1
|
Erlinger M, Molina-Ruiz R, Brumby A, Cordas D, Hunter M, Ferreiro Arguelles C, Yus M, Owens-Walton C, Jakabek D, Shaw M, Lopez Valdes E, Looi JCL. Striatal and thalamic automatic segmentation, morphology, and clinical correlates in Parkinsonism: Parkinson's disease, multiple system atrophy and progressive supranuclear palsy. Psychiatry Res Neuroimaging 2023; 335:111719. [PMID: 37806261 DOI: 10.1016/j.pscychresns.2023.111719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
Parkinson's disease (PD), multisystem atrophy (MSA), and progressive supranuclear palsy (PSP) present similarly with bradykinesia, tremor, rigidity, and cognitive impairments. Neuroimaging studies have found differential changes in the nigrostriatal pathway in these disorders, however whether the volume and shape of specific regions within this pathway can distinguish between atypical Parkinsonian disorders remains to be determined. This paper investigates striatal and thalamic volume and morphology as distinguishing biomarkers, and their relationship to neuropsychiatric symptoms. Automatic segmentation to calculate volume and shape analysis of the caudate nucleus, putamen, and thalamus were performed in 18 PD patients, 12 MSA, 15 PSP, and 20 healthy controls, then correlated with clinical measures. PSP bilateral thalami and right putamen were significantly smaller than controls, but not MSA or PD. The left caudate and putamen significantly correlated with the Neuropsychiatric Inventory total score. Bilateral thalamus, caudate, and left putamen had significantly different morphology between groups, driven by differences between PSP and healthy controls. This study demonstrated that PSP patient striatal and thalamic volume and shape are significantly different when compared with controls. Parkinsonian disorders could not be differentiated on volumetry or morphology, however there are trends for volumetric and morphological changes associated with PD, MSA, and PSP.
Collapse
Affiliation(s)
- M Erlinger
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia.
| | | | - A Brumby
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia
| | - D Cordas
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia
| | - M Hunter
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia
| | | | - M Yus
- Hospital Clinico San Carlos, Madrid, Spain
| | - C Owens-Walton
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia
| | - D Jakabek
- Neuroscience Research Australia, Sydney, Australia
| | - M Shaw
- Hospital Clinico San Carlos, Madrid, Spain
| | | | - J C L Looi
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, School of Clinical Medicine, Australian National University, Canberra, Australia
| |
Collapse
|
2
|
Josephs KA, Duffy JR, Martin PR, Stephens YC, Singh NA, Clark HM, Botha H, Lowe VJ, Whitwell JL, Utianski RL. Acoustic Analysis and Neuroimaging Correlates of Diadochokinetic Rates in Mild-Moderate Primary Progressive Apraxia of Speech. BRAIN AND LANGUAGE 2023; 240:105254. [PMID: 37584042 PMCID: PMC10424909 DOI: 10.1016/j.bandl.2023.105254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Speech rate can be judged clinically using diadochokinetic (DDK) tasks, such as alternating motion rates (AMR) and sequential motion rates (SMR). We evaluated whether acoustic AMR/SMR speech rates would differentiate primary progressive apraxia of speech (PPAOS) from healthy controls, and determined how DDK rates relate to phonetic and prosodic speech characteristics and brain metabolism on FDG-PET. Rate was calculated for each of three AMRs (repetitions of 'puh', 'tuh', and 'kuh') and for SMRs (repetitions of 'puhtuhkuh') for 27 PPAOS patients and 52 controls who underwent FDG-PET. PPAOS patients were slower than controls on all DDK tasks. All DDK rates correlated with apraxia of speech severity, with strongest associations with prosodic speech features. Slower DDK rates were associated with hypometabolism in the right cerebellar dentate and left supplementary motor area. Performance on AMR rate, not just SMR rate, may be impaired in mild PPAOS, but sensitivity and specificity require further study.
Collapse
Affiliation(s)
| | | | - Peter R. Martin
- Department of Quantitative Health Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | |
Collapse
|
3
|
Han IJ, Kwon HG, Lee WW, Yoon RG, Choi H, Kim HJ. Diffusion tensor tractography of the corticobulbar tract in a dysphagic patient with progressive supranuclear palsy: A case report. Medicine (Baltimore) 2023; 102:e32898. [PMID: 36820538 PMCID: PMC9907945 DOI: 10.1097/md.0000000000032898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
RATIONALE This paper reports the changes over time in the corticobulbar tract (CBT) analyzed using diffusion tensor tractography (DTT) in a dysphagic patient with progressive supranuclear palsy (PSP). PATIENT CONCERNS A 53-year-old man initially presented with dysarthria, gait disturbance, and bradykinesia, and approximately 1-year later, downward gaze paralysis appeared. Initially, there was no dysphagia; however, approximately 2 years after visiting the hospital, symptoms of dysphagia, including difficulty swallowing pills, aspiration, and oral movement impairments appeared. The symptoms gradually progressed, and finally, mouth opening was severely damaged to the extent that it was difficult to orally feed. INTERVENTIONS We performed diffusion tensor imaging 3 times; at 3-month, 20-month, and 41-month from onset. OUTCOMES On 3-month DTT, the left CBT was well reconstructed, whereas the right CBT showed partial tearing. In the 20-month DTT, both CBTs became thinner compared to the 3-month DTT. On 41-month DTT, both CBTs became much thinner than after 3-month and 20-month DTT. LESSONS We observed the degree of CBT injury over time in a dysphagic patient with PSP. These results suggest that the analysis of CBT using DTT is helpful in predicting the degree of dysphagia and prognosis in patients with PSP.
Collapse
Affiliation(s)
- In Jun Han
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Hyeok Gyu Kwon
- Department of Physical Therapy, College of Health Science, Eulji University, Gyeonggi, Republic of Korea
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Ra Gyoung Yoon
- Department of Radiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Hyoseon Choi
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
- * Correspondence: Hyun Jung Kim, Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Republic of Korea (e-mail: )
| |
Collapse
|
4
|
Diffusion tractography of superior cerebellar peduncle and dentatorubrothalamic tracts in two autopsy confirmed progressive supranuclear palsy variants: Richardson syndrome and the speech-language variant. Neuroimage Clin 2022; 35:103030. [PMID: 35597031 PMCID: PMC9123268 DOI: 10.1016/j.nicl.2022.103030] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/21/2022]
Abstract
Different changes in DTI metrics in SCP and DRTT can be seen across PSP subtypes. DRTT tractography reconstructions demonstrated specific changes in PSP-RS. DTI and clinical PSP scores are specifically linked across each PSP variant.
Background Progressive supranuclear palsy (PSP) is a 4-repeat tauopathy with neurodegeneration typically observed in the superior cerebellar peduncle (SCP) and dentatorubrothalamic tracts (DRTT). However, it is unclear how these tracts are differentially affected in different clinical variants of PSP. Objectives To determine whether diffusion tractography of the SCP and DRTT can differentiate autopsy-confirmed PSP with Richardson’s syndrome (PSP-RS) and PSP with predominant speech/language disorder (PSP-SL). Methods We studied 22 autopsy-confirmed PSP patients that included 12 with PSP-RS and 10 with PSP-SL. We compared these two groups to 11 patients with autopsy-confirmed Alzheimer’s disease with SL problems, i.e., logopenic progressive aphasia (AD-LPA) (disease controls) and 10 healthy controls. Whole brain tractography was performed to identify the SCP and DRTT, as well as the frontal aslant tract and superior longitudinal fasciculus. We assessed fractional anisotropy and mean diffusivity for each tract. Hierarchical linear modeling was used for statistical comparisons, and correlations were assessed with clinical disease severity, ocular motor impairment, and parkinsonism. DRTT connectomics matrix analysis was also performed across groups. Results The SCP showed decreased fractional anisotropy for PSP-RS and PSP-SL and increased mean diffusivity in PSP-RS, compared to controls and AD-LPA. Right DRTT fibers showed lower fractional anisotropy in PSP-RS and PSP-SL compared to controls and AD-LPA, with PSP-RS also showing lower values compared to PSP-SL. Reductions in connectivity were observed in infratentorial DRTT regions in PSP-RS vs cortical regions in PSP-SL. PSP-SL showed greater abnormalities in the frontal aslant tract and superior longitudinal fasciculus compared to controls, PSP-RS, and AD-LPA. Significant correlations were observed between ocular motor impairment and SCP in PSP-RS (p = 0.042), and DRTT in PSP-SL (p = 0.022). In PSP-SL, the PSP Rating Scale correlated with the SCP (p = 0.045) and DRTT (p = 0.008), and the Unified Parkinson’s Disease Rating Scale correlated with the DRTT (p = 0.014). Conclusions Degeneration of the SCP and DRTT are diagnostic features of both PSP-RS and PSP-SL and associations with clinical metrics validate the role of these tracts in PSP-related clinical features, particularly in PSP-SL.
Collapse
|
5
|
Kornaropoulos EN, Winzeck S, Rumetshofer T, Wikstrom A, Knutsson L, Correia MM, Sundgren PC, Nilsson M. Sensitivity of Diffusion MRI to White Matter Pathology: Influence of Diffusion Protocol, Magnetic Field Strength, and Processing Pipeline in Systemic Lupus Erythematosus. Front Neurol 2022; 13:837385. [PMID: 35557624 PMCID: PMC9087851 DOI: 10.3389/fneur.2022.837385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
There are many ways to acquire and process diffusion MRI (dMRI) data for group studies, but it is unknown which maximizes the sensitivity to white matter (WM) pathology. Inspired by this question, we analyzed data acquired for diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) at 3T (3T-DTI and 3T-DKI) and DTI at 7T in patients with systemic lupus erythematosus (SLE) and healthy controls (HC). Parameter estimates in 72 WM tracts were obtained using TractSeg. The impact on the sensitivity to WM pathology was evaluated for the diffusion protocol, the magnetic field strength, and the processing pipeline. Sensitivity was quantified in terms of Cohen's d for group comparison. Results showed that the choice of diffusion protocol had the largest impact on the effect size. The effect size in fractional anisotropy (FA) across all WM tracts was 0.26 higher when derived by DTI than by DKI and 0.20 higher in 3T compared with 7T. The difference due to the diffusion protocol was larger than the difference due to magnetic field strength for the majority of diffusion parameters. In contrast, the difference between including or excluding different processing steps was near negligible, except for the correction of distortions from eddy currents and motion which had a clearly positive impact. For example, effect sizes increased on average by 0.07 by including motion and eddy correction for FA derived from 3T-DTI. Effect sizes were slightly reduced by the incorporation of denoising and Gibbs-ringing removal (on average by 0.011 and 0.005, respectively). Smoothing prior to diffusion model fitting generally reduced effect sizes. In summary, 3T-DTI in combination with eddy current and motion correction yielded the highest sensitivity to WM pathology in patients with SLE. However, our results also indicated that the 3T-DKI and 7T-DTI protocols used here may be adjusted to increase effect sizes.
Collapse
Affiliation(s)
- Evgenios N. Kornaropoulos
- Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Stefan Winzeck
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
- BioMedIA Group, Department of Computing, Imperial College London, London, United Kingdom
| | | | - Anna Wikstrom
- Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Marta M. Correia
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Pia C. Sundgren
- Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
- Lund University BioImaging Center, Lund University, Lund, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Markus Nilsson
- Clinical Sciences, Diagnostic Radiology, Lund University, Lund, Sweden
| |
Collapse
|
6
|
Lipp I, Mole JP, Subramanian L, Linden DEJ, Metzler-Baddeley C. Investigating the Anatomy and Microstructure of the Dentato-rubro-thalamic and Subthalamo-ponto-cerebellar Tracts in Parkinson's Disease. Front Neurol 2022; 13:793693. [PMID: 35401393 PMCID: PMC8987292 DOI: 10.3389/fneur.2022.793693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Cerebellar-thalamic connections play a central role in deep brain stimulation-based treatment of tremor syndromes. Here, we used diffusion Magnetic Resonance Imaging (MRI) tractography to delineate the main cerebellar peduncles as well as two main white matter tracts that connect the cerebellum with the thalamus, the dentato-rubro-thalamic tract (DRTT) and the subthalamo-ponto-cerebellar tract (SPCT). We first developed a reconstruction protocol in young healthy adults with high-resolution diffusion imaging data and then demonstrate feasibility of transferring this protocol to clinical studies using standard diffusion MRI data from a cohort of patients with Parkinson's disease (PD) and their matched healthy controls. The tracts obtained closely corresponded to the previously described anatomical pathways and features of the DRTT and the SPCT. Second, we investigated the microstructure of these tracts with fractional anisotropy (FA), radial diffusivity (RD), and hindrance modulated orientational anisotropy (HMOA) in patients with PD and healthy controls. By reducing dimensionality of both the microstructural metrics and the investigated cerebellar and cerebellar-thalamic tracts using principal component analyses, we found global differences between patients with PD and controls, suggestive of higher fractional anisotropy, lower radial diffusivity, and higher hindrance modulated orientational anisotropy in patients. However, separate analyses for each of the tracts did not yield any significant differences. Our findings contribute to the characterization of the distinct anatomical connections between the cerebellum and the diencephalon. Microstructural differences between patients and controls in the cerebellar pathways suggest involvement of these structures in PD, complementing previous functional and diffusion imaging studies.
Collapse
Affiliation(s)
- Ilona Lipp
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Jilu Princy Mole
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Leena Subramanian
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - David E. J. Linden
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Claudia Metzler-Baddeley
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
7
|
Stamelou M, Respondek G, Giagkou N, Whitwell JL, Kovacs GG, Höglinger GU. Evolving concepts in progressive supranuclear palsy and other 4-repeat tauopathies. Nat Rev Neurol 2021; 17:601-620. [PMID: 34426686 DOI: 10.1038/s41582-021-00541-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Tauopathies are classified according to whether tau deposits predominantly contain tau isoforms with three or four repeats of the microtubule-binding domain. Those in which four-repeat (4R) tau predominates are known as 4R-tauopathies, and include progressive supranuclear palsy, corticobasal degeneration, argyrophilic grain disease, globular glial tauopathies and conditions associated with specific MAPT mutations. In these diseases, 4R-tau deposits are found in various cell types and anatomical regions of the brain and the conditions share pathological, pathophysiological and clinical characteristics. Despite being considered 'prototype' tauopathies and, therefore, ideal for studying neuroprotective agents, 4R-tauopathies are still severe and untreatable diseases for which no validated biomarkers exist. However, advances in research have addressed the issues of phenotypic overlap, early clinical diagnosis, pathophysiology and identification of biomarkers, setting a road map towards development of treatments. New clinical criteria have been developed and large cohorts with early disease are being followed up in prospective studies. New clinical trial readouts are emerging and biomarker research is focused on molecular pathways that have been identified. Lessons learned from failed trials of neuroprotective drugs are being used to design new trials. In this Review, we present an overview of the latest research in 4R-tauopathies, with a focus on progressive supranuclear palsy, and discuss how current evidence dictates ongoing and future research goals.
Collapse
Affiliation(s)
- Maria Stamelou
- Parkinson's Disease and Movement Disorders Dept, HYGEIA Hospital, Athens, Greece. .,European University of Cyprus, Nicosia, Cyprus. .,Philipps University, Marburg, Germany.
| | - Gesine Respondek
- Department of Neurology, Hanover Medical School, Hanover, Germany
| | - Nikolaos Giagkou
- Parkinson's Disease and Movement Disorders Dept, HYGEIA Hospital, Athens, Greece
| | | | - Gabor G Kovacs
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Disease (CRND), University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Günter U Höglinger
- Department of Neurology, Hanover Medical School, Hanover, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| |
Collapse
|
8
|
Chung SJ, Cho KH, Lee YH, Yoo HS, Baik K, Jung JH, Ye BS, Sohn YH, Cha J, Lee PH. Diffusion tensor imaging-based pontine damage as a degeneration marker in synucleinopathy. J Neurosci Res 2021; 99:2922-2931. [PMID: 34521154 DOI: 10.1002/jnr.24926] [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: 11/07/2020] [Revised: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 11/08/2022]
Abstract
The pons is one of the earliest affected regions in patients with synucleinopathies. We aimed to investigate the diagnostic value of measuring pontine damage using diffusion tensor imaging (DTI) in these patients. We enrolled 49 patients with Parkinson's disease (PD), 16 patients with idiopathic rapid eye movement sleep behavior disorder (iRBD), 23 patients with multiple system atrophy (MSA), and 39 healthy controls in this study. All the participants underwent high-resolution T1-weighted imaging and DTI. Mean diffusivity (MD) and fraction anisotropy (FA) values in the pons were calculated to characterize structural damage. The discriminatory power of pontine MD and FA values to differentiate patients with synucleinopathies from healthy controls was examined using receiver operating characteristics (ROC) analyses. Compared to healthy controls, patients with PD, iRBD, and MSA had increased MD values and decreased FA values in the pons, although no correlation was observed between these DTI measures and disease severity. The ROC analyses showed that MD values in the pons had a fair discriminatory power to differentiate healthy controls from patients with PD (area under the curve [AUC], 0.813), iRBD (AUC, 0.779), and MSA (AUC, 0.951). The AUC for pontine FA values was smaller than that for pontine MD values when differentiating healthy controls from patients with PD (AUC, 0.713; p = 0.054) and iRBD (AUC, 0.686; p = 0.045). Our results suggest that MD values in the pons may be a useful marker of brain stem neurodegeneration in patients with synucleinopathies.
Collapse
Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Kyoo Ho Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
9
|
Beliveau V, Krismer F, Skalla E, Schocke MM, Gizewski ER, Wenning GK, Poewe W, Seppi K, Scherfler C. Characterization and diagnostic potential of diffusion tractography in multiple system atrophy. Parkinsonism Relat Disord 2021; 85:30-36. [PMID: 33713904 DOI: 10.1016/j.parkreldis.2021.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/28/2021] [Accepted: 02/22/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Microstructural integrity of the middle cerebellar peduncle (MCP) and the putamen captured by diffusion-tensor imaging (DTI) is differentially affected in the parkinsonian and cerebellar variants of multiple system atrophy (MSA-P, MSA-C) compared to Parkinson's disease (PD). The current study applied DTI and tractography in order to 1) characterize the distribution of DTI metrics along the tracts of the MCP and from the putamen in MSA variants, and 2) evaluate the usefulness of combining these measures for the differential diagnosis of MSA-P against PD in the clinical setting. METHODS Twenty-nine MSA patients (MSA-C, n = 10; MSA-P, n = 19), with a mean disease duration of 2.8 ± 1.7 years, 19 PD patients, and 27 healthy controls (HC) were included in the study. Automatized tractography with a masking procedure was employed to isolate the MCP tracts. DTI measures along the tracts of the MCP and within the putamen were acquired and jointly used to classify MSA vs. PD, and MSA-P vs. PD. Putamen volume was additionally tested as classification feature in post hoc analyses. RESULTS DTI measures within the MCP and putamen showed significant alterations in MSA variants compared to HC and PD. Classification accuracy for MSA vs. PD and MSA-P vs PD using diffusion measures was 91.7% and 89.5%, respectively. When replacing the putaminal DTI measure by a normalized measure of putamen volume classification accuracy improved to 95.8% and 94.7%, respectively. CONCLUSION Multimodal information from MCP tractography and putamen volume yields excellent diagnostic accuracy to discriminate between early-to-moderately advanced patients with MSA and PD.
Collapse
Affiliation(s)
- Vincent Beliveau
- Medical University of Innsbruck, Department of Neurology, Anichstrasse 35, 6020, Innsbruck, Austria; Medical University of Innsbruck, Neuroimaging Research Core Facility, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Florian Krismer
- Medical University of Innsbruck, Department of Neurology, Anichstrasse 35, 6020, Innsbruck, Austria; Medical University of Innsbruck, Neuroimaging Research Core Facility, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Elisabeth Skalla
- Medical University of Innsbruck, Neuroimaging Research Core Facility, Anichstrasse 35, 6020, Innsbruck, Austria; Medical University of Innsbruck, Department of Neuroradiology, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Michael M Schocke
- Medical University of Innsbruck, Neuroimaging Research Core Facility, Anichstrasse 35, 6020, Innsbruck, Austria; Medical University of Innsbruck, Department of Neuroradiology, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Elke R Gizewski
- Medical University of Innsbruck, Neuroimaging Research Core Facility, Anichstrasse 35, 6020, Innsbruck, Austria; Medical University of Innsbruck, Department of Neuroradiology, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gregor K Wenning
- Medical University of Innsbruck, Department of Neurology, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Werner Poewe
- Medical University of Innsbruck, Department of Neurology, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Klaus Seppi
- Medical University of Innsbruck, Department of Neurology, Anichstrasse 35, 6020, Innsbruck, Austria; Medical University of Innsbruck, Neuroimaging Research Core Facility, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christoph Scherfler
- Medical University of Innsbruck, Department of Neurology, Anichstrasse 35, 6020, Innsbruck, Austria; Medical University of Innsbruck, Neuroimaging Research Core Facility, Anichstrasse 35, 6020, Innsbruck, Austria.
| |
Collapse
|
10
|
Whitwell JL, Tosakulwong N, Clark HM, Ali F, Botha H, Weigand SD, Sintini I, Machulda MM, Schwarz CG, Reid RI, Jack CR, Ahlskog JE, Josephs KA. Diffusion tensor imaging analysis in three progressive supranuclear palsy variants. J Neurol 2021; 268:3409-3420. [PMID: 33710456 DOI: 10.1007/s00415-020-10360-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinical variants of progressive supranuclear palsy (PSP) include the classic Richardson's syndrome (PSP-RS), as well as cortical presentations such as PSP-speech/language (PSP-SL) and subcortical presentations such as PSP-parkinsonism (PSP-P). Patterns of white matter tract degeneration underlying these variants, and the degree to which white matter patterns could differentiate these variants, is unclear. METHODS Forty-nine PSP patients (28 PSP-RS, 12 PSP-P, and 9 PSP-SL) were recruited by the Neurodegenerative Research Group and underwent diffusion tensor imaging. Regional diffusion tensor imaging metrics were compared across PSP variants using Bayesian linear mixed-effects models, with inter-variant differentiation assessed using the area under the receiver operator characteristic curve (AUROC). RESULTS All three variants showed degeneration of the body of the corpus callosum, posterior thalamic radiation, superior cerebellar peduncle, internal and external capsule, and superior fronto-occipital fasciculus. PSP-RS showed greater degeneration of superior cerebellar peduncle compared to PSP-P and PSP-SL, whereas PSP-SL showed greater degeneration of body and genu of the corpus callosum, internal capsule, external capsule, and superior longitudinal fasciculus compared to the other variants. Fractional anisotropy in body of the corpus callosum provided excellent differentiation of PSP-SL from both PSP-P and PSP-RS (AUROC = 0.91 and 0.92, respectively). Moderate differentiation of PSP-RS and PSP-P was achieved with fractional anisotropy in superior fronto-occipital fasciculus (AUROC = 0.68) and mean diffusivity in the superior cerebellar peduncle (AUROC = 0.65). CONCLUSION In this pilot study, patterns of white matter tract degeneration differed across PSP-RS, PSP-SL, and PSP-P, with the body of the corpus callosum showing some utility in the differentiation of PSP-SL from the other two variants.
Collapse
Affiliation(s)
| | - Nirubol Tosakulwong
- Department of Health Sciences Research (Biostatistics), Mayo Clinic, Rochester, MN, USA
| | | | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Stephen D Weigand
- Department of Health Sciences Research (Biostatistics), Mayo Clinic, Rochester, MN, USA
| | - Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert I Reid
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
11
|
Dentatorubrothalamic tract reduction using fixel-based analysis in corticobasal syndrome. Neuroradiology 2020; 63:529-538. [PMID: 32989557 DOI: 10.1007/s00234-020-02559-w] [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] [Received: 05/13/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The word "fixel" refers to the specific fiber population within each voxel, and fixel-based analysis (FBA) is a recently developed technique that facilitates fiber tract-specific statistical analysis. The aim of the paper is to apply FBA to detect impaired fibers for corticobasal syndrome (CBS) especially in regions that contain multiple crossed fibers. METHODS FBA was performed in cohorts of participants clinically diagnosed with CBS (n = 10) and Parkinson's disease (n = 15) or in healthy controls (n = 9). The parameters of the diffusion weighted image were echo time, 83 ms; time, 8123.6 ms; flip angle, 90°; section thickness, 2 mm; b = 1000 s/mm2; and 32 axes. Diffusion tensor analysis was conducted using tract-based spatial statistics (TBSS), and white matter volume was estimated via voxel-based morphometry. RESULTS A comparison of PD or HC to CBS revealed a significant difference in the dentatorubrothalamic tract of the brainstem in FBA in addition to the affected regions in voxel-based morphometry and TBSS (family-wise error-corrected p < 0.05). Reduction of the white matter fibers crossing the brainstem could not be detected via microstructural changes identified using TBSS, but it was detected using FBA. CONCLUSION FBA has some advantages in determining the distribution of corticobasal syndrome lesions.
Collapse
|
12
|
Arribarat G, De Barros A, Péran P. Modern Brainstem MRI Techniques for the Diagnosis of Parkinson's Disease and Parkinsonisms. Front Neurol 2020; 11:791. [PMID: 32849237 PMCID: PMC7417676 DOI: 10.3389/fneur.2020.00791] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/25/2020] [Indexed: 01/22/2023] Open
Abstract
The brainstem is the earliest vulnerable structure in many neurodegenerative diseases like in Multiple System Atrophy (MSA) or Parkinson's disease (PD). Up-to-now, MRI studies have mainly focused on whole-brain data acquisition. Due to its spatial localization, size, and tissue characteristics, brainstem poses particular challenges for MRI. We provide a brief overview on recent advances in brainstem-related MRI markers in Parkinson's disease and Parkinsonism's. Several MRI techniques investigating brainstem, mainly the midbrain, showed to be able to discriminate PD patients from controls or to discriminate PD patients from atypical parkinsonism patients: iron-sensitive MRI, nigrosome imaging, neuromelanin-sensitive MRI, diffusion tensor imaging and advanced diffusion imaging. A standardized multimodal brainstem-dedicated MRI approach at high resolution able to quantify microstructural modification in brainstem nuclei would be a promising tool to detect early changes in parkinsonian syndromes.
Collapse
Affiliation(s)
- Germain Arribarat
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Centre de Recherche Cerveau et Cognition (CNRS, Cerco, UMR5549), UPS, Toulouse, France
| | - Amaury De Barros
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Anatomy, Toulouse Faculty of Medicine, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Zhang H, Bao Y, Feng Y, Hu H, Wang Y. Evidence for Reciprocal Structural Network Interactions Between Bilateral Crus Lobes and Broca's Complex. Front Neuroanat 2020; 14:27. [PMID: 32625067 PMCID: PMC7316155 DOI: 10.3389/fnana.2020.00027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 11/24/2022] Open
Abstract
While the proximal dentatothalamocortical tracts are considered pivotal in the occurrence of cerebellar mutism syndrome (CMS) after medulloblastoma resection, how the cerebellum participates in motor–speech networks through direct structural connectivity is still unclear. Via tractography, we provide evidence of cerebellar streamlines projecting into the left inferior frontal gyrus majorly connecting Broca’s complex and the bilateral Crus lobes. The streamlines, named Crus–Broca tracts, originated from the bilateral Crus lobes, synapsed onto the dentate nucleus, ascended into the superior cerebellar peduncle (where these streamlines were closely superior to the superior border of the supratonsillar cleft and the superolateral roof of the fourth ventricle), surprisingly bypassed the left red nucleus and the left thalamus, and ended at the subregions of Broca’s complex. The streamlines, named Broca–Crus tracts, originated from the subregions of Broca’s complex and ended predominantly at the right Crus lobes. If verified, the existence of these connections would support the notion of the bilateral cerebellums’ participation in motor–speech planning, and the anatomical relationship of Broca–Crus tracts with the supratonsillar cleft would merit consideration for further studies aimed at further elucidating CMS mechanisms.
Collapse
Affiliation(s)
- Hui Zhang
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, China.,Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yue Bao
- Department of Neurosurgery, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Yuan Feng
- Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haijun Hu
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| | - Yibao Wang
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, China
| |
Collapse
|
15
|
Spotorno N, Hall S, Irwin DJ, Rumetshofer T, Acosta-Cabronero J, Deik AF, Spindler MA, Lee EB, Trojanowski JQ, van Westen D, Nilsson M, Grossman M, Nestor PJ, McMillan CT, Hansson O. Diffusion Tensor MRI to Distinguish Progressive Supranuclear Palsy from α-Synucleinopathies. Radiology 2019; 293:646-653. [PMID: 31617796 PMCID: PMC6889922 DOI: 10.1148/radiol.2019190406] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/21/2019] [Accepted: 08/21/2019] [Indexed: 01/25/2023]
Abstract
Background The differential diagnosis of progressive supranuclear palsy (PSP) and Lewy body disorders, which include Parkinson disease and dementia with Lewy bodies, is often challenging due to the overlapping symptoms. Purpose To develop a diagnostic tool based on diffusion tensor imaging (DTI) to distinguish between PSP and Lewy body disorders at the individual-subject level. Materials and Methods In this retrospective study, skeletonized DTI metrics were extracted from two independent data sets: the discovery cohort from the Swedish BioFINDER study and the validation cohort from the Penn Frontotemporal Degeneration Center (data collected between 2010 and 2018). Based on previous neuroimaging studies and neuropathologic evidence, a combination of regions hypothesized to be sensitive to pathologic features of PSP were identified (ie, the superior cerebellar peduncle and frontal white matter) and fractional anisotropy (FA) was used to compute an FA score for each individual. Classification performances were assessed by using logistic regression and receiver operating characteristic analysis. Results In the discovery cohort, 16 patients with PSP (mean age ± standard deviation, 73 years ± 5; eight women, eight men), 34 patients with Lewy body disorders (mean age, 71 years ± 6; 14 women, 20 men), and 44 healthy control participants (mean age, 66 years ± 8; 26 women, 18 men) were evaluated. The FA score distinguished between clinical PSP and Lewy body disorders with an area under the curve of 0.97 ± 0.04, a specificity of 91% (31 of 34), and a sensitivity of 94% (15 of 16). In the validation cohort, 34 patients with PSP (69 years ± 7; 22 women, 12 men), 25 patients with Lewy body disorders (70 years ± 7; nine women, 16 men), and 32 healthy control participants (64 years ± 7; 22 women, 10 men) were evaluated. The accuracy of the FA score was confirmed (area under the curve, 0.96 ± 0.04; specificity, 96% [24 of 25]; and sensitivity, 85% [29 of 34]). Conclusion These cross-validated findings lay the foundation for a clinical test to distinguish progressive supranuclear palsy from Lewy body disorders. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Shah in this issue.
Collapse
Affiliation(s)
- Nicola Spotorno
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Sara Hall
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - David J. Irwin
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Theodor Rumetshofer
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Julio Acosta-Cabronero
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Andres F. Deik
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Meredith A. Spindler
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Edward B. Lee
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - John Q. Trojanowski
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Danielle van Westen
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Markus Nilsson
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Murray Grossman
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Peter J. Nestor
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Corey T. McMillan
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| | - Oskar Hansson
- From the Clinical Memory Research Unit, Department of Clinical
Sciences, Malmö, Lund University, Sölvegatan 19, 22100 Lund, Sweden
(N.S., S.H., D.v.W., O.H.); Penn Frontotemporal Degeneration Center, Department
of Neurology, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pa (N.S., D.J.I., M.G., C.T.M.); Memory Clinic, Skåne
University Hospital, Malmö, Sweden (S.H., O.H.); Center for
Neurodegenerative Disease Research, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa (D.J.I., E.B.L., J.Q.T.); Department of
Diagnostic Radiology, Lund University, Lund, Sweden (T.R., D.v.W., M.N.);
Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology,
University College London, London, England (J.A.C.); Parkinson’s Disease
and Movement Disorders Center, Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pa (A.F.D., M.A.S.);
Alzheimer’s Disease Core Center, Department of Pathology and Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pa (E.B.L., J.Q.T.); and Queensland Brain Institute, University of Queensland
and Mater Misericordiae, Brisbane, Queensland, Australia (P.J.N.)
| |
Collapse
|
16
|
Differentiation of multiple system atrophy from Parkinson's disease by structural connectivity derived from probabilistic tractography. Sci Rep 2019; 9:16488. [PMID: 31712681 PMCID: PMC6848175 DOI: 10.1038/s41598-019-52829-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023] Open
Abstract
Recent studies combining diffusion tensor-derived metrics and machine learning have shown promising results in the discrimination of multiple system atrophy (MSA) and Parkinson’s disease (PD) patients. This approach has not been tested using more complex methodologies such as probabilistic tractography. The aim of this work is assessing whether the strength of structural connectivity between subcortical structures, measured as the number of streamlines (NOS) derived from tractography, can be used to classify MSA and PD patients at the single-patient level. The classification performance of subcortical FA and MD was also evaluated to compare the discriminant ability between diffusion tensor-derived metrics and NOS. Using diffusion-weighted images acquired in a 3 T MRI scanner and probabilistic tractography, we reconstructed the white matter tracts between 18 subcortical structures from a sample of 54 healthy controls, 31 MSA patients and 65 PD patients. NOS between subcortical structures were compared between groups and entered as features into a machine learning algorithm. Reduced NOS in MSA compared with controls and PD were found in connections between the putamen, pallidum, ventral diencephalon, thalamus, and cerebellum, in both right and left hemispheres. The classification procedure achieved an overall accuracy of 78%, with 71% of the MSA subjects and 86% of the PD patients correctly classified. NOS features outperformed the discrimination performance obtained with FA and MD. Our findings suggest that structural connectivity derived from tractography has the potential to correctly distinguish between MSA and PD patients. Furthermore, NOS measures obtained from tractography might be more useful than diffusion tensor-derived metrics for the detection of MSA.
Collapse
|
17
|
Seki M, Seppi K, Mueller C, Potrusil T, Goebel G, Reiter E, Nocker M, Kremser C, Wildauer M, Schocke M, Gizewski ER, Wenning GK, Poewe W, Scherfler C. Diagnostic Potential of Multimodal MRI Markers in Atypical Parkinsonian Disorders. JOURNAL OF PARKINSONS DISEASE 2019; 9:681-691. [DOI: 10.3233/jpd-181568] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Morinobu Seki
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Mueller
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Potrusil
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Wildauer
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Schocke
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R. Gizewski
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K. Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
18
|
Abos A, Segura B, Baggio HC, Campabadal A, Uribe C, Garrido A, Camara A, Muñoz E, Valldeoriola F, Marti MJ, Junque C, Compta Y. Disrupted structural connectivity of fronto-deep gray matter pathways in progressive supranuclear palsy. NEUROIMAGE-CLINICAL 2019; 23:101899. [PMID: 31229940 PMCID: PMC6593210 DOI: 10.1016/j.nicl.2019.101899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/09/2019] [Accepted: 06/13/2019] [Indexed: 01/04/2023]
Abstract
Background Structural connectivity is a promising methodology to detect patterns of neural network dysfunction in neurodegenerative diseases. This approach has not been tested in progressive supranuclear palsy (PSP). Objectives The aim of this study is reconstructing the structural connectome to characterize and detect the pathways of degeneration in PSP patients compared with healthy controls and their correlation with clinical features. The second objective is to assess the potential of structural connectivity measures to distinguish between PSP patients and healthy controls at the single-subject level. Methods Twenty healthy controls and 19 PSP patients underwent diffusion-weighted MRI with a 3T scanner. Structural connectivity, represented by number of streamlines, was derived from probabilistic tractography. Global and local network metrics were calculated based on graph theory. Results Reduced numbers of streamlines were predominantly found in connections between frontal areas and deep gray matter (DGM) structures in PSP compared with controls. Significant changes in structural connectivity correlated with clinical features in PSP patients. An abnormal small-world architecture was detected in the subnetwork comprising the frontal lobe and DGM structures in PSP patients. The classification procedure achieved an overall accuracy of 82.23% with 94.74% sensitivity and 70% specificity. Conclusion Our findings suggest that modelling the brain as a structural connectome is a useful method to detect changes in the organization and topology of white matter tracts in PSP patients. Secondly, measures of structural connectivity have the potential to correctly discriminate between PSP patients and healthy controls. Reduced structural connectivity in PSP patients compared with healthy controls Connectivity reductions in fronto-DGM tracts correlate with PSPRS and FAB scores PSP patients present abnormal small-world architecture in the fronto-DGM network.
Collapse
Affiliation(s)
- Alexandra Abos
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona.Barcelona, Catalonia, Spain.
| | - Barbara Segura
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona.Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona. Barcelona, Catalonia, Spain.
| | - Hugo C Baggio
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona.Barcelona, Catalonia, Spain.
| | - Anna Campabadal
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona.Barcelona, Catalonia, Spain.
| | - Carme Uribe
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona.Barcelona, Catalonia, Spain.
| | - Alicia Garrido
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Ana Camara
- Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Esteban Muñoz
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona. Barcelona, Catalonia, Spain; Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, Barcelona, Catalonia, Spain; Institute of Biomedical Research August Pi i Sunyer (IDIBAPS). Barcelona, Catalonia, Spain.
| | - Francesc Valldeoriola
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona. Barcelona, Catalonia, Spain; Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, Barcelona, Catalonia, Spain; Institute of Biomedical Research August Pi i Sunyer (IDIBAPS). Barcelona, Catalonia, Spain.
| | - Maria Jose Marti
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona. Barcelona, Catalonia, Spain; Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, Barcelona, Catalonia, Spain; Institute of Biomedical Research August Pi i Sunyer (IDIBAPS). Barcelona, Catalonia, Spain.
| | - Carme Junque
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona.Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona. Barcelona, Catalonia, Spain; Institute of Biomedical Research August Pi i Sunyer (IDIBAPS). Barcelona, Catalonia, Spain.
| | - Yaroslau Compta
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona. Barcelona, Catalonia, Spain; Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institute of Neuroscience, University of Barcelona, Barcelona, Catalonia, Spain; Institute of Biomedical Research August Pi i Sunyer (IDIBAPS). Barcelona, Catalonia, Spain.
| |
Collapse
|
19
|
Sjöström H, Surova Y, Nilsson M, Granberg T, Westman E, van Westen D, Svenningsson P, Hansson O. Mapping of apparent susceptibility yields promising diagnostic separation of progressive supranuclear palsy from other causes of parkinsonism. Sci Rep 2019; 9:6079. [PMID: 30988382 PMCID: PMC6465307 DOI: 10.1038/s41598-019-42565-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/02/2019] [Indexed: 01/11/2023] Open
Abstract
There is a need for methods that distinguish Parkinson’s disease (PD) from progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), which have similar characteristics in the early stages of the disease. In this prospective study, we evaluate mapping of apparent susceptibility based on susceptibility weighted imaging (SWI) for differential diagnosis. We included 134 patients with PD, 11 with PSP, 10 with MSA and 44 healthy controls. SWI data were processed into maps of apparent susceptibility. In PSP, apparent susceptibility was increased in the red nucleus compared to all other groups, and in globus pallidus, putamen, substantia nigra and the dentate nucleus compared to PD and controls. In MSA, putaminal susceptibility was increased compared to PD and controls. Including all studied regions and using discriminant analysis between PSP and PD, 100% sensitivity and 97% specificity was achieved, and 91% sensitivity and 90% specificity in separating PSP from MSA. Correlations between putaminal susceptibility and disease severity in PD could warrant further research into using susceptibility mapping for monitoring disease progression and in clinical trials. Our study indicates that susceptibility in deep nuclei could play a role in the diagnosis of atypical parkinsonism, especially in PSP.
Collapse
Affiliation(s)
- Henrik Sjöström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, 171 65, Sweden. .,Department of Neurology, Karolinska University Hospital, Stockholm, 141 86, Sweden.
| | - Yulia Surova
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, 212 24, Malmö, Sweden.,Neurology Clinic, Skåne University Hospital, Lund, 221 85, Sweden
| | - Markus Nilsson
- Clinical Sciences Lund, Department of Radiology, Lund University, Lund, 221 85, Sweden
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, 171 65, Sweden.,Department of Radiology, Karolinska University Hospital, Stockholm, 141 86, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, 141 57, Sweden.,Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, United Kingdom
| | - Danielle van Westen
- Diagnostic Radiology, Department of Clinical Sciences, Lund University, Lund, 221 85, Sweden.,Department for Image and Function, Skåne University Hospital, Lund, 221 85, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, 171 65, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, 141 86, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, 212 24, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, 212 24, Sweden
| |
Collapse
|
20
|
Quattrone A, Caligiuri ME, Morelli M, Nigro S, Vescio B, Arabia G, Nicoletti G, Nisticò R, Salsone M, Novellino F, Barbagallo G, Vaccaro MG, Sabatini U, Vescio V, Stanà C, Rocca F, Caracciolo M, Quattrone A. Imaging counterpart of postural instability and vertical ocular dysfunction in patients with PSP: A multimodal MRI study. Parkinsonism Relat Disord 2019; 63:124-130. [PMID: 30803901 DOI: 10.1016/j.parkreldis.2019.02.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/09/2019] [Accepted: 02/16/2019] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We investigated the imaging counterpart of two functional domains (ocular motor dysfunction and postural instability) in progressive supranuclear palsy (PSP) patients classified according to the new clinical diagnostic criteria. METHODS Forty-eight patients with probable PSP-Richardson's syndrome (PSP-RS), 30 with probable PSP-parkinsonism (PSP-P), 37 with Parkinson's disease (PD), and 38 controls were enrolled. For each functional domain, PSP patients were stratified by two certainty levels: vertical supranuclear gaze palsy (O1) and slowness of vertical saccades (O2) for ocular motor dysfunction; early unprovoked falls and tendency to fall on the pull-test for postural instability. Voxel-based morphometry (VBM), whole-brain fractional anisotropy (FA) and MR planimetric measurements were analysed and compared across patient groups. RESULTS O1 was present in 64%, and O2 in 36% of all PSP patients. All PSP-RS patients showed early unprovoked falls. TBSS whole-brain analysis revealed that superior cerebellar peduncles (SCPs) were the only structures with significantly lower FA values in PSP-RS compared with PSP-P patients. PSP/O1 patients had lower FA values in midbrain than PSP/O2 patients. By contrast, VBM revealed no differences in grey matter volume between PSP patient groups. MR Planimetric measurements confirmed atrophy of midbrain and SCPs, in line with DTI findings. CONCLUSIONS Our study demonstrates that SCPs were significantly more damaged in patients with PSP-RS in comparison with PSP-P patients, thus suggesting the role of SCPs in developing postural instability. Midbrain damage was less severe in O2 than in O1 patients, suggesting that the degree of vertical ocular dysfunction reflects the severity of midbrain atrophy.
Collapse
Affiliation(s)
- Andrea Quattrone
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Maria Eugenia Caligiuri
- Neuroscience Center, Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Maurizio Morelli
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Salvatore Nigro
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | | | - Gennarina Arabia
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Giuseppe Nicoletti
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Rita Nisticò
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Maria Salsone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Fabiana Novellino
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Gaetano Barbagallo
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Maria Grazia Vaccaro
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Umberto Sabatini
- Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy
| | - Virginia Vescio
- Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy
| | - Carlo Stanà
- Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy
| | - Federico Rocca
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Manuela Caracciolo
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Center, Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.
| |
Collapse
|
21
|
Nigro S, Bianco MG, Arabia G, Morelli M, Nisticò R, Novellino F, Salsone M, Augimeri A, Quattrone A. Track density imaging in progressive supranuclear palsy: A pilot study. Hum Brain Mapp 2018; 40:1729-1737. [PMID: 30474903 DOI: 10.1002/hbm.24484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 12/27/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterized by white matter (WM) changes in different supra- and infratentorial brain structures. We used track density imaging (TDI) to characterize WM microstructural alterations in patients with PSP-Richardson's Syndrome (PSP-RS). Moreover, we investigated the diagnostic utility of TDI in distinguishing patients with PSP-RS from those with Parkinson's disease and healthy controls (HC). Twenty PSP-RS patients, 21 PD patients, and 23 HC underwent a 3 T MRI diffusion-weighted (DW) imaging. Then, we combined constrained spherical deconvolution and WM probabilistic tractography to reconstruct track density maps by calculating the number of WM streamlines traversing each voxel. Voxel-wise analysis was performed to assess group differences in track density maps. A support vector machine (SVM) approach was also used to evaluate the performance of TDI for discriminating between groups. Relative to PD patients, decreases in track density in PSP-RS patients were found in brainstem, cerebellum, thalamus, corpus callosum, and corticospinal tract. Similar findings were obtained between PSP-RS patients and HC. No differences in TDI were observed between PD and HC. SVM approach based on whole-brain analysis differentiated PD patients from PSP-RS with an area under the curve (AUC) of 0.82. The AUC reached a value of 0.98 considering only the voxels belonging to the superior cerebellar peduncle. This study shows that TDI may represent a useful approach for characterizing WM alterations in PSP-RS patients. Moreover, track density decrease in PSP could be considered a new feature for the differentiation of patients with PSP-RS from those with PD.
Collapse
Affiliation(s)
- Salvatore Nigro
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | | | - Gennarina Arabia
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Maurizio Morelli
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Rita Nisticò
- Institute of Bioimaging and Molecular Physiology, National Research Council, Catanzaro, Italy
| | - Fabiana Novellino
- Institute of Bioimaging and Molecular Physiology, National Research Council, Catanzaro, Italy
| | - Maria Salsone
- Institute of Bioimaging and Molecular Physiology, National Research Council, Catanzaro, Italy
| | | | - Aldo Quattrone
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy.,Institute of Bioimaging and Molecular Physiology, National Research Council, Catanzaro, Italy.,Neuroscience Center, Magna Graecia University, Catanzaro, Italy
| |
Collapse
|
22
|
Abstract
Qualitative and quantitative structural magnetic resonance imaging offer objective measures of the underlying neurodegeneration in atypical parkinsonism. Regional changes in tissue volume, signal changes and increased deposition of iron as assessed with different structural MRI techniques are surrogate markers of underlying neurodegeneration and may reflect cell loss, microglial proliferation and astroglial activation. Structural MRI has been explored as a tool to enhance diagnostic accuracy in differentiating atypical parkinsonian disorders (APDs). Moreover, the longitudinal assessment of serial structural MRI-derived parameters offers the opportunity for robust inferences regarding the progression of APDs. This review summarizes recent research findings as (1) a diagnostic tool for APDs as well as (2) as a tool to assess longitudinal changes of serial MRI-derived parameters in the different APDs.
Collapse
|
23
|
Abstract
The dentate nucleus (DN) of the cerebellum is the major output nucleus of the cerebellum and is rich in iron. Quantitative susceptibility mapping (QSM) provides better iron-sensitive MRI contrast to delineate the boundary of the DN than either T2-weighted images or susceptibility-weighted images. Prior DN atlases used T2-weighted or susceptibility-weighted images to create DN atlases. Here, we employ QSM images to develop an improved dentate nucleus atlas for use in imaging studies. The DN was segmented in QSM images from 38 healthy volunteers. The resulting DN masks were transformed to a common space and averaged to generate the DN atlas. The center of mass of the left and right sides of the QSM-based DN atlas in the Montreal Neurological Institute space was -13.8, -55.8, and -36.4 mm, and 13.8, -55.7, and -36.4 mm, respectively. The maximal probability and mean probability of the DN atlas with the individually segmented DNs in this cohort were 100 and 39.3%, respectively, in contrast to the maximum probability of approximately 75% and the mean probability of 23.4 to 33.7% with earlier DN atlases. Using QSM, which provides superior iron-sensitive MRI contrast for delineating iron-rich structures, an improved atlas for the dentate nucleus has been generated. The atlas can be applied to investigate the role of the DN in both normal cortico-cerebellar physiology and the variety of disease states in which it is implicated.
Collapse
|
24
|
Seki M, Seppi K, Mueller C, Potrusil T, Goebel G, Reiter E, Nocker M, Steiger R, Wildauer M, Gizewski ER, Wenning GK, Poewe W, Scherfler C. Diagnostic potential of dentatorubrothalamic tract analysis in progressive supranuclear palsy. Parkinsonism Relat Disord 2018; 49:81-87. [PMID: 29463454 DOI: 10.1016/j.parkreldis.2018.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/04/2018] [Accepted: 02/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The differentiation of progressive supranuclear palsy-parkinsonism (PSP-P) from Parkinson's disease (PD) remains a major clinical challenge. OBJECTIVES To evaluate the diagnostic potential of observer-independent assessments of microstructural integrity within infratentorial brain regions to differentiate PSP-Richardson's syndrome (PSP-RS), PSP-P and PD. METHODS 3T MRI parameters of mean diffusivity, fractional anisotropy, grey and white matter volumes from patients with PSP-RS (n = 12), PSP-P (n = 12) and mean disease duration of 2.4 ± 1.7 years were compared with PD patients (n = 20) and healthy controls (n = 23) by using statistical parametric mapping and the spatially unbiased infratentorial template. Subsequently MRI measurements of the dentatorubrothalamic tract were determined observer-independently by a validated probabilistic infratentorial atlas. The impairment of gait and postural stability was evaluated by a sum-score derived from the Unified Parkinson Disease Rating Scale. RESULTS Significant mean diffusivity increases, fractional anisotropy decreases and corresponding volume loss were localized in mesencephalic tegmentum, superior cerebellar peduncle, decussation of superior cerebellar peduncle and dentate nucleus in PSP-RS and PSP-P compared to PD and healthy controls. Altered microstructural integrity of the dentatorubrothalamic tract in PSP-RS was significantly more pronounced compared to PSP-P and correlated significantly with the gait and postural stability sum-score. Linear discriminant analysis identified diffusion tensor imaging measures of the dentatorubrothalamic tract and the gait and postural stability sum-score to classify correctly 95.5% of PRP-RS, PSP-P and PD patients. CONCLUSIONS Observer-independent analysis of microstructural integrity within the dentatorubrothalamic tract in combination with assessments of gait and postural stability differentiate PSP-P from PSP-RS and PD in early to moderately advanced stages.
Collapse
Affiliation(s)
- Morinobu Seki
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria.
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
| | | | - Thomas Potrusil
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Ruth Steiger
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Matthias Wildauer
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Elke R Gizewski
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
| |
Collapse
|
25
|
Svärd D, Nilsson M, Lampinen B, Lätt J, Sundgren PC, Stomrud E, Minthon L, Hansson O, van Westen D. The effect of white matter hyperintensities on statistical analysis of diffusion tensor imaging in cognitively healthy elderly and prodromal Alzheimer's disease. PLoS One 2017; 12:e0185239. [PMID: 28934374 PMCID: PMC5608410 DOI: 10.1371/journal.pone.0185239] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/09/2017] [Indexed: 11/20/2022] Open
Abstract
Diffusion tensor imaging (DTI) has been used to study microstructural white matter alterations in a variety of conditions including normal aging and Alzheimer's disease (AD). White matter hyperintensities (WMH) are common in cognitively healthy elderly as well as in AD and exhibit elevated mean diffusivity (MD) and reduced fractional anisotropy (FA). However, the effect of WMH on statistical analysis of DTI estimates has not been thoroughly studied. In the present study we address this in two ways. First, we investigate the effect of WMH on MD and FA in the dorsal and ventral cingulum, the superior longitudinal fasciculus, and the corticospinal tract, by comparing two matched groups of cognitively healthy elderly (n = 21 + 21) with unequal WMH load. Second, we assess the effects of adjusting for WMH load when comparing MD and FA in prodromal AD subjects (n = 83) to cognitively healthy elderly (n = 132) in the abovementioned white matter tracts. Results showed the WMH in cognitively healthy elderly to have a generally large effect on DTI estimates (Cohen’s d = 0.63 to 1.27 for significant differences in MD and −1.06 to −0.69 for FA). These effect sizes were comparable to those of various neurological and psychiatric diseases (Cohen’s d = 0.57 to 2.20 for differences in MD and −1.76 to −0.61 for FA). Adjusting for WMH when comparing DTI estimates in prodromal AD subjects to cognitively healthy elderly improved the explanatory power as well as the outcome of the analysis, indicating that some of the differences in MD and FA were largely driven by unequal WMH load between the groups rather than alterations in normal-appearing white matter (NAWM). Thus, our findings suggest that if the purpose of a study is to compare alterations in NAWM between two groups using DTI it may be necessary to adjust the statistical analysis for WMH.
Collapse
Affiliation(s)
- Daniel Svärd
- Diagnostic Radiology, Lund University, Lund, Sweden
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
- * E-mail:
| | - Markus Nilsson
- Lund University Bioimaging Center, Lund University, Lund, Sweden
| | - Björn Lampinen
- Medical Radiation Physics, Lund University, Lund, Sweden
| | - Jimmy Lätt
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Pia C. Sundgren
- Diagnostic Radiology, Lund University, Lund, Sweden
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Erik Stomrud
- Clinical Memory Research, Lund University, Malmoö, Sweden
| | | | - Oskar Hansson
- Clinical Memory Research, Lund University, Malmoö, Sweden
- Memory Clinic, Skåne University Hospital, Lund, Sweden
| | - Danielle van Westen
- Diagnostic Radiology, Lund University, Lund, Sweden
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
26
|
Heim B, Krismer F, De Marzi R, Seppi K. Magnetic resonance imaging for the diagnosis of Parkinson's disease. J Neural Transm (Vienna) 2017; 124:915-964. [PMID: 28378231 PMCID: PMC5514207 DOI: 10.1007/s00702-017-1717-8] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/22/2017] [Indexed: 12/11/2022]
Abstract
The differential diagnosis of parkinsonian syndromes is considered one of the most challenging in neurology and error rates in the clinical diagnosis can be high even at specialized centres. Despite several limitations, magnetic resonance imaging (MRI) has undoubtedly enhanced the diagnostic accuracy in the differential diagnosis of neurodegenerative parkinsonism over the last three decades. This review aims to summarize research findings regarding the value of the different MRI techniques, including advanced sequences at high- and ultra-high-field MRI and modern image analysis algorithms, in the diagnostic work-up of Parkinson's disease. This includes not only the exclusion of alternative diagnoses for Parkinson's disease such as symptomatic parkinsonism and atypical parkinsonism, but also the diagnosis of early, new onset, and even prodromal Parkinson's disease.
Collapse
Affiliation(s)
- Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Roberto De Marzi
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria.
| |
Collapse
|
27
|
Power BD, Jakabek D, Hunter-Dickson M, Wilkes FA, van Westen D, Santillo AF, Walterfang M, Velakoulis D, Nilsson C, Looi JCL. Morphometric analysis of thalamic volume in progressive supranuclear palsy: In vivo evidence of regionally specific bilateral thalamic atrophy. Psychiatry Res Neuroimaging 2017; 265:65-71. [PMID: 28550719 DOI: 10.1016/j.pscychresns.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/11/2017] [Accepted: 05/11/2017] [Indexed: 11/25/2022]
Abstract
We investigated whether differences were detectable in the volume and shape of the dorsal thalamus on magnetic resonance imaging in patients with progressive supranuclear palsy (PSP). Manual segmentation of the left and right thalami on magnetic resonance imaging scans occurred in 22 patients with clinically diagnosed PSP and 23 healthy controls; thalamic volumes (left, right, total) were calculated. Between group differences were explored by multivariate analysis of co-variance, using age and intracranial volume as covariates. Analysis of the shape of the thalamus was performed using the spherical harmonic point distribution method software package. Patients with PSP were found to have significant bilateral thalamic atrophy on magnetic resonance imaging; there was significant shape deflation over the anterior-lateral and anterior-ventral surfaces bilaterally, and over the right caudal thalamus. Recognizing decreased thalamic morphology in PSP patients in vivo may be an important component of an ensemble of diagnostic biomarkers in the future, particularly given the difficulty of distinguishing PSP from other Parkinsonian conditions early in the disease course.
Collapse
Affiliation(s)
- Brian D Power
- School of Medicine Fremantle, The University of Notre Dame Australia, Fremantle, Australia; Clinical Research Centre, North Metropolitan Health Service - Mental Health, Perth, Australia.
| | - David Jakabek
- University of Wollongong, Wollongong, NSW, Australia.
| | - Mitchell Hunter-Dickson
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia.
| | - Fiona A Wilkes
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia.
| | - Danielle van Westen
- Center for Medical Imaging and Physiology, Skåne University Hospital, and Diagnostic Radiology, Department of Clinical Sciences, Lund University, Lund, Sweden; Diagnostic Radiology, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Alexander F Santillo
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, Melbourne, Australia.
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, Melbourne, Australia.
| | - Christer Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Jeffrey C L Looi
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia; Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, Melbourne, Australia
| |
Collapse
|
28
|
Whitwell JL, Höglinger GU, Antonini A, Bordelon Y, Boxer AL, Colosimo C, van Eimeren T, Golbe LI, Kassubek J, Kurz C, Litvan I, Pantelyat A, Rabinovici G, Respondek G, Rominger A, Rowe JB, Stamelou M, Josephs KA. Radiological biomarkers for diagnosis in PSP: Where are we and where do we need to be? Mov Disord 2017; 32:955-971. [PMID: 28500751 PMCID: PMC5511762 DOI: 10.1002/mds.27038] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/11/2022] Open
Abstract
PSP is a pathologically defined neurodegenerative tauopathy with a variety of clinical presentations including typical Richardson's syndrome and other variant PSP syndromes. A large body of neuroimaging research has been conducted over the past two decades, with many studies proposing different structural MRI and molecular PET/SPECT biomarkers for PSP. These include measures of brainstem, cortical and striatal atrophy, diffusion weighted and diffusion tensor imaging abnormalities, [18F] fluorodeoxyglucose PET hypometabolism, reductions in striatal dopamine imaging and, most recently, PET imaging with ligands that bind to tau. Our aim was to critically evaluate the degree to which structural and molecular neuroimaging metrics fulfill criteria for diagnostic biomarkers of PSP. We queried the PubMed, Cochrane, Medline, and PSYCInfo databases for original research articles published in English over the past 20 years using postmortem diagnosis or the NINDS-SPSP criteria as the diagnostic standard from 1996 to 2016. We define a five-level theoretical construct for the utility of neuroimaging biomarkers in PSP, with level 1 representing group-level findings, level 2 representing biomarkers with demonstrable individual-level diagnostic utility, level 3 representing biomarkers for early disease, level 4 representing surrogate biomarkers of PSP pathology, and level 5 representing definitive PSP biomarkers of PSP pathology. We discuss the degree to which each of the currently available biomarkers fit into this theoretical construct, consider the role of biomarkers in the diagnosis of Richardson's syndrome, variant PSP syndromes and autopsy confirmed PSP, and emphasize current shortfalls in the field. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
| | - Günter U. Höglinger
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, IRCCS Hospital San Camillo, Venice and Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
| | - Thilo van Eimeren
- German Center for Neurodegenerative Diseases (DZNE), Germany
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Lawrence I. Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Carolin Kurz
- Psychiatrische Klinik, Ludwigs-Maximilians-Universität, München, Germany
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, CA, USA
| | | | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Gesine Respondek
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Axel Rominger
- Deptartment of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - James B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Maria Stamelou
- Second Department of Neurology, Attikon University Hospital, University of Athens, Greece; Philipps University, Marburg, Germany; Movement Disorders Dept., HYGEIA Hospital, Athens, Greece
| | | |
Collapse
|
29
|
Bacchi S, Chim I, Patel S. Specificity and sensitivity of magnetic resonance imaging findings in the diagnosis of progressive supranuclear palsy. J Med Imaging Radiat Oncol 2017; 62:21-31. [DOI: 10.1111/1754-9485.12613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 03/11/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Stephen Bacchi
- University of Adelaide; Adelaide South Australia Australia
| | - Ivana Chim
- University of Adelaide; Adelaide South Australia Australia
| | - Sandy Patel
- Royal Adelaide Hospital; Adelaide South Australia Australia
| |
Collapse
|
30
|
Upadhyay N, Suppa A, Piattella MC, Giannì C, Bologna M, Di Stasio F, Petsas N, Tona F, Fabbrini G, Berardelli A, Pantano P. Functional disconnection of thalamic and cerebellar dentate nucleus networks in progressive supranuclear palsy and corticobasal syndrome. Parkinsonism Relat Disord 2017; 39:52-57. [PMID: 28318985 DOI: 10.1016/j.parkreldis.2017.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/10/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
Abstract
AIM To assess functional rearrangement following neurodegeneration in the thalamus and dentate nucleus in patients with progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). METHODS We recruited 19 patients with PSP, 11 with CBS and 14 healthy subjects. All the subjects underwent resting-state (rs) fMRI using a 3T system. Whole brain functional connectivity of the thalamus and dentate nucleus were calculated by means of a seed-based approach with FEAT script in FSL toolbox. Thalamic volume was calculated by means of FIRST, and the dentate area by means of Jim software. RESULTS Both thalamic volume and dentate area were significantly smaller in PSP and CBS patients than in healthy subjects. No significant difference emerged in thalamic volume between PSP and CBS patients, whereas dentate area was significantly smaller in PSP than in CBS. Thalamic functional connectivity was significantly reduced in both patient groups in various cortical, subcortical and cerebellar areas. By contrast, changes in dentate nucleus functional connectivity differed in PSP and CBS: it decreased in subcortical and prefrontal cortical areas in PSP, but increased asymmetrically in the frontal cortex in CBS. CONCLUSIONS Evaluating the dentate nucleus size and its functional connectivity may help to differentiate patients with PSP from those with CBS.
Collapse
Affiliation(s)
- Neeraj Upadhyay
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Antonio Suppa
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy
| | | | - Costanza Giannì
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Matteo Bologna
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy
| | | | - Nikolaos Petsas
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Francesca Tona
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Giovanni Fabbrini
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy
| | - Patrizia Pantano
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed Institute, Pozzilli (IS), Italy.
| |
Collapse
|
31
|
Brain MR Contribution to the Differential Diagnosis of Parkinsonian Syndromes: An Update. PARKINSONS DISEASE 2016; 2016:2983638. [PMID: 27774334 PMCID: PMC5059618 DOI: 10.1155/2016/2983638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/08/2016] [Accepted: 09/01/2016] [Indexed: 12/26/2022]
Abstract
Brain magnetic resonance (MR) represents a useful and feasible tool for the differential diagnosis of Parkinson's disease. Conventional MR may reveal secondary forms of parkinsonism and may show peculiar brain alterations of atypical parkinsonian syndromes. Furthermore, advanced MR techniques, such as morphometric-volumetric analyses, diffusion-weighted imaging, diffusion tensor imaging, tractography, proton MR spectroscopy, and iron-content sensitive imaging, have been used to obtain quantitative parameters useful to increase the diagnostic accuracy. Currently, many MR studies have provided both qualitative and quantitative findings, reflecting the underlying neuropathological pattern of the different degenerative parkinsonian syndromes. Although the variability in the methods and results across the studies limits the conclusion about which technique is the best, specific radiologic phenotypes may be identified. Qualitative/quantitative MR changes in the substantia nigra do not discriminate between different parkinsonisms. In the absence of extranigral abnormalities, the diagnosis of PD is more probable, whereas basal ganglia changes (mainly in the putamen) suggest the diagnosis of an atypical parkinsonian syndrome. In this context, changes in pons, middle cerebellar peduncles, and cerebellum suggest the diagnosis of MSA, in midbrain and superior cerebellar peduncles the diagnosis of PSP, and in whole cerebral hemispheres (mainly in frontoparietal cortex with asymmetric distribution) the diagnosis of Corticobasal Syndrome.
Collapse
|
32
|
Alterations of Diffusion Kurtosis and Neurite Density Measures in Deep Grey Matter and White Matter in Parkinson's Disease. PLoS One 2016; 11:e0157755. [PMID: 27362763 PMCID: PMC4928807 DOI: 10.1371/journal.pone.0157755] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 06/03/2016] [Indexed: 11/28/2022] Open
Abstract
In Parkinson’s disease (PD), pathological microstructural changes occur and such changes might be detected using diffusion magnetic resonance imaging (dMRI). However, it is unclear whether dMRI improves PD diagnosis or helps differentiating between phenotypes, such as postural instability gait difficulty (PIGD) and tremor dominant (TD) PD. We included 105 patients with PD and 44 healthy controls (HC), all of whom underwent dMRI as part of the prospective Swedish BioFINDER study. Diffusion kurtosis imaging (DKI) and neurite density imaging (NDI) analyses were performed using regions of interest in the basal ganglia, the thalamus, the pons and the midbrain as well as tractography of selected white matter tracts. In the putamen, the PD group showed increased mean diffusivity (MD) (p = .003), decreased fractional anisotropy (FA) (p = .001) and decreased mean kurtosis (MK), compared to HC (p = .024). High MD and a low MK in the putamen were associated with more severe motor and cognitive symptomatology (p < .05). Also, patients with PIGD exhibited increased MD in the putamen compared to the TD patients (p = .009). In the thalamus, MD was increased (p = .001) and FA was decreased (p = .032) in PD compared to HC. Increased MD and decreased FA correlated negatively with motor speed and balance (p < .05). In the superior longitudinal fasciculus (SLF), MD (p = .019) and fiso were increased in PD compared to HC (p = .03). These changes correlated negatively with motor speed (p < .002) and balance (p < .037). However, most of the observed changes in PD were also present in cases with either multiple system atrophy (n = 11) or progressive supranuclear palsy (n = 10). In conclusion, PD patients exhibit microstructural changes in the putamen, the thalamus, and the SLF, which are associated with worse disease severity. However, the dMRI changes are not sufficiently specific to improve the diagnostic work-up of PD. Longitudinal studies should evaluate whether dMRI measures can be used to track disease progression.
Collapse
|
33
|
Rojas JC, Karydas A, Bang J, Tsai RM, Blennow K, Liman V, Kramer JH, Rosen H, Miller BL, Zetterberg H, Boxer AL. Plasma neurofilament light chain predicts progression in progressive supranuclear palsy. Ann Clin Transl Neurol 2016; 3:216-25. [PMID: 27042681 PMCID: PMC4774256 DOI: 10.1002/acn3.290] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/22/2015] [Accepted: 12/31/2015] [Indexed: 12/12/2022] Open
Abstract
Objective Blood‐based biomarkers for neurodegenerative conditions could improve diagnosis and treatment development. Neurofilament light chain (NfL), a marker of axonal injury, is elevated in cerebrospinal fluid (CSF) of patients with progressive supranuclear palsy (PSP). The goal of this study was to determine the diagnostic and prognostic value of plasma NfL in patients with PSP. Methods Plasma NfL was measured with ultrasensitive digital immunoassay‐based technology at baseline and 1‐year follow‐up in a pilot cohort of 15 PSP patients and 12 healthy controls, and a validation cohort of 147 PSP patients. Mixed linear models tested the ability of plasma NfL to predict neurological, cognitive and functional decline, and brain atrophy. Results Baseline mean plasma NfL levels were elevated in PSP patients (31 ± 4 pg/mL, vs. control, 17.5 ± 1 pg/mL, P < 0.05) and this difference persisted at follow‐up. A cutoff value of 20 pg/mL related to the diagnosis of PSP with a sensitivity of 0.80 and specificity of 0.83 (positive likelihood ratio = 4.7 and a negative likelihood radio of 0.24). Patients with higher NfL levels had more severe neurological (PSPRS, −36.9% vs. −28.9%, P = 0.04), functional (SEADL, −38.2% vs. −20%, P = 0.03), and neuropsychological (RBANS, −23.9% vs. −12.3%, P = 001) deterioration over 1 year. Higher baseline NfL predicted greater whole‐brain and superior cerebellar peduncle volume loss. Plasma and CSF NfL were significantly correlated (r = 0.74, P = 0.002). Interpretation Plasma NfL is elevated in PSP and could be of value as a biomarker both to assist clinical diagnosis and to monitor pharmacodynamic effects on the neurodegenerative process in clinical trials.
Collapse
Affiliation(s)
- Julio C Rojas
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Anna Karydas
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Jee Bang
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Richard M Tsai
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Sahlgrenska Academy at University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden
| | - Victor Liman
- Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Sahlgrenska Academy at University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden
| | - Joel H Kramer
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Howard Rosen
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Bruce L Miller
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Sahlgrenska Academy at University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden; Department of Molecular Neuroscience UCL Institute of Neurology Queen Square London United Kingdom
| | - Adam L Boxer
- Memory and Aging Center Department of Neurology University of California, San Francisco San Francisco California
| |
Collapse
|