1
|
Ide S, Murakami Y, Futatsuya K, Anai K, Yoshimatsu Y, Fukumitsu S, Tsukamoto J, Hashimoto T, Adachi H, Ueda I, Kakeda S, Aoki T. Usefulness of Olfactory Bulb Measurement in 3D-FIESTA in Differentiating Parkinson Disease from Atypical Parkinsonism. AJNR Am J Neuroradiol 2024:ajnr.A8275. [PMID: 38871365 DOI: 10.3174/ajnr.a8275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND PURPOSE Parkinson disease is a prevalent disease, with olfactory dysfunction recognized as an early nonmotor manifestation. It is sometimes difficult to differentiate Parkinson disease from atypical parkinsonism using conventional MR imaging and motor symptoms. It is also known that olfactory loss occurs to a lesser extent or is absent in atypical parkinsonism. To the best of our knowledge, no study has examined olfactory bulb changes to differentiate Parkinson disease from atypical parkinsonism, even in an early diagnosis, and its association with conventional MR imaging findings. Hence, we aimed to assess the utility of olfactory bulb measurements in differentiating Parkinson disease from atypical parkinsonism even in the early stage. MATERIALS AND METHODS In this retrospective study, we enrolled 108 patients with Parkinson disease, 13 with corticobasal syndrome, 15 with multiple system atrophy, and 17 with progressive supranuclear palsy who developed parkinsonism. Thirty-nine age-matched healthy subjects served as controls. All subjects underwent conventional MR imaging and 3D FIESTA for olfactory bulb measurements using manual ROI quantification of the cross-sectional olfactory bulb area using the coronal plane. Bilateral olfactory bulb measurements were averaged. For group comparisons, we used the Welch t test, and we assessed diagnostic accuracy using receiver operating characteristic analysis. RESULTS Patients with Parkinson disease had a mean olfactory bulb area of 4.2 (SD, 1.0 mm2), significantly smaller than in age-matched healthy subjects (6.6 [SD, 1.7 mm2], P < .001), and those with corticobasal syndrome (5.4 [SD, 1.2 mm2], P < .001), multiple system atrophy (6.5 [SD, 1.2 mm2], P < .001), and progressive supranuclear palsy (5.4 [SD, 1.2 mm2], P < .001). The receiver operating characteristic analysis for the olfactory bulb area measurements showed good diagnostic performance in differentiating Parkinson disease from atypical parkinsonism, with an area under the curve of 0.87, an optimal cutoff value of 5.1 mm2, and a false-positive rate of 18%. When we compared within 2 years of symptom onset, the olfactory bulb in Parkinson disease (4.2 [SD, 1.1 mm2]) remained significantly smaller than in atypical parkinsonism (versus corticobasal syndrome (6.1 [SD, 0.7 mm2]), P < .001; multiple system atrophy (6.3 [SD, 1.4 mm2]), P < .001; and progressive supranuclear palsy (5.2 [1.3 mm2], P = .003, respectively). CONCLUSIONS 3D FIESTA-based olfactory bulb measurement holds promise for distinguishing Parkinson disease from atypical parkinsonism, especially in the early stage.
Collapse
Affiliation(s)
- Satoru Ide
- From the Department of Radiology (S.I., Y.M., K.F., K.A., Y.Y., S.F., J.T., T.A.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yu Murakami
- From the Department of Radiology (S.I., Y.M., K.F., K.A., Y.Y., S.F., J.T., T.A.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koichiro Futatsuya
- From the Department of Radiology (S.I., Y.M., K.F., K.A., Y.Y., S.F., J.T., T.A.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kenta Anai
- From the Department of Radiology (S.I., Y.M., K.F., K.A., Y.Y., S.F., J.T., T.A.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuta Yoshimatsu
- From the Department of Radiology (S.I., Y.M., K.F., K.A., Y.Y., S.F., J.T., T.A.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoshi Fukumitsu
- From the Department of Radiology (S.I., Y.M., K.F., K.A., Y.Y., S.F., J.T., T.A.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Jun Tsukamoto
- From the Department of Radiology (S.I., Y.M., K.F., K.A., Y.Y., S.F., J.T., T.A.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tomoyo Hashimoto
- Department of Neurology (T.H., H.A), School of Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Hiroaki Adachi
- Department of Neurology (T.H., H.A), School of Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Issei Ueda
- Center for Evolutionary Cognitive Sciences, (I.U.), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
| | - Shingo Kakeda
- Department of Radiology (S.K.), Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Takatoshi Aoki
- From the Department of Radiology (S.I., Y.M., K.F., K.A., Y.Y., S.F., J.T., T.A.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| |
Collapse
|
2
|
Varga Z, Keller J, Robinson SD, Serranova T, Nepozitek J, Zogala D, Trnka J, Ruzicka E, Sonka K, Dusek P. Whole brain pattern of iron accumulation in REM sleep behavior disorder. Hum Brain Mapp 2024; 45:e26675. [PMID: 38590155 PMCID: PMC11002348 DOI: 10.1002/hbm.26675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/10/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Isolated REM sleep behavior disorder (iRBD) is an early stage of synucleinopathy with most patients progressing to Parkinson's disease (PD) or related conditions. Quantitative susceptibility mapping (QSM) in PD has identified pathological iron accumulation in the substantia nigra (SN) and variably also in basal ganglia and cortex. Analyzing whole-brain QSM across iRBD, PD, and healthy controls (HC) may help to ascertain the extent of neurodegeneration in prodromal synucleinopathy. 70 de novo PD patients, 70 iRBD patients, and 60 HCs underwent 3 T MRI. T1 and susceptibility-weighted images were acquired and processed to space standardized QSM. Voxel-based analyses of grey matter magnetic susceptibility differences comparing all groups were performed on the whole brain and upper brainstem levels with the statistical threshold set at family-wise error-corrected p-values <.05. Whole-brain analysis showed increased susceptibility in the bilateral fronto-parietal cortex of iRBD patients compared to both PD and HC. This was not associated with cortical thinning according to the cortical thickness analysis. Compared to iRBD, PD patients had increased susceptibility in the left amygdala and hippocampal region. Upper brainstem analysis revealed increased susceptibility within the bilateral SN for both PD and iRBD compared to HC; changes were located predominantly in nigrosome 1 in the former and nigrosome 2 in the latter group. In the iRBD group, abnormal dopamine transporter SPECT was associated with increased susceptibility in nigrosome 1. iRBD patients display greater fronto-parietal cortex involvement than incidental early-stage PD cohort indicating more widespread subclinical neuropathology. Dopaminergic degeneration in the substantia nigra is paralleled by susceptibility increase, mainly in nigrosome 1.
Collapse
Affiliation(s)
- Zsoka Varga
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of MedicineCharles University and General University Hospital in PragueCzech Republic
| | - Jiri Keller
- Radiodiagnostic DepartmentNa Homolce HospitalPragueCzech Republic
| | - Simon Daniel Robinson
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaAustria
| | - Tereza Serranova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of MedicineCharles University and General University Hospital in PragueCzech Republic
| | - Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of MedicineCharles University and General University Hospital in PragueCzech Republic
| | - David Zogala
- Department of Nuclear Medicine, First Faculty of MedicineCharles University and General University Hospital in PragueCzech Republic
| | - Jiri Trnka
- Department of Nuclear Medicine, First Faculty of MedicineCharles University and General University Hospital in PragueCzech Republic
| | - Evzen Ruzicka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of MedicineCharles University and General University Hospital in PragueCzech Republic
| | - Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of MedicineCharles University and General University Hospital in PragueCzech Republic
| | - Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of MedicineCharles University and General University Hospital in PragueCzech Republic
- Department of Radiology, First Faculty of MedicineCharles University and General University Hospital in PragueCzech Republic
| |
Collapse
|
3
|
Carlos AF, Josephs KA. The Role of Clinical Assessment in the Era of Biomarkers. Neurotherapeutics 2023; 20:1001-1018. [PMID: 37594658 PMCID: PMC10457273 DOI: 10.1007/s13311-023-01410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
Hippocratic Medicine revolved around the three main principles of patient, disease, and physician and promoted the systematic observation of patients, rational reasoning, and interpretation of collected information. Although these remain the cardinal features of clinical assessment today, Medicine has evolved from a more physician-centered to a more patient-centered approach. Clinical assessment allows physicians to encounter, observe, evaluate, and connect with patients. This establishes the patient-physician relationship and facilitates a better understanding of the patient-disease relationship, as the ultimate goal is to diagnose, prognosticate, and treat. Biomarkers are at the core of the more disease-centered approach that is currently revolutionizing Medicine as they provide insight into the underlying disease pathomechanisms and biological changes. Genetic, biochemical, radiographic, and clinical biomarkers are currently used. Here, we define a seven-level theoretical construct for the utility of biomarkers in neurodegenerative diseases. Level 1-3 biomarkers are considered supportive of clinical assessment, capable of detecting susceptibility or risk factors, non-specific neurodegeneration or dysfunction, and/or changes at the individual level which help increase clinical diagnostic accuracy and confidence. Level 4-7 biomarkers have the potential to surpass the utility of clinical assessment through detection of early disease stages and prediction of underlying pathology. In neurodegenerative diseases, biomarkers can potentiate, but cannot substitute, clinical assessment. In this current era, aside from adding to the discovery, evaluation/validation, and implementation of more biomarkers, clinical assessment remains crucial to maintaining the personal, humanistic, and sociocultural aspects of patient care. We would argue that clinical assessment is a custom that should never go obsolete.
Collapse
Affiliation(s)
- Arenn F Carlos
- Department of Neurology, Mayo Clinic, 200 1st St. S.W., Rochester, MN, 55905, USA.
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, 200 1st St. S.W., Rochester, MN, 55905, USA
| |
Collapse
|
4
|
Mao Z, Yu Y. Diagnostic Performance of Putaminal Hypointensity on Susceptibility MRI in Distinguishing Parkinson Disease from Progressive Supranuclear Palsy: A Meta-Analysis. Mov Disord Clin Pract 2022; 10:168-174. [PMID: 36825057 PMCID: PMC9941919 DOI: 10.1002/mdc3.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/21/2022] [Accepted: 08/31/2022] [Indexed: 11/11/2022] Open
Abstract
Background Idiopathic Parkinson's disease (IPD) and progressive supranuclear palsy (PSP) have similar clinical signs and symptoms, making accurate clinical diagnosis difficult. T2* gradient echo (T2* GRE), susceptibility-weighted imaging (SWI), and quantitative susceptibility mapping (QSM) are susceptibility MR imaging sequences that provide more information about brain iron levels than other conventional MR imaging. Objective This study aimed to evaluate the diagnostic power of putaminal hypointensity on T2* GRE, SWI, and QSM in distinguishing PSP from IPD. Methods Eligible studies were identified via systematic searches of PubMed and Clarivate Analytics® Web of Science® Core Collection. Studies that satisfied the inclusion and exclusion criteria were reviewed. A meta-analysis was conducted using the hierarchical summary receiver operating characteristic curve approach. Results Our literature search of the two databases yielded 562 primary articles, 10 of which were deemed relevant and only six were eligible for further analyses. We performed a meta-analysis of putaminal hypointensity measurements: 438 patients with IPD and 109 patients with PSP were enrolled in the quantitative synthesis. The meta-analysis of six studies with 547 patients revealed a sensitivity of 69% (95% confidence interval (CI): 33%-90%) and specificity of 91% (95% CI: 80%-96%) for putaminal hypointensity on T2* GRE, SWI, or QSM distinguishing PSP from IPD. Conclusions Putaminal hypointensity on T2* GRE, SWI, or QSM is able to distinguish patients with PSP from those with IPD with high specificity. Further multicenter prospective studies on patients are needed to verify our results.
Collapse
Affiliation(s)
- Zhijuan Mao
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Ying Yu
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| |
Collapse
|
7
|
Miyata M, Kakeda S, Yoneda T, Ide S, Okada K, Adachi H, Korogi Y. Signal intensity of cerebral gyri in corticobasal syndrome on phase difference enhanced magnetic resonance images: Comparison of progressive supranuclear palsy and Parkinson's disease. J Neurol Sci 2020; 419:117210. [PMID: 33130433 DOI: 10.1016/j.jns.2020.117210] [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: 05/16/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
We evaluated cerebral gyri (CG) on phase difference enhanced imaging (PADRE) of corticobasal syndrome (CBS), progressive supranuclear palsy (PSP), and Parkinson's disease (PD) patients to determine whether it is possible to discriminate among them on an individual basis. Two radiologists reviewed appearance of the normal CG and that of CBS patients on PADRE, and deviations from the appearance of the normal CG were recorded. Next, based on the CG abnormalities, two other reviewers reviewed PADRE images from 12 CBS, 14 PSP, and 30 PD patients. In healthy subjects on the PADRE images, the signal intensity (SI) of the gray matter (GM) was homogeneously, slightly hyperintense to the subcortical white matter (SCWM), and the SI of the SCWM was homogeneously hypointense. In CBS patients, hypointense layer in superficial GM and disappearance of hypointense in SCWM. The frequency of the abnormal findings on PADRE in the blinded manner by two readers was 100% (12/12), 3% (1/30), and 29% (4/14 in Reader 1) or 36% (5/14 in Reader 2) in CBS PD, and PSP patients, respectively. Laterality of the PADRE findings was showed in 12 (100%) CBS patients and 3 (21%) PSP, but not in any PD patients. The previously reported typical findings in CBS on conventional magnetic resonance image (MRIs) were observed in only 42% (5/12) of CBS patients. In conclusion, the abnormal findings in CG on PADRE appears more useful than conventional MRI findings for discriminating CBS from PD on an individual basis.
Collapse
Affiliation(s)
- Mari Miyata
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
| | - Shingo Kakeda
- Department of Radiology, Hirosaki University, Aomori, Japan
| | - Tetsuya Yoneda
- Department of Medical Physics in Advanced Biomedical Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoru Ide
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Kazumasa Okada
- Department of Neurology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Hiroaki Adachi
- Department of Neurology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| |
Collapse
|