Department of Neurological Imaging, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Imaging University Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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27
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Saeed U, Lang AE, Masellis M. Neuroimaging Advances in Parkinson's Disease and Atypical Parkinsonian Syndromes. Front Neurol 2020; 11:572976. [PMID: 33178113 PMCID: PMC7593544 DOI: 10.3389/fneur.2020.572976] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson's disease (PD) and atypical Parkinsonian syndromes are progressive heterogeneous neurodegenerative diseases that share clinical characteristic of parkinsonism as a common feature, but are considered distinct clinicopathological disorders. Based on the predominant protein aggregates observed within the brain, these disorders are categorized as, (1) α-synucleinopathies, which include PD and other Lewy body spectrum disorders as well as multiple system atrophy, and (2) tauopathies, which comprise progressive supranuclear palsy and corticobasal degeneration. Although, great strides have been made in neurodegenerative disease research since the first medical description of PD in 1817 by James Parkinson, these disorders remain a major diagnostic and treatment challenge. A valid diagnosis at early disease stages is of paramount importance, as it can help accommodate differential prognostic and disease management approaches, enable the elucidation of reliable clinicopathological relationships ideally at prodromal stages, as well as facilitate the evaluation of novel therapeutics in clinical trials. However, the pursuit for early diagnosis in PD and atypical Parkinsonian syndromes is hindered by substantial clinical and pathological heterogeneity, which can influence disease presentation and progression. Therefore, reliable neuroimaging biomarkers are required in order to enhance diagnostic certainty and ensure more informed diagnostic decisions. In this article, an updated presentation of well-established and emerging neuroimaging biomarkers are reviewed from the following modalities: (1) structural magnetic resonance imaging (MRI), (2) diffusion-weighted and diffusion tensor MRI, (3) resting-state and task-based functional MRI, (4) proton magnetic resonance spectroscopy, (5) transcranial B-mode sonography for measuring substantia nigra and lentiform nucleus echogenicity, (6) single photon emission computed tomography for assessing the dopaminergic system and cerebral perfusion, and (7) positron emission tomography for quantifying nigrostriatal functions, glucose metabolism, amyloid, tau and α-synuclein molecular imaging, as well as neuroinflammation. Multiple biomarkers obtained from different neuroimaging modalities can provide distinct yet corroborative information on the underlying neurodegenerative processes. This integrative "multimodal approach" may prove superior to single modality-based methods. Indeed, owing to the international, multi-centered, collaborative research initiatives as well as refinements in neuroimaging technology that are currently underway, the upcoming decades will mark a pivotal and exciting era of further advancements in this field of neuroscience.
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Affiliation(s)
- Usman Saeed
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Center, Toronto, ON, Canada.,Cognitive and Movement Disorders Clinic, Sunnybrook Health Sciences Center, Toronto, ON, Canada
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28
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Reimão S, Guerreiro C, Seppi K, Ferreira JJ, Poewe W. A Standardized MR Imaging Protocol for Parkinsonism. Mov Disord 2020; 35:1745-1750. [PMID: 32914459 DOI: 10.1002/mds.28204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Sofia Reimão
- Neuroimaging Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carla Guerreiro
- Neuroimaging Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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29
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Cho SJ, Bae YJ, Kim JM, Kim D, Baik SH, Sunwoo L, Choi BS, Kim JH. Diagnostic performance of neuromelanin-sensitive magnetic resonance imaging for patients with Parkinson's disease and factor analysis for its heterogeneity: a systematic review and meta-analysis. Eur Radiol 2020; 31:1268-1280. [PMID: 32886201 DOI: 10.1007/s00330-020-07240-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/12/2020] [Accepted: 08/28/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the diagnostic performance of neuromelanin-sensitive magnetic resonance imaging discriminating between patients with Parkinson's disease and normal healthy controls and to identify factors causing heterogeneity influencing the diagnostic performance. METHODS A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed for studies reporting the relevant topic before February 17, 2020. The pooled sensitivity and specificity values with their 95% confidence intervals were calculated using bivariate random-effects modeling. Subgroup and meta-regression analyses were also performed to determine factors influencing heterogeneity. RESULTS Twelve articles including 403 patients with Parkinson's disease and 298 control participants were included in this systematic review and meta-analysis. Neuromelanin-sensitive magnetic resonance imaging showed a pooled sensitivity of 89% (95% confidence interval, 86-92%) and a pooled specificity of 83% (95% confidence interval, 76-88%). In the subgroup and meta-regression analysis, a disease duration longer than 5 and 10 years, comparisons using measured volumes instead of signal intensities, a slice thickness in terms of magnetic resonance imaging parameters of more than 2 mm, and semi-/automated segmentation methods instead of manual segmentation improved the diagnostic performance. CONCLUSION Neuromelanin-sensitive magnetic resonance imaging had a favorable diagnostic performance in discriminating patients with Parkinson's disease from healthy controls. To improve diagnostic accuracy, further investigations directly comparing these heterogeneity-affecting factors and optimizing these parameters are necessary. KEY POINTS • Neuromelanin-sensitive MRI favorably discriminates patients with Parkinson's disease from healthy controls. • Disease duration, parameters used for comparison, magnetic resonance imaging slice thickness, and segmentation methods affected heterogeneity across the studies.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea.
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Donghyun Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
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30
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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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31
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Chougar L, Pyatigorskaya N, Degos B, Grabli D, Lehéricy S. The Role of Magnetic Resonance Imaging for the Diagnosis of Atypical Parkinsonism. Front Neurol 2020; 11:665. [PMID: 32765399 PMCID: PMC7380089 DOI: 10.3389/fneur.2020.00665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
The diagnosis of Parkinson's disease and atypical Parkinsonism remains clinically difficult, especially at the early stage of the disease, since there is a significant overlap of symptoms. Multimodal MRI has significantly improved diagnostic accuracy and understanding of the pathophysiology of Parkinsonian disorders. Structural and quantitative MRI sequences provide biomarkers sensitive to different tissue properties that detect abnormalities specific to each disease and contribute to the diagnosis. Machine learning techniques using these MRI biomarkers can effectively differentiate atypical Parkinsonian syndromes. Such approaches could be implemented in a clinical environment and improve the management of Parkinsonian patients. This review presents different structural and quantitative MRI techniques, their contribution to the differential diagnosis of atypical Parkinsonian disorders and their interest for individual-level diagnosis.
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Affiliation(s)
- Lydia Chougar
- Institut du Cerveau et de la Moelle épinière-ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS UMR 7225, Paris, France.,ICM, "Movement Investigations and Therapeutics" Team (MOV'IT), Paris, France.,ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Nadya Pyatigorskaya
- Institut du Cerveau et de la Moelle épinière-ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS UMR 7225, Paris, France.,ICM, "Movement Investigations and Therapeutics" Team (MOV'IT), Paris, France.,ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Bertrand Degos
- Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, MemoLife Labex, Paris, France.,Department of Neurology, Avicenne University Hospital, Sorbonne Paris Nord University, Bobigny, France
| | - David Grabli
- Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Stéphane Lehéricy
- Institut du Cerveau et de la Moelle épinière-ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS UMR 7225, Paris, France.,ICM, "Movement Investigations and Therapeutics" Team (MOV'IT), Paris, France.,ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France
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32
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Ryman SG, Poston KL. MRI biomarkers of motor and non-motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 2020; 73:85-93. [PMID: 31629653 PMCID: PMC7145760 DOI: 10.1016/j.parkreldis.2019.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/03/2019] [Accepted: 10/05/2019] [Indexed: 12/19/2022]
Abstract
Parkinson's disease is a heterogeneous disorder with both motor and non-motor symptoms that contribute to functional impairment. To develop effective, disease modifying treatments for these symptoms, biomarkers are necessary to detect neuropathological changes early in the disease course and monitor changes over time. Advances in MRI scan sequences and analytical techniques present numerous promising metrics to detect changes within the nigrostriatal system, implicated in the cardinal motor symptoms of the disease, and detect broader dysfunction involved in the non-motor symptoms, such as cognitive impairment. There is emerging evidence that iron sensitive, neuromelanin sensitive, diffusion sensitive, and resting state functional magnetic imaging measures can capture changes within the nigrostriatal system. Iron, neuromelanin, and diffusion sensitive measures demonstrate high specificity and sensitivity in distinguishing Parkinson's disease relative to controls, with inconsistent results differentiating Parkinson's disease relative to atypical parkinsonian disorders. They may also serve as useful monitoring biomarkers, with each possibly detecting different aspects of the disease course (early nigrosome changes versus broader substantia nigra changes). Investigations of non-motor symptoms, such as cognitive impairment, require careful consideration of the nature of cognitive deficits to characterize regional and network specific impairment. While the early, executive dysfunction observed is consistent with nigrostriatal degeneration, the memory and visuospatial impairments, the harbingers of a dementia process reflect dopaminergic independent dysfunction involving broader regions of the brain.
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Affiliation(s)
- Sephira G Ryman
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, 300 Pasteur Dr. Room A343. MC-5235, Stanford, CA, 94305, USA.
| | - Kathleen L Poston
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, 300 Pasteur Dr. Room A343. MC-5235, Stanford, CA, 94305, USA.
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33
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Amlang CJ, Trujillo Diaz D, Louis ED. Essential Tremor as a "Waste Basket" Diagnosis: Diagnosing Essential Tremor Remains a Challenge. Front Neurol 2020; 11:172. [PMID: 32269548 PMCID: PMC7109309 DOI: 10.3389/fneur.2020.00172] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/24/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: The diagnosis of essential tremor (ET) remains a clinical one, and diagnostic errors are common. We aimed to (1) determine precisely how frequently ET diagnoses are misapplied (i.e., what percentage of patients who have been assigned an “ET” diagnosis actually have another movement disorder), (2) determine which other movement disorders are most often misclassified as “ET,” and (3) examine the clinical features that were most associated with diagnostic errors. Methods: One hundred four consecutive patients were included who met the following criteria: (1) initial outpatient evaluation by one of the authors (EDL) between January 2015 and December 2019 and (2) pre-evaluation diagnosis of ET. Data on an extensive number of clinical features were extracted from the electronic medical record. Results: Forty-seven (45.2%) patients received a post-evaluation diagnosis of ET, 29 (27.9%) of dystonia, and 28 (26.9%) of other diagnoses including Parkinson's disease (PD) [6 (5.8%)]. Factors associated with an alternative post-evaluation diagnosis other than ET were pre-evaluation diagnosis made by a non-neurologist, shorter tremor duration, irregular tremor, abnormal limb postures, among others. Discussion: Diagnosing ET remains a challenge, with the diagnosis being over-applied and being used as a “waste basket.” More than one-half of the patients who were referred to our clinic with an intake diagnosis of ET were given an alternative post-evaluation diagnosis. While PD was reported to be the most frequently missed diagnosis in a past study, dystonia was most commonly missed in our study. Several clinical features can help to differentiate ET from other tremor disorders.
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Affiliation(s)
- Christian J Amlang
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Daniel Trujillo Diaz
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, United States
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34
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Abstract
PURPOSE OF REVIEW Being a disease with heterogeneous presentations and unclear consensus on its diagnostic criteria, it is difficult to differentiate vascular parkinsonism (VaP) from other neurodegenerative parkinsonism variants. Ongoing research on structural and functional neuroimaging targeting dopaminergic pathway provides us more insight into the pathophysiology of VaP to improve diagnostic accuracy. The aim of this article is to review how the emerging imaging modalities help the diagnostic process and treatment decision in VaP. RECENT FINDINGS Dopamine transporter imaging is a promising tool in differentiating presynaptic parkinsonism and VaP. It also predicts the levodopa responders in VaP. Advanced MRI techniques including volumetry, diffusion tensor imaging and sequences visualising substantia nigra are under development, and they are complementary to each other in detecting structural and functional changes in VaP, which is crucial to ensure the quality of future therapeutic trials for VaP. Dopamine transporter imaging is recommended to patients with suspected VaP. Multimodal MRI in VaP would be an important area to be investigated in the near future.
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Affiliation(s)
- Karen K Y Ma
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shi Lin
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- BrainNow Research Institute, Guangdong Province, Shenzhen, China
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- BrainNow Research Institute, Guangdong Province, Shenzhen, China.
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35
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Zupan G, Šuput D, Pirtošek Z, Vovk A. Semi-Automatic Signature-Based Segmentation Method for Quantification of Neuromelanin in Substantia Nigra. Brain Sci 2019; 9:brainsci9120335. [PMID: 31766668 PMCID: PMC6956028 DOI: 10.3390/brainsci9120335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/16/2022] Open
Abstract
In Parkinson's disease (PD), there is a reduction of neuromelanin (NM) in the substantia nigra (SN). Manual quantification of the NM volume in the SN is unpractical and time-consuming; therefore, we aimed to quantify NM in the SN with a novel semi-automatic segmentation method. Twenty patients with PD and twelve healthy subjects (HC) were included in this study. T1-weighted spectral pre-saturation with inversion recovery (SPIR) images were acquired on a 3T scanner. Manual and semi-automatic atlas-free local statistics signature-based segmentations measured the surface and volume of SN, respectively. Midbrain volume (MV) was calculated to normalize the data. Receiver operating characteristic (ROC) analysis was performed to determine the sensitivity and specificity of both methods. PD patients had significantly lower SN mean surface (37.7 ± 8.0 vs. 56.9 ± 6.6 mm2) and volume (235.1 ± 45.4 vs. 382.9 ± 100.5 mm3) than HC. After normalization with MV, the difference remained significant. For surface, sensitivity and specificity were 91.7 and 95 percent, respectively. For volume, sensitivity and specificity were 91.7 and 90 percent, respectively. Manual and semi-automatic segmentation methods of the SN reliably distinguished between PD patients and HC. ROC analysis shows the high sensitivity and specificity of both methods.
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Affiliation(s)
- Gašper Zupan
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (G.Z.); (Z.P.); (A.V.)
| | - Dušan Šuput
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (G.Z.); (Z.P.); (A.V.)
- Correspondence: ; Tel.: +386-1-543-7821
| | - Zvezdan Pirtošek
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (G.Z.); (Z.P.); (A.V.)
- Department of Neurology, University Medical Center, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Andrej Vovk
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (G.Z.); (Z.P.); (A.V.)
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Molecular Imaging of the Dopamine Transporter. Cells 2019; 8:cells8080872. [PMID: 31405186 PMCID: PMC6721747 DOI: 10.3390/cells8080872] [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: 05/17/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 02/06/2023] Open
Abstract
Dopamine transporter (DAT) single-photon emission tomography (SPECT) with (123)Ioflupane is a widely used diagnostic tool for patients with suspected parkinsonian syndromes, as it assists with differentiating between Parkinson’s disease (PD) or atypical parkinsonisms and conditions without a presynaptic dopaminergic deficit such as essential tremor, vascular and drug-induced parkinsonisms. Recent evidence supports its utility as in vivo proof of degenerative parkinsonisms, and DAT imaging has been proposed as a potential surrogate marker for dopaminergic nigrostriatal neurons. However, the interpretation of DAT-SPECT imaging may be challenged by several factors including the loss of DAT receptor density with age and the effect of certain drugs on dopamine uptake. Furthermore, a clear, direct relationship between nigral loss and DAT decrease has been controversial so far. Striatal DAT uptake could reflect nigral neuronal loss once the loss exceeds 50%. Indeed, reduction of DAT binding seems to be already present in the prodromal stage of PD, suggesting both an early synaptic dysfunction and the activation of compensatory changes to delay the onset of symptoms. Despite a weak correlation with PD severity and progression, quantitative measurements of DAT binding at baseline could be used to predict the emergence of late-disease motor fluctuations and dyskinesias. This review addresses the possibilities and limitations of DAT-SPECT in PD and, focusing specifically on regulatory changes of DAT in surviving DA neurons, we investigate its role in diagnosis and its prognostic value for motor complications as disease progresses.
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Neuropathology and pathogenesis of extrapyramidal movement disorders: a critical update. II. Hyperkinetic disorders. J Neural Transm (Vienna) 2019; 126:997-1027. [DOI: 10.1007/s00702-019-02030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/14/2019] [Indexed: 12/14/2022]
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Jin L, Wang J, Wang C, Lian D, Zhou Y, Zhang Y, Lv M, Li Y, Huang Z, Cheng X, Fei G, Liu K, Zeng M, Zhong C. Combined Visualization of Nigrosome-1 and Neuromelanin in the Substantia Nigra Using 3T MRI for the Differential Diagnosis of Essential Tremor and de novo Parkinson's Disease. Front Neurol 2019; 10:100. [PMID: 30809189 PMCID: PMC6379476 DOI: 10.3389/fneur.2019.00100] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/25/2019] [Indexed: 01/12/2023] Open
Abstract
Differentiating early-stage Parkinson's disease (PD) from essential tremor (ET) remains challenging. In the current study, we aimed to evaluate whether visual analyses of neuromelanin-sensitive magnetic resonance imaging (NM-MRI) combined with nigrosome-1 (N1) imaging using quantitative susceptibility mapping (QSM) in the substantia nigra (SN) are of diagnostic value in the differentiation of de novo PD from untreated ET. Sixty-eight patients with de novo PD, 25 patients with untreated ET, and 34 control participants underwent NM-MRI and QSM. NM and N1 signals in the SN on MR images were visually evaluated using a 3-point ordinal scale. Receiver operating characteristic (ROC) analyses were performed to determine the diagnostic values of the visual ratings of NM and N1. The diagnostic values of the predicted probabilities were calculated via logistic regression analysis using the combination of NM and N1 visual ratings, as well as their quadratic items. The proportions of invisible NM and invisible N1 were significantly higher in the PD group than those in the ET and control groups (p < 0.001). The sensitivity/specificity for differentiating PD from ET was 0.882/0.800 for NM and 0.794/0.920 for N1, respectively. Combining the two biomarkers, the area under the curve (AUC) of the predicted probabilities was 0.935, and the sensitivity/specificity was 0.853/0.920 when the cutoff value was set to 0.704. Our findings demonstrate that visual analyses combing NM and N1 imaging in the SN may aid in differential diagnosis of PD and ET. Furthermore, our results suggest that patients with PD exhibit larger iron deposits in the SN than those with ET.
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Affiliation(s)
- Lirong Jin
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical Imaging Institute, Shanghai, China
| | - Changpeng Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Danlan Lian
- Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Ying Zhou
- Department of Neurology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Yong Zhang
- MR Research, GE Healthcare, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanfang Li
- Department of Neurology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Zhen Huang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoqin Cheng
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guoqiang Fei
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical Imaging Institute, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical Imaging Institute, Shanghai, China
| | - Chunjiu Zhong
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
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Pavese N. Is neuromelanin the imaging biomarker for the early diagnosis of Parkinson's disease that we were looking for? Parkinsonism Relat Disord 2019; 58:1-2. [DOI: 10.1016/j.parkreldis.2018.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
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Ogawa T, Fujii S, Kuya K, Kitao SI, Shinohara Y, Ishibashi M, Tanabe Y. Role of Neuroimaging on Differentiation of Parkinson's Disease and Its Related Diseases. Yonago Acta Med 2018. [PMID: 30275744 DOI: 10.33160/yam.2018.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An accurate diagnosis of Parkinson's disease (PD) is a prerequisite for therapeutic management. In spite of recent advances in the diagnosis of parkinsonian disorders, PD is misdiagnosed in between 6 and 25% of patients, even in specialized movement disorder centers. Although the gold standard for the diagnosis of PD is a neuropathological assessment, neuroimaging has been playing an important role in the differential diagnosis of PD and is used for clinical diagnostic criteria. In clinical practice, differential diagnoses of PD include atypical parkinsonian syndromes such as dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, caused by a striatal dopamine deficiency following nigrostrial degeneration. PD may also be mimicked by syndromes not associated with a striatal dopamine deficiency such as essential tremor, drug-induced parkinsonism, and vascular parkinsonism. Moreover, difficulties are associated with the clinical differentiation of patients with parkinsonism from those with Alzheimer's disease. In this review, we summarize the typical imaging findings of PD and its related diseases described above using morphological imaging modalities (conventional MR imaging and neuromelanin MR imaging) and functional imaging modalities (99mTc-ethyl cysteinate dimer perfusion single photon emission computed tomography, 123I-metaiodobenzylguanidine myocardial scintigraphy, and 123I-FP-CIT dopamine transporter single photon emission computed tomography) that are clinically available in most hospitals. We also attempt to provide a diagnostic approach for the differential diagnosis of PD and its related diseases in clinical practice.
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Affiliation(s)
- Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Keita Kuya
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Shin-Ichiro Kitao
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yuki Shinohara
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Mana Ishibashi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoshio Tanabe
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
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De Micco R, Russo A, Tessitore A. Structural MRI in Idiopathic Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 141:405-438. [PMID: 30314605 DOI: 10.1016/bs.irn.2018.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Among modern neuroimaging modalities, magnetic resonance imaging (MRI) is a widely available, non-invasive, and cost-effective method to detect structural and functional abnormalities related to neurodegenerative disorders. In the last decades, MRI have been widely implemented to support PD diagnosis as well as to provide further insights into motor and non-motor symptoms pathophysiology, complications and treatment-related effects. Different aspects of the brain morphology and function may be derived from a single scan, by applying different analytic approaches. Biomarkers of neurodegeneration as well as tissue microstructural changes may be extracted from structural MRI techniques. In this chapter, we analyze the role of structural imaging to differentiate PD patients from controls and to define neural substrates of motor and non-motor PD symptoms. Evidence collected in the premotor PD phase will be also critically discussed. White matter as well as gray matter integrity imaging studies has been reviewed, aiming to highlight points of strength and limits to their potential application in clinical settings.
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Affiliation(s)
- Rosa De Micco
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy; MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Antonio Russo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy; MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Alessandro Tessitore
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy; MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Napoli, Italy.
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Neuromelanin-sensitive MRI of the substantia nigra: An imaging biomarker to differentiate essential tremor from tremor-dominant Parkinson's disease. Parkinsonism Relat Disord 2018; 58:3-8. [PMID: 30037690 DOI: 10.1016/j.parkreldis.2018.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/02/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION We aimed to evaluate whether neuromelanin-sensitive MRI (NM-MRI) features in the substantia nigra pars compacta (SNc) were of diagnostic value to differentiate untreated essential tremor (ET) from de novo tremor-dominant Parkinson's disease (PDT). METHODS Eighteen untreated ET patients, 21 de novo PDT patients and 21 healthy control subjects were recruited. All the subjects underwent clinical examination, motor and cognitive evaluations, as well as NM-MRI. High signal intensity of the lateral, central and medial SNc subregions on NM-MRI were evaluated using the width, signal intensity (contrast-to-noise ratio, CNR) and visual analysis. Diagnostic test performance of SNc values was investigated by using receiver operating characteristic analysis and net reclassification improvement (NRI). RESULTS The width and CNR values of the lateral and central SNc subregions in PDT were significantly decreased compared with those in ET and control group. Using visual analysis, the total visual score of all SNc subregions was significantly reduced in PDT when compared with ET and control group. The width of the lateral SNc subregion allowed the best differentiation between ET and PDT, and visual analysis also showed good diagnostic value. NRI result indicated that visual analysis and the width of the lateral SNc subregion had the same diagnostic power. CONCLUSIONS The neuromelanin changes of SNc in ET and PDT follow the different patterns. Both the measurements and visual analysis of SNc on NM-MRI provide high diagnostic accuracy for differentiating ET from PDT subtype. NM-MRI is a potential tool in diagnostic work-up of tremor disorders.
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Taniguchi D, Hatano T, Kamagata K, Okuzumi A, Oji Y, Mori A, Hori M, Aoki S, Hattori N. Neuromelanin imaging and midbrain volumetry in progressive supranuclear palsy and Parkinson's disease. Mov Disord 2018; 33:1488-1492. [DOI: 10.1002/mds.27365] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/29/2018] [Accepted: 02/07/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Daisuke Taniguchi
- Department of Neurology; Juntendo University, School of Medicine; Tokyo Japan
| | - Taku Hatano
- Department of Neurology; Juntendo University, School of Medicine; Tokyo Japan
| | - Koji Kamagata
- Department of Radiology; Juntendo University, School of Medicine; Tokyo Japan
| | - Ayami Okuzumi
- Department of Neurology; Juntendo University, School of Medicine; Tokyo Japan
| | - Yutaka Oji
- Department of Neurology; Juntendo University, School of Medicine; Tokyo Japan
| | - Akio Mori
- Department of Neurology; Juntendo University, School of Medicine; Tokyo Japan
| | - Masaaki Hori
- Department of Radiology; Juntendo University, School of Medicine; Tokyo Japan
| | - Shigeki Aoki
- Department of Radiology; Juntendo University, School of Medicine; Tokyo Japan
| | - Nobutaka Hattori
- Department of Neurology; Juntendo University, School of Medicine; Tokyo Japan
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Peterson AC, Li CSR. Noradrenergic Dysfunction in Alzheimer's and Parkinson's Diseases-An Overview of Imaging Studies. Front Aging Neurosci 2018; 10:127. [PMID: 29765316 PMCID: PMC5938376 DOI: 10.3389/fnagi.2018.00127] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/16/2018] [Indexed: 12/31/2022] Open
Abstract
Noradrenergic dysfunction contributes to cognitive impairment in Alzheimer's Disease (AD) and Parkinson's Disease (PD). Conventional therapeutic strategies seek to enhance cholinergic and dopaminergic neurotransmission in AD and PD, respectively, and few studies have examined noradrenergic dysfunction as a target for medication development. We review the literature of noradrenergic dysfunction in AD and PD with a focus on human imaging studies that implicate the locus coeruleus (LC) circuit. The LC sends noradrenergic projections diffusely throughout the cerebral cortex and plays a critical role in attention, learning, working memory, and cognitive control. The LC undergoes considerable degeneration in both AD and PD. Advances in magnetic resonance imaging have facilitated greater understanding of how structural and functional alteration of the LC may contribute to cognitive decline in AD and PD. We discuss the potential roles of the noradrenergic system in the pathogenesis of AD and PD with an emphasis on postmortem anatomical studies, structural MRI studies, and functional MRI studies, where we highlight changes in LC connectivity with the default mode network (DMN). LC degeneration may accompany deficient capacity in suppressing DMN activity and increasing saliency and task control network activities to meet behavioral challenges. We finish by proposing potential and new directions of research to address noradrenergic dysfunction in AD and PD.
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Affiliation(s)
- Andrew C Peterson
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States.,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, United States
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Wang J, Li Y, Huang Z, Wan W, Zhang Y, Wang C, Cheng X, Ye F, Liu K, Fei G, Zeng M, Jin L. Neuromelanin-sensitive magnetic resonance imaging features of the substantia nigra and locus coeruleus in de novo
Parkinson's disease and its phenotypes. Eur J Neurol 2018. [PMID: 29520900 DOI: 10.1111/ene.13628] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- J. Wang
- Department of Radiology; Zhongshan Hospital; Fudan University; Shanghai China
- Shanghai Medical Imaging Institute; Shanghai China
| | - Y. Li
- Department of Neurology; Zhongshan Hospital; Fudan University; Shanghai China
| | - Z. Huang
- Department of Neurology; Zhongshan Hospital; Fudan University; Shanghai China
| | - W. Wan
- Department of Neurology; Zhongshan Hospital; Fudan University; Shanghai China
| | - Y. Zhang
- MR Research; GE Healthcare; Shanghai China
| | - C. Wang
- Department of Neurology; Zhongshan Hospital; Fudan University; Shanghai China
| | - X. Cheng
- Department of Neurology; Zhongshan Hospital; Fudan University; Shanghai China
| | - F. Ye
- Department of Radiology; Zhongshan Hospital; Fudan University; Shanghai China
- Shanghai Medical Imaging Institute; Shanghai China
| | - K. Liu
- Department of Radiology; Zhongshan Hospital; Fudan University; Shanghai China
- Shanghai Medical Imaging Institute; Shanghai China
| | - G. Fei
- Department of Neurology; Zhongshan Hospital; Fudan University; Shanghai China
| | - M. Zeng
- Department of Radiology; Zhongshan Hospital; Fudan University; Shanghai China
- Shanghai Medical Imaging Institute; Shanghai China
| | - L. Jin
- Department of Neurology; Zhongshan Hospital; Fudan University; Shanghai China
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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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Neuroimaging in Parkinson's disease: focus on substantia nigra and nigro-striatal projection. Curr Opin Neurol 2018; 30:416-426. [PMID: 28537985 DOI: 10.1097/wco.0000000000000463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW The diagnosis of Parkinson disease is based on clinical features; however, unmet need is an imaging signature for Parkinson disease and the early differential diagnosis with atypical parkinsonisms. A summary of the molecular imaging and MRI recent evidences for Parkinson disease diagnosis will be presented in this review. RECENT FINDINGS The nigro-striatal dysfunction explored by dopamine transporter imaging is not a mandatory diagnostic criterion for Parkinson disease, recent evidence supported its utility as in-vivo proof of degenerative parkinsonisms, and there might be compensatory mechanisms leading to an early overestimation. The visualization of abnormalities in substantia nigra by MRI has been recently described as sensitive and specific tool for Parkinson disease diagnosis, even in preclinical conditions, whereas it is not useful for distinguishing between Parkinson disease and atypical parkinsonisms. The relationship between the nigral anatomical changes, evaluated as structural alterations or neuromelanin signal decrease and the dopaminergic nigro-striatal function needs to be further clarified. SUMMARY With the hopeful advent of potential neuroprotective drugs for PD, it is crucial to have imaging measures that are able to detect at risk subjects. Moreover it is desirable to increase the knowledge about which measure better predicts the probability and the time of clinical conversion to PD.
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Pavese N, Tai YF. Nigrosome Imaging and Neuromelanin Sensitive MRI in Diagnostic Evaluation of Parkinsonism. Mov Disord Clin Pract 2018; 5:131-140. [PMID: 30363419 DOI: 10.1002/mdc3.12590] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 12/02/2017] [Accepted: 12/24/2017] [Indexed: 12/24/2022] Open
Abstract
Background Recent developments in magnetic resonance imaging (MRI) techniques have offered new research opportunities to visualize in vivo substantia nigra pathology in Parkinson's disease (PD). This paper summarizes the main findings of nigrosome imaging and neuromelanin sensitive MRI studies in patients with PD and other parkinsonisms. Methods The PubMed database was searched from 2005 to 2017 using the following keywords: Parkinson's disease and parkinsonism, in combination with MRI, nigrosome, neuromelanin, and iron. Only publications in English were included. Results Nigrosome or dorsal nigral hyperintensity abnormalities are studied using T2* and susceptibility weighted imaging MRI sequences in most studies, whereas Neuromelanin imaging is usually performed using T1-weighted fast spin echo sequence. Nigrosome abnormalities have been consistently demonstrated in PD patients, and nigrosome imaging has high sensitivity and specificity in distinguishing PD from healthy controls, though it is unable to reliably separate PD from atypical parkinsonisms. Reduced neuromelanin-related signals and/or volume loss in neuromelanin containing structures have been found in PD patients, and neuromelanin sensitive MRI imaging can also discriminate PD patients from healthy controls with high accuracy, though there is a degree of heterogeneity in the imaging findings. Preliminary findings suggested that longitudinal change of neuromelanin signal could be detected in PD, raising the possibility of using it as a marker of disease progression. Conclusion Nigrosome imaging and neuromelanin sensitive MRI are promising tools to study nigral pathology and to improve the diagnosis of PD. However, further studies are required to standardize analysis approaches, confirm longitudinal changes, and assess their generalizability.
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Affiliation(s)
- Nicola Pavese
- Newcastle Magnetic Resonance Centre & Positron Emission Tomography Centre Newcastle University Newcastle Upon Tyne United Kingdom.,Department of Nuclear Medicine and PET Centre Aarhus University Hospital Nørrebrogade 44, 8000, Aarhus Denmark
| | - Yen F Tai
- Division of Brain Sciences Imperial College London London United Kingdom
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