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Lv Q, Wang X, Lin P, Wang X. Neuromelanin-sensitive magnetic resonance imaging in the study of mental disorder: A systematic review. Psychiatry Res Neuroimaging 2024; 339:111785. [PMID: 38325165 DOI: 10.1016/j.pscychresns.2024.111785] [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: 08/17/2023] [Revised: 11/26/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024]
Abstract
Dopamine and norepinephrine are implicated in the pathophysiology of mental disorders, but non-invasive study of their neuronal function remains challenging. Recent research suggests that neuromelanin-sensitive magnetic resonance imaging (NM-MRI) techniques may overcome this limitation by enabling the non-invasive imaging of the substantia nigra (SN)/ ventral tegmental area (VTA) dopaminergic and locus coeruleus (LC) noradrenergic systems. A review of 19 studies that met the criteria for NM-MRI application in mental disorders found that despite the use of heterogeneous sequence parameters and metrics, nearly all studies reported differences in contrast ratio (CNR) of LC or SN/VTA between patients with mental disorders and healthy controls. These findings suggest that NM-MRI is a valuable tool in psychiatry, but the differences in sequence parameters across studies hinder comparability, and a standardized analysis pipeline is needed to improve the reliability of results. Further research using standardized methods is needed to better understand the role of dopamine and norepinephrine in mental disorders.
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Affiliation(s)
- Qiuyu Lv
- Department of Psychology and Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, 410081, China; Institute of Interdisciplinary Studies, Hunan Normal University, Changsha, 410081, China
| | - Xuanyi Wang
- Department of Psychology and Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, 410081, China; Institute of Interdisciplinary Studies, Hunan Normal University, Changsha, 410081, China
| | - Pan Lin
- Department of Psychology and Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, 410081, China; Institute of Interdisciplinary Studies, Hunan Normal University, Changsha, 410081, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China.; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China..
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Hutchison RM, Fraser K, Yang M, Fox T, Hirschhorn E, Njingti E, Scott D, Bedell BJ, Kistner KM, Cedarbaum JM, Evans KC, Graham D, Martarello L, Mollenhauer B, Lang AE, Dam T, Beaver J. Cinpanemab in Early Parkinson Disease: Evaluation of Biomarker Results From the Phase 2 SPARK Clinical Trial. Neurology 2024; 102:e209137. [PMID: 38315945 DOI: 10.1212/wnl.0000000000209137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/29/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Sensitive, reliable, and scalable biomarkers are needed to accelerate the development of therapies for Parkinson disease (PD). In this study, we evaluate the biomarkers of early PD diagnosis, disease progression, and treatment effect collected in the SPARK. METHODS Cinpanemab is a human-derived monoclonal antibody binding preferentially to aggregated forms of extracellular α-synuclein. SPARK was a randomized, double-blind, placebo-controlled, phase 2 multicenter trial evaluating 3 cinpanemab doses administered intravenously every 4 weeks for 52 weeks with an active treatment dose-blind extension period for up to 112 weeks. SPARK enrolled 357 participants diagnosed with PD within 3 years, aged 40-80 years, ≤2.5 on the modified Hoehn and Yahr scale, and with evidence of striatal dopaminergic deficit. The primary outcome was change from baseline in the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale total score. Secondary and exploratory biomarker outcomes evaluated change from baseline at week 52 relative to placebo. Dopamine transporter SPECT and MRI were used to quantify changes in the nigrostriatal dopamine pathway and regional atrophy. CSF and plasma samples were used to assess change in total α-synuclein levels, α-synuclein seeding, and neurofilament light chain levels. SPARK was conducted from January 2018 to April 2021 and terminated due to lack of efficacy. RESULTS Approximately 3.8% (15/398) of SPECT-imaged participants did not have evidence of dopaminergic deficit and were screen-failed. Binary classification of α-synuclein seeding designated 93% (110/118) of the enrolled CSF subgroup as positive for α-synuclein seeds at baseline. Clinical disease progression was observed, with no statistically significant difference in cinpanemab groups compared with that in placebo. Ninety-nine percent of participants with positive α-synuclein seeding remained positive through week 52. No statistically significant changes from baseline were observed between treatment groups and placebo across biomarker measures. Broadly, there was minimal annual change with high interindividual variability across biomarkers-with striatal binding ratios of the ipsilateral putamen showing the greatest mean change/SD over time. DISCUSSION Biomarker results indicated enrollment of the intended population with early PD, but there was no significant correlation with disease progression or clear evidence of a cinpanemab treatment effect on biomarker measures. Suitable biomarkers for evaluating disease severity and progression in early PD trials are still needed. TRIAL REGISTRATION INFORMATION NCT03318523 (clinicaltrials.gov/ct2/show/NCT03318523); Submitted October 24, 2017; First patient enrolled January 2018.
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Affiliation(s)
- R Matthew Hutchison
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Kyle Fraser
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Minhua Yang
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Tara Fox
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Elizabeth Hirschhorn
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Edwin Njingti
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - David Scott
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Barry J Bedell
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Kristi M Kistner
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Jesse M Cedarbaum
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Karleyton C Evans
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Danielle Graham
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Laurent Martarello
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Brit Mollenhauer
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Anthony E Lang
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - Tien Dam
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
| | - John Beaver
- From Biogen Inc. (R.M.H., K.F., M.Y., E.H., K.C.E., D.G., L.M., J.B.), Cambridge, MA; Biogen Inc. (T.F.), Maidenhead, United Kingdom; Formerly Biogen Inc. at time of study (E.N., J.M.C., T.D.); Clario (D.S.), Princeton, NJ; Biospective Inc. (B.J.B.), Montreal, Quebec, Canada; Nucleus Global (K.M.K.), Atlanta, GA; Coeruleus Clinical Sciences LLC (J.M.C.), Woodbridge, CT; Department of Neurology (B.M.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, and Scientific Employee with an Honorary Contract at German Center for Neurodegenerative Diseases (DZNE), Germany; Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.); and Edmond J. Safra Program in Parkinson's Disease (A.E.L.), Toronto, Ontario, Canada
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Lin CP, Frigerio I, Bol JGJM, Bouwman MMA, Wesseling AJ, Dahl MJ, Rozemuller AJM, van der Werf YD, Pouwels PJW, van de Berg WDJ, Jonkman LE. Microstructural integrity of the locus coeruleus and its tracts reflect noradrenergic degeneration in Alzheimer's disease and Parkinson's disease. Transl Neurodegener 2024; 13:9. [PMID: 38336865 PMCID: PMC10854137 DOI: 10.1186/s40035-024-00400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Degeneration of the locus coeruleus (LC) noradrenergic system contributes to clinical symptoms in Alzheimer's disease (AD) and Parkinson's disease (PD). Diffusion magnetic resonance imaging (MRI) has the potential to evaluate the integrity of the LC noradrenergic system. The aim of the current study was to determine whether the diffusion MRI-measured integrity of the LC and its tracts are sensitive to noradrenergic degeneration in AD and PD. METHODS Post-mortem in situ T1-weighted and multi-shell diffusion MRI was performed for 9 AD, 14 PD, and 8 control brain donors. Fractional anisotropy (FA) and mean diffusivity were derived from the LC, and from tracts between the LC and the anterior cingulate cortex, the dorsolateral prefrontal cortex (DLPFC), the primary motor cortex (M1) or the hippocampus. Brain tissue sections of the LC and cortical regions were obtained and immunostained for dopamine-beta hydroxylase (DBH) to quantify noradrenergic cell density and fiber load. Group comparisons and correlations between outcome measures were performed using linear regression and partial correlations. RESULTS The AD and PD cases showed loss of LC noradrenergic cells and fibers. In the cortex, the AD cases showed increased DBH + immunoreactivity in the DLPFC compared to PD cases and controls, while PD cases showed reduced DBH + immunoreactivity in the M1 compared to controls. Higher FA within the LC was found for AD, which was correlated with loss of noradrenergic cells and fibers in the LC. Increased FA of the LC-DLPFC tract was correlated with LC noradrenergic fiber loss in the combined AD and control group, whereas the increased FA of the LC-M1 tract was correlated with LC noradrenergic neuronal loss in the combined PD and control group. The tract alterations were not correlated with cortical DBH + immunoreactivity. CONCLUSIONS In AD and PD, the diffusion MRI-detected alterations within the LC and its tracts to the DLPFC and the M1 were associated with local noradrenergic neuronal loss within the LC, rather than noradrenergic changes in the cortex.
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Affiliation(s)
- Chen-Pei Lin
- Amsterdam UMC, Department of Anatomy and Neurosciences, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Brain imaging, Amsterdam, The Netherlands.
| | - Irene Frigerio
- Amsterdam UMC, Department of Anatomy and Neurosciences, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, The Netherlands
| | - John G J M Bol
- Amsterdam UMC, Department of Anatomy and Neurosciences, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Maud M A Bouwman
- Amsterdam UMC, Department of Anatomy and Neurosciences, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, The Netherlands
| | - Alex J Wesseling
- Amsterdam UMC, Department of Anatomy and Neurosciences, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, The Netherlands
| | - Martin J Dahl
- Center for Lifespan Psychology, Max Planck Institute for Human Development, 14195, Berlin, Germany
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
| | - Annemieke J M Rozemuller
- Amsterdam UMC, Department of Pathology, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Ysbrand D van der Werf
- Amsterdam UMC, Department of Anatomy and Neurosciences, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity and Attention Program, Amsterdam, The Netherlands
| | - Petra J W Pouwels
- Amsterdam Neuroscience, Brain imaging, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Wilma D J van de Berg
- Amsterdam UMC, Department of Anatomy and Neurosciences, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Laura E Jonkman
- Amsterdam UMC, Department of Anatomy and Neurosciences, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain imaging, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
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Trujillo P, Aumann MA, Claassen DO. Neuromelanin-sensitive MRI as a promising biomarker of catecholamine function. Brain 2024; 147:337-351. [PMID: 37669320 PMCID: PMC10834262 DOI: 10.1093/brain/awad300] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/17/2023] [Accepted: 08/20/2023] [Indexed: 09/07/2023] Open
Abstract
Disruptions to dopamine and noradrenergic neurotransmission are noted in several neurodegenerative and psychiatric disorders. Neuromelanin-sensitive (NM)-MRI offers a non-invasive approach to visualize and quantify the structural and functional integrity of the substantia nigra and locus coeruleus. This method may aid in the diagnosis and quantification of longitudinal changes of disease and could provide a stratification tool for predicting treatment success of pharmacological interventions targeting the dopaminergic and noradrenergic systems. Given the growing clinical interest in NM-MRI, understanding the contrast mechanisms that generate this signal is crucial for appropriate interpretation of NM-MRI outcomes and for the continued development of quantitative MRI biomarkers that assess disease severity and progression. To date, most studies associate NM-MRI measurements to the content of the neuromelanin pigment and/or density of neuromelanin-containing neurons, while recent studies suggest that the main source of the NM-MRI contrast is not the presence of neuromelanin but the high-water content in the dopaminergic and noradrenergic neurons. In this review, we consider the biological and physical basis for the NM-MRI contrast and discuss a wide range of interpretations of NM-MRI. We describe different acquisition and image processing approaches and discuss how these methods could be improved and standardized to facilitate large-scale multisite studies and translation into clinical use. We review the potential clinical applications in neurological and psychiatric disorders and the promise of NM-MRI as a biomarker of disease, and finally, we discuss the current limitations of NM-MRI that need to be addressed before this technique can be utilized as a biomarker and translated into clinical practice and offer suggestions for future research.
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Affiliation(s)
- Paula Trujillo
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Megan A Aumann
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
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Shaff N, Erhardt E, Nitschke S, Julio K, Wertz C, Vakhtin A, Caprihan A, Suarez‐Cedeno G, Deligtisch A, Richardson SP, Mayer AR, Ryman SG. Comparison of automated and manual quantification methods for neuromelanin-sensitive MRI in Parkinson's disease. Hum Brain Mapp 2024; 45:e26544. [PMID: 38041476 PMCID: PMC10789205 DOI: 10.1002/hbm.26544] [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: 06/30/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023] Open
Abstract
Neuromelanin-sensitive magnetic resonance imaging quantitative analysis methods have provided promising biomarkers that can noninvasively quantify degeneration of the substantia nigra in patients with Parkinson's disease. However, there is a need to systematically evaluate the performance of manual and automated quantification approaches. We evaluate whether spatial, signal-intensity, or subject specific abnormality measures using either atlas based or manually traced identification of the substantia nigra better differentiate patients with Parkinson's disease from healthy controls using logistic regression models and receiver operating characteristics. Inference was performed using bootstrap analyses to calculate 95% confidence interval bounds. Pairwise comparisons were performed by generating 10,000 permutations, refitting the models, and calculating a paired difference between metrics. Thirty-one patients with Parkinson's disease and 22 healthy controls were included in the analyses. Signal intensity measures significantly outperformed spatial and subject specific abnormality measures, with the top performers exhibiting excellent ability to differentiate patients with Parkinson's disease and healthy controls (balanced accuracy = 0.89; area under the curve = 0.81; sensitivity =0.86; and specificity = 0.83). Atlas identified substantia nigra metrics performed significantly better than manual tracing metrics. These results provide clear support for the use of automated signal intensity metrics and additional recommendations. Future work is necessary to evaluate whether the same metrics can best differentiate atypical parkinsonism, perform similarly in de novo and mid-stage cohorts, and serve as longitudinal monitoring biomarkers.
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Affiliation(s)
| | - Erik Erhardt
- Department of Mathematics and StatisticsUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | | | - Kayla Julio
- The Mind Research NetworkAlbuquerqueNew MexicoUSA
| | | | | | | | - Gerson Suarez‐Cedeno
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of NeurologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Amanda Deligtisch
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of NeurologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Sarah Pirio Richardson
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of NeurologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
- New Mexico VA Health Care SystemAlbuquerqueNew MexicoUSA
| | | | - Sephira G. Ryman
- The Mind Research NetworkAlbuquerqueNew MexicoUSA
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of NeurologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
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6
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Pagliaccio D, Wengler K, Durham K, Fontaine M, Rueppel M, Becker H, Bilek E, Pieper S, Risdon C, Horga G, Fitzgerald KD, Marsh R. Probing midbrain dopamine function in pediatric obsessive-compulsive disorder via neuromelanin-sensitive magnetic resonance imaging. Mol Psychiatry 2023; 28:3075-3082. [PMID: 37198261 PMCID: PMC10189717 DOI: 10.1038/s41380-023-02105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
Obsessive-compulsive disorder (OCD) is an impairing psychiatric condition, which often onsets in childhood. Growing research highlights dopaminergic alterations in adult OCD, yet pediatric studies are limited by methodological constraints. This is the first study to utilize neuromelanin-sensitive MRI as a proxy for dopaminergic function among children with OCD. N = 135 youth (6-14-year-olds) completed high-resolution neuromelanin-sensitive MRI across two sites; n = 64 had an OCD diagnosis. N = 47 children with OCD completed a second scan after cognitive-behavioral therapy. Voxel-wise analyses identified that neuromelanin-MRI signal was higher among children with OCD compared to those without (483 voxels, permutation-corrected p = 0.018). Effects were significant within both the substania nigra pars compacta (p = 0.004, Cohen's d = 0.51) and ventral tegmental area (p = 0.006, d = 0.50). Follow-up analyses indicated that more severe lifetime symptoms (t = -2.72, p = 0.009) and longer illness duration (t = -2.22, p = 0.03) related to lower neuromelanin-MRI signal. Despite significant symptom reduction with therapy (p < 0.001, d = 1.44), neither baseline nor change in neuromelanin-MRI signal associated with symptom improvement. Current results provide the first demonstration of the utility of neuromelanin-MRI in pediatric psychiatry, specifically highlighting in vivo evidence for midbrain dopamine alterations in treatment-seeking youth with OCD. Neuromelanin-MRI likely indexes accumulating alterations over time, herein, implicating dopamine hyperactivity in OCD. Given evidence of increased neuromelanin signal in pediatric OCD but negative association with symptom severity, additional work is needed to parse potential longitudinal or compensatory mechanisms. Future studies should explore the utility of neuromelanin-MRI biomarkers to identify early risk prior to onset, parse OCD subtypes or symptom heterogeneity, and explore prediction of pharmacotherapy response.
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Affiliation(s)
- David Pagliaccio
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
- New York State Psychiatric Institute, New York, NY, USA.
| | - Kenneth Wengler
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Katherine Durham
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Martine Fontaine
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Meryl Rueppel
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Hannah Becker
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Emily Bilek
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Pieper
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Caroline Risdon
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Guillermo Horga
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Rachel Marsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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7
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Seong M, Park S, Sung YH, Kim EY. Diagnostic performance of a high-spatial-resolution voxelwise analysis of neuromelanin-sensitive imaging in early-stage idiopathic Parkinson's disease. BMC Med Imaging 2023; 23:64. [PMID: 37202720 DOI: 10.1186/s12880-023-01018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Quantitative assessments of neuromelanin (NM) of the substantia nigra pars compacta (SNpc) in neuromelanin-sensitive MRI (NM-MRI) to determine its abnormality have been conducted by measuring either the volume or contrast ratio (CR) of the SNpc. A recent study determined the regions in the SNpc that are significantly different between early-stage idiopathic Parkinson's disease (IPD) patients and healthy controls (HCs) using a high spatial-resolution NM-MRI template, which enables a template-based voxelwise analysis to overcome the susceptibility of CR measurement to inter-rater discrepancy. We aimed to assess the diagnostic performance, which has not been reported, of the CRs between early-stage IPD patients and HCs using a NM-MRI template. METHODS We retrospectively enrolled early-stage IPD patients (n = 50) and HCs (n = 50) who underwent 0.8-mm isovoxel NM-MRI and dopamine-transporter PET as the standard of reference. A template-based voxelwise analysis revealed two regions in nigrosomes 1 and 2 (N1 and N2, respectively), with significant differences in each substantia nigra (SNpc) between IPD and HCs. The mean CR values of N1, N2, volume-weighted mean of N1 and N2 (N1 + N2), and whole SNpc on each side were compared between IPD and HC using the independent t-test or the Mann-Whitney U test. The diagnostic performance was compared in each region using receiver operating characteristic curves. RESULTS The mean CR values in the right N1 (0.149459 vs. 0.194505), left N1 (0.133328 vs. 0.169160), right N2 (0.230245 vs. 0.278181), left N2 (0.235784 vs. 0.314169), right N1 + N2 (0.155322 vs. 0.278143), left N1 + N2 (0.140991 vs. 0.276755), right whole SNpc (0.131397 vs. 0.141422), and left whole SNpc (0.127099 vs. 0.137873) significantly differed between IPD patients and HCs (all p < 0.001). The areas under the curve of the left N1 + N2, right N1 + N2, left N1, right N1, left N2, right N2, left whole SNpc, and right whole SNpc were 0.994 (sensitivity, 98.0%; specificity, 94.0%), 0.985, 0.804, 0.802, 0.777, 0.766, 0.632, and 0.606, respectively. CONCLUSION Our NM-MRI template-based CR measurements revealed significant differences between early-stage IPD patients and HCs. The CR values of the left N1 + N2 demonstrated the highest diagnostic performance.
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Affiliation(s)
- Minjung Seong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | | | - Young Hee Sung
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eung Yeop Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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8
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Park S, Sung YH, Kim WR, Noh Y, Kim EY. Correlation Between Neuromelanin-Sensitive MRI and 18F-FP-CIT PET in Early-Stage Parkinson's Disease: Utility of a Voxel-Wise Analysis by Using High-Spatial-Resolution MRI. J Clin Neurol 2023; 19:156-164. [PMID: 36854333 PMCID: PMC9982185 DOI: 10.3988/jcn.2022.0147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND AND PURPOSE The correlation between dopamine transporter (DAT) imaging and neuromelanin-sensitive magnetic resonance imaging (NM-MRI) in early-stage Parkinson's disease (PD) has not yet been established. This study aimed to determine the correlation between NM-MRI and DAT positron-emission tomography (PET) in patients with early-stage PD. METHODS Fifty drug-naïve patients with early-stage PD who underwent both 0.8-mm isovoxel NM-MRI and DAT PET were enrolled retrospectively. Using four regions of interest (nigrosome 1 and nigrosome 2 [N1 and N2] regions) from a previous study, the contrast ratios (CRs) of 12 regions were measured: N1, N2, flipped N1, flipped N2, combined N1 and N2, and whole substantia nigra pars compacta [SNpc] (all on both sides). The clinically more affected side was separately assessed. The standardized uptake value ratios (SUVRs) were measured in the striatum using DAT PET. A partial correlation analysis was performed between the SUVR and CR measurements. RESULTS CR of the flipped left N1 region was significantly correlated with SUVR of the right posterior putamen (p=0.047), and CR values of the left N1 region, left N2 region, flipped right N1 region, and combined left N1 and N2 regions were significantly correlated with SUVR of the left posterior putamen (p=0.011, 0.038, 0.020, and 0.010, respectively). SUVR of the left anterior putamen was significantly correlated with CR of the left N2 region (p=0.027). On the clinically more affected side, the CR values of the N1 region, combined N1 and N2 regions, and the whole SNpc were significantly correlated with SUVR of the posterior putamen (p=0.001, 0.024, and 0.021, respectively). There were significant correlations between the SUVR of the anterior putamen and the CR values of the N1 region, combined N1 and N2 regions, and whole SNpc (p=0.027, 0.001, and 0.036, respectively). CONCLUSIONS This study found that there were significant correlations between CR values in the SNpc on NM-MRI and striatal SUVR values on DAT PET on both sides in early-stage PD.
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Affiliation(s)
| | - Young Hee Sung
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woo Ram Kim
- Neuroscience Research Institute, Gachon University, Incheon, Korea
| | - Young Noh
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Eung Yeop Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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9
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He N, Chen Y, LeWitt PA, Yan F, Haacke EM. Application of Neuromelanin MR Imaging in Parkinson Disease. J Magn Reson Imaging 2023; 57:337-352. [PMID: 36017746 PMCID: PMC10086789 DOI: 10.1002/jmri.28414] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 01/20/2023] Open
Abstract
MRI has been used to develop biomarkers for movement disorders such as Parkinson disease (PD) and other neurodegenerative disorders with parkinsonism such as progressive supranuclear palsy and multiple system atrophy. One of these imaging biomarkers is neuromelanin (NM), whose integrity can be assessed from its contrast and volume. NM is found mainly in certain brain stem structures, namely, the substantia nigra pars compacta (SNpc), the ventral tegmental area, and the locus coeruleus. Another major biomarker is brain iron, which often increases in concert with NM degeneration. These biomarkers have the potential to improve diagnostic certainty in differentiating between PD and other neurodegenerative disorders similar to PD, as well as provide a better understanding of pathophysiology. Mapping NM in vivo has clinical importance for gauging the premotor phase of PD when there is a greater than 50% loss of dopaminergic SNpc melanized neurons. As a metal ion chelator, NM can absorb iron. When NM is released from neurons, it deposits iron into the intracellular tissues of the SNpc; the result is iron that can be imaged and measured using quantitative susceptibility mapping. An increase of iron also leads to the disappearance of the nigrosome-1 sign, another neuroimage biomarker for PD. Therefore, mapping NM and iron changes in the SNpc are a practical means for improving early diagnosis of PD and in monitoring disease progression. In this review, we discuss the functions and location of NM, how NM-MRI is performed, the automatic mapping of NM and iron content, how NM-related imaging biomarkers can be used to enhance PD diagnosis and differentiate it from other neurodegenerative disorders, and potential advances in NM imaging methods. With major advances currently evolving for rapid imaging and artificial intelligence, NM-related biomarkers are likely to have increasingly important roles for enhancing diagnostic capabilities in PD. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Yongsheng Chen
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Peter A LeWitt
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Neurology, Henry Ford Hospital, Parkinson's Disease and Movement Disorders Program, Detroit, Michigan, USA
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - E Mark Haacke
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China.,Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Radiology, Wayne State University School of Medicine, Detroit, Michigan, USA.,SpinTech, Inc, Bingham Farms, Michigan, USA
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10
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Acceleration of neuromelanin-sensitive MRI sequences in the substantia nigra using standard MRI options. Neuroradiology 2023; 65:307-312. [PMID: 36169662 PMCID: PMC9859863 DOI: 10.1007/s00234-022-03058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Neuromelanin MRI (NM-MRI) is applied as a proxy measurement of dopaminergic functioning of the substantia nigra pars compacta (SN). To increase its clinical applicability, a fast and easily applicable NM-MRI sequence is needed. This study therefore compared accelerated NM-MRI sequences using standard available MRI options with a validated 2D gradient recalled echo NM-MRI sequence with off-resonance magnetization transfer (MT) pulse (2D-MToffRes). METHODS We used different combinations of compressed sense (CS) acceleration, repetition times (TR), and MT pulse to accelerate the validated 2D-MToffRes. In addition, we compared a recently introduced 3D sequence with the 2D-MToffRes. RESULTS Our results show that the 2D sequences perform best with good to excellent reliability. Only excellent intraclass correlation coefficients were found for the CS factor 2 sequences. CONCLUSION We conclude that there are several reliable approaches to accelerate NM-MRI, in particular by using CS.
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11
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Pizarro-Galleguillos BM, Kunert L, Brüggemann N, Prasuhn J. Iron- and Neuromelanin-Weighted Neuroimaging to Study Mitochondrial Dysfunction in Patients with Parkinson's Disease. Int J Mol Sci 2022; 23:ijms232213678. [PMID: 36430157 PMCID: PMC9696602 DOI: 10.3390/ijms232213678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
The underlying causes of Parkinson's disease are complex, and besides recent advances in elucidating relevant disease mechanisms, no disease-modifying treatments are currently available. One proposed pathophysiological hallmark is mitochondrial dysfunction, and a plethora of evidence points toward the interconnected nature of mitochondria in neuronal homeostasis. This also extends to iron and neuromelanin metabolism, two biochemical processes highly relevant to individual disease manifestation and progression. Modern neuroimaging methods help to gain in vivo insights into these intertwined pathways and may pave the road to individualized medicine in this debilitating disorder. In this narrative review, we will highlight the biological rationale for studying these pathways, how distinct neuroimaging methods can be applied in patients, their respective limitations, and which challenges need to be overcome for successful implementation in clinical studies.
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Affiliation(s)
- Benjamin Matis Pizarro-Galleguillos
- Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
- Institute of Neurogenetics, University of Lübeck, 23588 Lübeck, Germany
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Center for Brain, Behavior, and Metabolism, University of Lübeck, 23562 Lübeck, Germany
| | - Liesa Kunert
- Institute of Neurogenetics, University of Lübeck, 23588 Lübeck, Germany
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Center for Brain, Behavior, and Metabolism, University of Lübeck, 23562 Lübeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, 23588 Lübeck, Germany
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Center for Brain, Behavior, and Metabolism, University of Lübeck, 23562 Lübeck, Germany
- Correspondence: ; Tel.: +49-451-500-43420; Fax: +49-451-500-43424
| | - Jannik Prasuhn
- Institute of Neurogenetics, University of Lübeck, 23588 Lübeck, Germany
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Center for Brain, Behavior, and Metabolism, University of Lübeck, 23562 Lübeck, Germany
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12
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Wallert ED, van de Giessen E, Knol RJJ, Beudel M, de Bie RMA, Booij J. Imaging Dopaminergic Neurotransmission in Neurodegenerative Disorders. J Nucl Med 2022; 63:27S-32S. [PMID: 35649651 PMCID: PMC9165729 DOI: 10.2967/jnumed.121.263197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/25/2022] [Indexed: 12/14/2022] Open
Abstract
Imaging of dopaminergic transmission in neurodegenerative disorders such as Parkinson disease (PD) or dementia with Lewy bodies plays a major role in clinical practice and in clinical research. We here review the role of imaging of the nigrostriatal pathway, as well as of striatal receptors and dopamine release, in common neurodegenerative disorders in clinical practice and research. Imaging of the nigrostriatal pathway has a high diagnostic accuracy to detect nigrostriatal degeneration in disorders characterized by nigrostriatal degeneration, such as PD and dementia with Lewy bodies, and disorders of more clinical importance, namely in patients with clinically uncertain parkinsonism. Imaging of striatal dopamine D2/3 receptors is not recommended for the differential diagnosis of parkinsonian disorders in clinical practice anymore. Regarding research, recently the European Medicines Agency has qualified dopamine transporter imaging as an enrichment biomarker for clinical trials in early PD, which underlines the high diagnostic accuracy of this imaging tool and will be implemented in future trials. Also, imaging of the presynaptic dopaminergic system plays a major role in, for example, examining the extent of nigrostriatal degeneration in preclinical and premotor phases of neurodegenerative disorders and to examine subtypes of PD. Also, imaging of postsynaptic dopamine D2/3 receptors plays a role in studying, for example, the neuronal substrate of impulse control disorders in PD, as well as in measuring endogenous dopamine release to examine, for example, motor complications in the treatment of PD. Finally, novel MRI sequences as neuromelanin-sensitive MRI are promising new tools to study nigrostriatal degeneration in vivo.
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Affiliation(s)
- Elon D Wallert
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Remco J J Knol
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands; and
| | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;
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13
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Chougar L, Arsovic E, Gaurav R, Biondetti E, Faucher A, Valabrègue R, Pyatigorskaya N, Dupont G, Lejeune FX, Cormier F, Corvol JC, Vidailhet M, Degos B, Grabli D, Lehéricy S. Regional Selectivity of Neuromelanin Changes in the Substantia Nigra in Atypical Parkinsonism. Mov Disord 2022; 37:1245-1255. [PMID: 35347754 DOI: 10.1002/mds.28988] [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: 11/01/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Neurodegeneration in the substantia nigra pars compacta (SNc) in parkinsonian syndromes may affect the nigral territories differently. OBJECTIVE The objective of this study was to investigate the regional selectivity of neurodegenerative changes in the SNc in patients with Parkinson's disease (PD) and atypical parkinsonism using neuromelanin-sensitive magnetic resonance imaging (MRI). METHODS A total of 22 healthy controls (HC), 38 patients with PD, 22 patients with progressive supranuclear palsy (PSP), 20 patients with multiple system atrophy (MSA, 13 with the parkinsonian variant, 7 with the cerebellar variant), 7 patients with dementia with Lewy body (DLB), and 4 patients with corticobasal syndrome were analyzed. volume and signal-to-noise ratio (SNR) values of the SNc were derived from neuromelanin-sensitive MRI in the whole SNc. Analysis of signal changes was performed in the sensorimotor, associative, and limbic territories of the SNc. RESULTS SNc volume and corrected volume were significantly reduced in PD, PSP, and MSA versus HC. Patients with PSP had lower volume, corrected volume, SNR, and contrast-to-noise ratio than HC and patients with PD and MSA. Patients with PSP had greater SNR reduction in the associative region than HC and patients with PD and MSA. Patients with PD had reduced SNR in the sensorimotor territory, unlike patients with PSP. Patients with MSA did not differ from patients with PD. CONCLUSIONS This study provides the first MRI comparison of the topography of neuromelanin changes in parkinsonism. The spatial pattern of changes differed between PSP and synucleinopathies. These nigral topographical differences are consistent with the topography of the extranigral involvement in parkinsonian syndromes. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lydia Chougar
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Department of Neuroradiology, F-75013, Paris, France, Paris, France.,ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France
| | - Emina Arsovic
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France.,Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Department of Neuroradiology, F-75013, Paris, France, Paris, France
| | - Rahul Gaurav
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France.,Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France
| | - Emma Biondetti
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France.,Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France
| | - Alice Faucher
- Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France.,Service de Neurologie, Hôpital Avicenne, Hôpitaux Universitaires de Paris Seine-Saint-Denis, APHP, Bobigny, France
| | - Romain Valabrègue
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France
| | - Nadya Pyatigorskaya
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France.,Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Department of Neuroradiology, F-75013, Paris, France, Paris, France
| | - Gwendoline Dupont
- Centre hospitalier universitaire François Mitterrand, Département de Neurologie, Université de Bourgogne, Dijon, France
| | - François-Xavier Lejeune
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France.,ICM, Data and Analysis Core, Paris, France
| | - Florence Cormier
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France.,Clinique des mouvements anormaux, Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France.,ICM, Centre d'Investigation Clinique Neurosciences, Paris, France
| | - Marie Vidailhet
- ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France.,Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France.,Clinique des mouvements anormaux, Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Bertrand Degos
- Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France.,Service de Neurologie, Hôpital Avicenne, Hôpitaux Universitaires de Paris Seine-Saint-Denis, APHP, Bobigny, France
| | - David Grabli
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France.,Clinique des mouvements anormaux, Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Stéphane Lehéricy
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France.,Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Department of Neuroradiology, F-75013, Paris, France, Paris, France
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14
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Schulz J, Zimmermann J, Sorg C, Menegaux A, Brandl F. Magnetic resonance imaging of the dopamine system in schizophrenia - A scoping review. Front Psychiatry 2022; 13:925476. [PMID: 36203848 PMCID: PMC9530597 DOI: 10.3389/fpsyt.2022.925476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
For decades, aberrant dopamine transmission has been proposed to play a central role in schizophrenia pathophysiology. These theories are supported by human in vivo molecular imaging studies of dopamine transmission, particularly positron emission tomography. However, there are several downsides to such approaches, for example limited spatial resolution or restriction of the measurement to synaptic processes of dopaminergic neurons. To overcome these limitations and to measure complementary aspects of dopamine transmission, magnetic resonance imaging (MRI)-based approaches investigating the macrostructure, metabolism, and connectivity of dopaminergic nuclei, i.e., substantia nigra pars compacta and ventral tegmental area, can be employed. In this scoping review, we focus on four dopamine MRI methods that have been employed in patients with schizophrenia so far: neuromelanin MRI, which is thought to measure long-term dopamine function in dopaminergic nuclei; morphometric MRI, which is assumed to measure the volume of dopaminergic nuclei; diffusion MRI, which is assumed to measure fiber-based structural connectivity of dopaminergic nuclei; and resting-state blood-oxygenation-level-dependent functional MRI, which is thought to measure functional connectivity of dopaminergic nuclei based on correlated blood oxygenation fluctuations. For each method, we describe the underlying signal, outcome measures, and downsides. We present the current state of research in schizophrenia and compare it to other disorders with either similar (psychotic) symptoms, i.e., bipolar disorder and major depressive disorder, or dopaminergic abnormalities, i.e., substance use disorder and Parkinson's disease. Finally, we discuss overarching issues and outline future research questions.
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Affiliation(s)
- Julia Schulz
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Juliana Zimmermann
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Sorg
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Aurore Menegaux
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felix Brandl
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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15
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Bae YJ, Kim JM, Choi BS, Song YS, Nam Y, Cho SJ, Kim JH, Kim SE. MRI Findings in Parkinson’s Disease: Radiologic Assessment of Nigrostriatal Degeneration. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:508-526. [PMID: 36238511 PMCID: PMC9514534 DOI: 10.3348/jksr.2022.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/15/2022]
Abstract
파킨슨병은 중뇌 흑질에 위치한 도파민성 신경세포의 퇴행성 소실로 인해 발생하는 이상운동질환이다. 최근 다양한 자기공명영상기법의 발전으로 파킨슨병에서 일어나는 병리생태학적인 변화를 반영하는 여러 영상 소견들이 보고되었다. 여러 연구에서 이러한 영상 소견들은 파킨슨병의 진단 및 비정형 파킨슨증과의 감별 등에 유의미한 도움을 줄 수 있는 것이 밝혀졌다. 본 종설에서는, 파킨슨병에서 일어나는 흑질선조체 변성의 병태생리를 나타낼 수 있는 나이그로좀 영상 및 뉴로멜라닌 영상 등을 포함한 자기공명영상기법들과 각 영상에서 나타나는 소견에 대하여 자세히 다루었다.
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Affiliation(s)
- Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoonho Nam
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Korea
| | - Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Eun Kim
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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16
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Wieland L, Schlagenhauf F. Editorial for "Cross-Scanner Harmonization of Neuromelanin-Sensitive MRI for Multisite Studies". J Magn Reson Imaging 2021; 55:1584-1585. [PMID: 34536047 DOI: 10.1002/jmri.27924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Lara Wieland
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
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17
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Wieland L, Fromm S, Hetzer S, Schlagenhauf F, Kaminski J. Neuromelanin-Sensitive Magnetic Resonance Imaging in Schizophrenia: A Meta-Analysis of Case-Control Studies. Front Psychiatry 2021; 12:770282. [PMID: 34777070 PMCID: PMC8581671 DOI: 10.3389/fpsyt.2021.770282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Psychiatry is in urgent need of reliable biomarkers. Novel neuromelanin-sensitive magnetic resonance imaging (NM-MRI) sequences provide a time-efficient and non-invasive way to investigate the human brain in-vivo. This gives insight into the metabolites of dopaminergic signaling and may provide further evidence for potential dopaminergic alterations in patients with schizophrenia (SCZ). The present systematic review provides a meta-analysis of case-control studies using neuromelanin-sensitive sequences in SCZ vs. healthy controls (HC). Methods: According to predefined search terms and inclusion criteria studies were extracted on PubMed. Meta-analyses with a fixed and random-effects model with inverse variance method, DerSimonian-Laird estimator for τ2, and Cohen's d were calculated. Bias was assessed using funnel plots. The primary study outcome was contrast-to-noise ratio (CNR) in the substantia nigra compared between HC and SCZ. Results: The total sample of k = 6 studies included n = 183 cases and n = 162 controls. Across all studies we found a significant elevation of CNR in the substantia nigra (d = 0.42 [0.187; 0.655], z = 3.521, p < 0.001) in cases compared to controls. We found no significant difference in the control region of locus coeruleus (d = -0.07 [-0.446; 0.302], z = -0.192, p = 0.847), with CNR for the latter only reported in k = 3 studies. Conclusion: CNR in the substantia nigra were significantly elevated in cases compared to controls. Our results support neuromelanin as a candidate biomarker for dopaminergic dysfunction in schizophrenia. Further studies need to assess this candidate marker in large, longitudinal cohorts and address potential effects of disease state, medication and correlations with symptoms.
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Affiliation(s)
- Lara Wieland
- Department of Psychiatry and Psychotherapy Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, Berlin, Germany
| | - Sophie Fromm
- Department of Psychiatry and Psychotherapy Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, Berlin, Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jakob Kaminski
- Department of Psychiatry and Psychotherapy Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
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