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Angelini L, Paparella G, Bologna M. Distinguishing essential tremor from Parkinson's disease: clinical and experimental tools. Expert Rev Neurother 2024:1-16. [PMID: 39016323 DOI: 10.1080/14737175.2024.2372339] [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: 04/25/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Essential tremor (ET) and Parkinson's disease (PD) are the most common causes of tremor and the most prevalent movement disorders, with overlapping clinical features that can lead to diagnostic challenges, especially in the early stages. AREAS COVERED In the present paper, the authors review the clinical and experimental studies and emphasized the major aspects to differentiate between ET and PD, with particular attention to cardinal phenomenological features of these two conditions. Ancillary and experimental techniques, including neurophysiology, neuroimaging, fluid biomarker evaluation, and innovative methods, are also discussed for their role in differential diagnosis between ET and PD. Special attention is given to investigations and tools applicable in the early stages of the diseases, when the differential diagnosis between the two conditions is more challenging. Furthermore, the authors discuss knowledge gaps and unsolved issues in the field. EXPERT OPINION Distinguishing ET and PD is crucial for prognostic purposes and appropriate treatment. Additionally, accurate diagnosis is critical for optimizing clinical and experimental research on pathophysiology and innovative therapies. In a few years, integrated technologies could enable accurate, reliable diagnosis from early disease stages or prodromal stages in at-risk populations, but further research combining different techniques is needed.
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Affiliation(s)
| | - Giulia Paparella
- IRCCS Neuromed, Pozzilli, (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Alushaj E, Handfield-Jones N, Kuurstra A, Morava A, Menon RS, Owen AM, Sharma M, Khan AR, MacDonald PA. Increased iron in the substantia nigra pars compacta identifies patients with early Parkinson'sdisease: A 3T and 7T MRI study. Neuroimage Clin 2024; 41:103577. [PMID: 38377722 PMCID: PMC10944193 DOI: 10.1016/j.nicl.2024.103577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
Degeneration in the substantia nigra (SN) pars compacta (SNc) underlies motor symptoms in Parkinson's disease (PD). Currently, there are no neuroimaging biomarkers that are sufficiently sensitive, specific, reproducible, and accessible for routine diagnosis or staging of PD. Although iron is essential for cellular processes, it also mediates neurodegeneration. MRI can localize and quantify brain iron using magnetic susceptibility, which could potentially provide biomarkers of PD. We measured iron in the SNc, SN pars reticulata (SNr), total SN, and ventral tegmental area (VTA), using quantitative susceptibility mapping (QSM) and R2* relaxometry, in PD patients and age-matched healthy controls (HCs). PD patients, diagnosed within five years of participation and HCs were scanned at 3T (22 PD and 23 HCs) and 7T (17 PD and 21 HCs) MRI. Midbrain nuclei were segmented using a probabilistic subcortical atlas. QSM and R2* values were measured in midbrain subregions. For each measure, groups were contrasted, with Age and Sex as covariates, and receiver operating characteristic (ROC) curve analyses were performed with repeated k-fold cross-validation to test the potential of our measures to classify PD patients and HCs. Statistical differences of area under the curves (AUCs) were compared using the Hanley-MacNeil method (QSM versus R2*; 3T versus 7T MRI). PD patients had higher QSM values in the SNc at both 3T (padj = 0.001) and 7T (padj = 0.01), but not in SNr, total SN, or VTA, at either field strength. No significant group differences were revealed using R2* in any midbrain region at 3T, though increased R2* values in SNc at 7T MRI were marginally significant in PDs compared to HCs (padj = 0.052). ROC curve analyses showed that SNc iron measured with QSM, distinguished early PD patients from HCs at the single-subject level with good diagnostic accuracy, using 3T (mean AUC = 0.83, 95 % CI = 0.82-0.84) and 7T (mean AUC = 0.80, 95 % CI = 0.79-0.81) MRI. Mean AUCs reported here are from averages of tests in the hold-out fold of cross-validated samples. The Hanley-MacNeil method demonstrated that QSM outperforms R2* in discriminating PD patients from HCs at 3T, but not 7T. There were no significant differences between 3T and 7T in diagnostic accuracy of QSM values in SNc. This study highlights the importance of segmenting midbrain subregions, performed here using a standardized atlas, and demonstrates high accuracy of SNc iron measured with QSM at 3T MRI in identifying early PD patients. QSM measures of SNc show potential for inclusion in neuroimaging diagnostic biomarkers of early PD. An MRI diagnostic biomarker of PD would represent a significant clinical advance.
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Affiliation(s)
- Erind Alushaj
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada; Western Institute for Neuroscience, Western University, London, Ontario N6A 3K7, Canada
| | - Nicholas Handfield-Jones
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada; Western Institute for Neuroscience, Western University, London, Ontario N6A 3K7, Canada
| | - Alan Kuurstra
- Robarts Research Institute, Western University, London, Ontario N6A 3K7, Canada; Department of Medical Biophysics, Western University, London, Ontario N6A 3K7, Canada
| | - Anisa Morava
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario N6A 3K7, Canada
| | - Ravi S Menon
- Robarts Research Institute, Western University, London, Ontario N6A 3K7, Canada; Department of Medical Biophysics, Western University, London, Ontario N6A 3K7, Canada
| | - Adrian M Owen
- Western Institute for Neuroscience, Western University, London, Ontario N6A 3K7, Canada; Department of Physiology and Pharmacology, Western University, London, Ontario N6A 3K7, Canada
| | - Manas Sharma
- Department of Radiology, Western University, London, Ontario N6A 3K7, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario N6A 3K7, Canada
| | - Ali R Khan
- Robarts Research Institute, Western University, London, Ontario N6A 3K7, Canada; Department of Medical Biophysics, Western University, London, Ontario N6A 3K7, Canada
| | - Penny A MacDonald
- Western Institute for Neuroscience, Western University, London, Ontario N6A 3K7, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario N6A 3K7, Canada.
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Chau MT, Agzarian M, Wilcox RA, Dwyer A, Bezak E, Todd G. Simple quantitative planimetric measurement of nigrosome-1 for clinical settings. J Neurol Sci 2023; 454:120857. [PMID: 37939625 DOI: 10.1016/j.jns.2023.120857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Loss of MRI hyperintense signal in nigrosome-1 (assessed with susceptibility-weighted imaging) is a biomarker for Parkinson's disease (PD). Current clinical practice involves subjectively rating the appearance of nigrosome-1 which is challenging. The study aimed to test and compare a simple method for quantifying nigrosome-1 with the current subjective rating method. METHODS Two experienced neuroradiologists measured area of hyperintense signal in nigrosome-1 (quantitative method) and rated nigrosome-1 appearance (as normal, attenuated, or absent; subjective method) in 42 patients encompassing the full spectrum of nigrosome-1 integrity (21 patients aged 55.5 ± 20.9 years with Essential tremor (ET) and a subset of 21 patients aged 69.6 ± 8.6 years with PD). Neuroradiologists were blinded to each other's measurements, clinical notes, and patient group. RESULTS Both methods yielded a significant difference between the groups (PD vs ET; p < 0.001). Pooled (across sides) area of nigrosome-1 hyperintense signal was significantly smaller in the PD group (median = 2.1 mm2, range = 0-15.8 mm2) than ET group (median = 8.3 mm2, range = 0-15.7 mm2; p < 0.001). Inter-rater reliability was high to very high for both methods (subjective: weighted kappa = 0.640, p < 0.001; quantitative: W = 0.733, p = 0.004). Our primary hypothesis that area of nigrosome-1 hyperintense signal exhibits higher inter-rater reliability than subjective rating of nigrosome-1 appearance was not supported. CONCLUSION The simple quantitative method, used with subjectively rated nigrosome-1 appearance, may improve confidence in longitudinal clinical reporting, when nigrosome-1 is attenuated. However, further work on the incremental diagnostic value of planimetry and bias, repeatability and reproducibility are needed before it can be recommended in clinical practice.
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Affiliation(s)
- Minh T Chau
- UniSA Allied Health & Human Performance and Alliance for Research in Exercise, Nutrition and Activity (ARENA), City East Campus, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; South Australia Medical Imaging, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, SA 5042, Australia
| | - Marc Agzarian
- South Australia Medical Imaging, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, SA 5042, Australia; College of Medicine and Public Health, Flinders University, 1 Flinders Drive, Bedford Park, SA 5042, Australia
| | - Robert A Wilcox
- College of Medicine and Public Health, Flinders University, 1 Flinders Drive, Bedford Park, SA 5042, Australia; Neurology Department, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, SA 5042, Australia; UniSA Clinical & Health Sciences and Alliance for Research in Exercise, Nutrition and Activity (ARENA), City East Campus, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Andrew Dwyer
- South Australia Medical Imaging, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, SA 5042, Australia; College of Medicine and Public Health, Flinders University, 1 Flinders Drive, Bedford Park, SA 5042, Australia; Clinical and Research Imaging Centre, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5000, Australia
| | - Eva Bezak
- UniSA Allied Health & Human Performance and Alliance for Research in Exercise, Nutrition and Activity (ARENA), City East Campus, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Gabrielle Todd
- UniSA Clinical & Health Sciences and Alliance for Research in Exercise, Nutrition and Activity (ARENA), City East Campus, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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Biswas D, Banerjee R, Sarkar S, Choudhury S, Sanyal P, Tiwari M, Kumar H. Nigrosome and Neuromelanin Imaging as Tools to Differentiate Parkinson's Disease and Parkinsonism. Ann Indian Acad Neurol 2022; 25:1029-1035. [PMID: 36911494 PMCID: PMC9996486 DOI: 10.4103/aian.aian_285_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
Parkinson's disease (PD) lacks a definitive diagnosis due to a lack of pathological validation of patients at antemortem. The risk of misdiagnosis is high in the early stages of PD, often eluded by atypical parkinsonian symptoms. Neuroimaging and laboratory biomarkers are being sought to aid in the clinical diagnosis of PD. Nigrosome imaging and neuromelanin (NM)-sensitive magnetic resonance imaging (MRI) are the new emerging tools, both technically simple plus cost-effective for studying nigral pathology, and have shown potential for authenticating the clinical diagnosis of PD. Visual assessment of the nigrosome-1 appearance, at 3 or 7 Tesla, yields excellent diagnostic accuracy for differentiating idiopathic PD from healthy controls. Moreover, midbrain atrophy and putaminal hypointensity in nigrosome-1 imaging are valid pointers in distinguishing PD from allied parkinsonian disorders. The majority of studies employed T2 and susceptibility-weighted imaging MRI sequences to visualize nigrosome abnormalities, whereas T1-weighted fast-spin echo sequences were used for NM imaging. The diagnostic performance of NM-sensitive MRI in discriminating PD from normal HC can be improved further. Longitudinal studies with adequate sampling of varied uncertain PD cases should be designed to accurately evaluate the sensitivity and diagnostic potential of nigrosome and NM imaging techniques. Equal weightage is to be given to uniformity and standardization of protocols, data analysis, and interpretation of results. There is tremendous scope for identifying disease-specific structural changes in varied forms of parkinsonism with these low-cost imaging tools. Nigrosome-1 and midbrain NM imaging may not only provide an accurate diagnosis of PD but could mature into tools for personally tailored treatment and prognosis.
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Affiliation(s)
- Deblina Biswas
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
| | - Rebecca Banerjee
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
| | - Swagata Sarkar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
- Department of Physiology, University of Calcutta, Kolkata, West Bengal, India
| | - Supriyo Choudhury
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
| | - Pritimoy Sanyal
- Department of Computer Science and Engineering, Maulana Abul Kalam Azad University of Technology, West Bengal, India
| | - Mona Tiwari
- Department of Radiology, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
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An Updated Overview of the Magnetic Resonance Imaging of Brain Iron in Movement Disorders. Behav Neurol 2022; 2022:3972173. [PMID: 35251368 PMCID: PMC8894064 DOI: 10.1155/2022/3972173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/29/2022] [Indexed: 01/12/2023] Open
Abstract
Brain iron load is one of the most important neuropathological hallmarks in movement disorders. Specifically, the iron provides most of the paramagnetic metal signals in the brain and its accumulation seems to play a key role, although not completely explained, in the degeneration of the basal ganglia, as well as other brain structures. Moreover, iron distribution patterns have been implicated in depicting different movement disorders. This work reviewed current literature on Magnetic Resonance Imaging for Brain Iron Detection and Quantification (MRI-BIDQ) in neurodegenerative processes underlying movement disorders.
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Multimodal brain and retinal imaging of dopaminergic degeneration in Parkinson disease. Nat Rev Neurol 2022; 18:203-220. [PMID: 35177849 DOI: 10.1038/s41582-022-00618-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
Parkinson disease (PD) is a progressive disorder characterized by dopaminergic neurodegeneration in the brain. The development of parkinsonism is preceded by a long prodromal phase, and >50% of dopaminergic neurons can be lost from the substantia nigra by the time of the initial diagnosis. Therefore, validation of in vivo imaging biomarkers for early diagnosis and monitoring of disease progression is essential for future therapeutic developments. PET and single-photon emission CT targeting the presynaptic terminals of dopaminergic neurons can be used for early diagnosis by detecting axonal degeneration in the striatum. However, these techniques poorly differentiate atypical parkinsonian syndromes from PD, and their availability is limited in clinical settings. Advanced MRI in which pathological changes in the substantia nigra are visualized with diffusion, iron-sensitive susceptibility and neuromelanin-sensitive sequences potentially represents a more accessible imaging tool. Although these techniques can visualize the classic degenerative changes in PD, they might be insufficient for phenotyping or prognostication of heterogeneous aspects of PD resulting from extranigral pathologies. The retina is an emerging imaging target owing to its pathological involvement early in PD, which correlates with brain pathology. Retinal optical coherence tomography (OCT) is a non-invasive technique to visualize structural changes in the retina. Progressive parafoveal thinning and fovea avascular zone remodelling, as revealed by OCT, provide potential biomarkers for early diagnosis and prognostication in PD. As we discuss in this Review, multimodal imaging of the substantia nigra and retina is a promising tool to aid diagnosis and management of PD.
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Moskalenko AN, Filatov AS, Fedotova EY, Konovalov RN, Illarioshkin SN. Visual analysis of nigrosome-1 in the differential diagnosis of Parkinson's disease and essential tremor. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2022. [DOI: 10.24075/brsmu.2022.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Differentiation between Parkinson’s disease, especially in its early stages, and essential tremor, which is a phenotypically similar movement disorder, still remains an unsolved challenge for neurology. The aim of this study was to assess the diagnostic significance of nigrosome imaging (nigrosomes are dopaminergic neuron clusters in the substantia nigra of the midbrain) using 3T high-resolution SW-MRI. The study was conducted in 20 patients with Parkinson’s disease and 10 patients with essential tremor. Visual analysis of the acquired nigrosome-1 images was performed using a 4-point ordinal rating scale. Differences in sex, age and duration of the disease were calculated using the Fisher exact test and the Mann–Whitney U test. The diagnostic value of the method was assessed using Pearson’s chisquared test. Nigrosome-1 was bilaterally or unilaterally absent in 70% of parkinsonian patients. Less specific changes to the substantia nigra (SN) were observed in two more parkinsonian patients (10%), whose nigrosome-1 appeared reduced in size. By contrast, nigrosome-1 was bilaterally intact in all patients (100%) with essential tremor (p < 0.001). Our preliminary findings demonstrate the high potential of noninvasive nigrosome-1 imaging in the differential diagnosis of Parkinson’s disease and essential tremor.
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Affiliation(s)
| | - AS Filatov
- Research Center of Neurology, Moscow, Russia
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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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Haller S, Davidsson A, Tisell A, Ochoa-Figueroa M, Georgiopoulos C. MRI of nigrosome-1: A potential triage tool for patients with suspected parkinsonism. J Neuroimaging 2021; 32:273-278. [PMID: 34724281 DOI: 10.1111/jon.12944] [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: 09/21/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Susceptibility-weighted imaging (SWI) of nigrosome-1 is an emerging and clinically applicable imaging marker for parkinsonism, which can be derived from routinely performed brain MRI. The purpose of the study was to assess whether SWI can be used as a triage tool for more efficient selection of subsequent Dopamine Transporter Scan (DaTSCAN) single-photon emission computed tomography (SPECT). METHODS We examined 72 consecutive patients with suspected parkinsonism with both DaTSCAN SPECT and SWI (48 in Philips Ingenia, 24 in GE Signa). Additionally, we examined 24 healthy controls with SWI (14 in Philips Ingenia, 10 in GE Signa). Diagnostic performance of SWI and DaTSCAN SPECT was assessed on the basis of clinical diagnosis, in terms of sensitivity, specificity, and diagnostic accuracy. RESULTS A total of 54 parkinsonism patients (69 years ± 9, 32 men), 18 nonparkinsonism patients (69.4 years ± 9, 10 men), and 24 healthy controls (62 years ± 8, 10 men) were recruited. SWI had a specificity of 92% and a sensitivity of 74%, whereas DaTSCAN SPECT had 83% and 94%, respectively. By preselecting patients with abnormal or inconclusive SWI, the diagnostic performance of DaTSCAN SPECT improved (specificity 100%, sensitivity 95%). Scans from Philips were associated with significantly lower image quality compared to GE (p < .001). The experienced rater outperformed the less experienced one in diagnostic accuracy (82% vs. 68%). CONCLUSIONS SWI can be used as triage tool because normal SWI can in most cases rule out parkinsonism. However, the performance of SWI depends on acquisition parameters and rater's experience.
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Affiliation(s)
- Sven Haller
- CIMC - Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland.,Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anette Davidsson
- Department of Clinical Physiology, Linköping University, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Tisell
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Medical Radiation Physics, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Miguel Ochoa-Figueroa
- Department of Clinical Physiology, Linköping University, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology, Linköping University, Linköping, Sweden
| | - Charalampos Georgiopoulos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology, Linköping University, Linköping, Sweden
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10
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Düzel E, Costagli M, Donatelli G, Speck O, Cosottini M. Studying Alzheimer disease, Parkinson disease, and amyotrophic lateral sclerosis with 7-T magnetic resonance. Eur Radiol Exp 2021; 5:36. [PMID: 34435242 PMCID: PMC8387546 DOI: 10.1186/s41747-021-00221-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/07/2021] [Indexed: 12/18/2022] Open
Abstract
Ultra-high-field (UHF) magnetic resonance (MR) scanners, that is, equipment operating at static magnetic field of 7 tesla (7 T) and above, enable the acquisition of data with greatly improved signal-to-noise ratio with respect to conventional MR systems (e.g., scanners operating at 1.5 T and 3 T). The change in tissue relaxation times at UHF offers the opportunity to improve tissue contrast and depict features that were previously inaccessible. These potential advantages come, however, at a cost: in the majority of UHF-MR clinical protocols, potential drawbacks may include signal inhomogeneity, geometrical distortions, artifacts introduced by patient respiration, cardiac cycle, and motion. This article reviews the 7 T MR literature reporting the recent studies on the most widespread neurodegenerative diseases: Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis.
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Affiliation(s)
- Emrah Düzel
- Otto-von-Guericke University Magdeburg, Magdeburg, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany. .,University College London, London, UK.
| | - Mauro Costagli
- IRCCS Stella Maris, Pisa, Italy.,University of Genoa, Genova, Italy
| | - Graziella Donatelli
- Fondazione Imago 7, Pisa, Italy.,Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Oliver Speck
- Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Mirco Cosottini
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,University of Pisa, Pisa, Italy
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Feraco P, Gagliardo C, La Tona G, Bruno E, D’angelo C, Marrale M, Del Poggio A, Malaguti MC, Geraci L, Baschi R, Petralia B, Midiri M, Monastero R. Imaging of Substantia Nigra in Parkinson's Disease: A Narrative Review. Brain Sci 2021; 11:brainsci11060769. [PMID: 34207681 PMCID: PMC8230134 DOI: 10.3390/brainsci11060769] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 12/15/2022] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder, characterized by motor and non-motor symptoms due to the degeneration of the pars compacta of the substantia nigra (SNc) with dopaminergic denervation of the striatum. Although the diagnosis of PD is principally based on a clinical assessment, great efforts have been expended over the past two decades to evaluate reliable biomarkers for PD. Among these biomarkers, magnetic resonance imaging (MRI)-based biomarkers may play a key role. Conventional MRI sequences are considered by many in the field to have low sensitivity, while advanced pulse sequences and ultra-high-field MRI techniques have brought many advantages, particularly regarding the study of brainstem and subcortical structures. Nowadays, nigrosome imaging, neuromelanine-sensitive sequences, iron-sensitive sequences, and advanced diffusion weighted imaging techniques afford new insights to the non-invasive study of the SNc. The use of these imaging methods, alone or in combination, may also help to discriminate PD patients from control patients, in addition to discriminating atypical parkinsonian syndromes (PS). A total of 92 articles were identified from an extensive review of the literature on PubMed in order to ascertain the-state-of-the-art of MRI techniques, as applied to the study of SNc in PD patients, as well as their potential future applications as imaging biomarkers of disease. Whilst none of these MRI-imaging biomarkers could be successfully validated for routine clinical practice, in achieving high levels of accuracy and reproducibility in the diagnosis of PD, a multimodal MRI-PD protocol may assist neuroradiologists and clinicians in the early and differential diagnosis of a wide spectrum of neurodegenerative disorders.
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Affiliation(s)
- Paola Feraco
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Via S. Giacomo 14, 40138 Bologna, Italy;
- Neuroradiology Unit, S. Chiara Hospital, 38122 Trento, Italy;
| | - Cesare Gagliardo
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.L.T.); (E.B.); (C.D.); (M.M.)
- Correspondence:
| | - Giuseppe La Tona
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.L.T.); (E.B.); (C.D.); (M.M.)
| | - Eleonora Bruno
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.L.T.); (E.B.); (C.D.); (M.M.)
| | - Costanza D’angelo
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.L.T.); (E.B.); (C.D.); (M.M.)
| | - Maurizio Marrale
- Department of Physics and Chemistry, University of Palermo, 90128 Palermo, Italy;
| | - Anna Del Poggio
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, San Raffaele Vita-Salute University, 20132 Milan, Italy;
| | | | - Laura Geraci
- Diagnostic and Interventional Neuroradiology Unit, A.R.N.A.S. Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy;
| | - Roberta Baschi
- Section of Neurology, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (R.B.); (R.M.)
| | | | - Massimo Midiri
- Section of Radiological Sciences, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (G.L.T.); (E.B.); (C.D.); (M.M.)
| | - Roberto Monastero
- Section of Neurology, Department of Biomedicine, Neurosciences & Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy; (R.B.); (R.M.)
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12
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Bae YJ, Kim JM, Sohn CH, Choi JH, Choi BS, Song YS, Nam Y, Cho SJ, Jeon B, Kim JH. Imaging the Substantia Nigra in Parkinson Disease and Other Parkinsonian Syndromes. Radiology 2021; 300:260-278. [PMID: 34100679 DOI: 10.1148/radiol.2021203341] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Parkinson disease is characterized by dopaminergic cell loss in the substantia nigra of the midbrain. There are various imaging markers for Parkinson disease. Recent advances in MRI have enabled elucidation of the underlying pathophysiologic changes in the nigral structure. This has contributed to accurate and early diagnosis and has improved disease progression monitoring. This article aims to review recent developments in nigral imaging for Parkinson disease and other parkinsonian syndromes, including nigrosome imaging, neuromelanin imaging, quantitative iron mapping, and diffusion-tensor imaging. In particular, this article examines nigrosome imaging using 7-T MRI and 3-T susceptibility-weighted imaging. Finally, this article discusses volumetry and its clinical importance related to symptom manifestation. This review will improve understanding of recent advancements in nigral imaging of Parkinson disease. Published under a CC BY 4.0 license.
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Affiliation(s)
- Yun Jung Bae
- From the Departments of Radiology (Y.J.B., B.S.C., S.J.C., J.H.K.), Neurology (J.M.K., J.H.C.), and Nuclear Medicine (Y.S.S.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; Departments of Radiology (C.H.S.) and Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea (Y.N.)
| | - Jong-Min Kim
- From the Departments of Radiology (Y.J.B., B.S.C., S.J.C., J.H.K.), Neurology (J.M.K., J.H.C.), and Nuclear Medicine (Y.S.S.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; Departments of Radiology (C.H.S.) and Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea (Y.N.)
| | - Chul-Ho Sohn
- From the Departments of Radiology (Y.J.B., B.S.C., S.J.C., J.H.K.), Neurology (J.M.K., J.H.C.), and Nuclear Medicine (Y.S.S.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; Departments of Radiology (C.H.S.) and Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea (Y.N.)
| | - Ji-Hyun Choi
- From the Departments of Radiology (Y.J.B., B.S.C., S.J.C., J.H.K.), Neurology (J.M.K., J.H.C.), and Nuclear Medicine (Y.S.S.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; Departments of Radiology (C.H.S.) and Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea (Y.N.)
| | - Byung Se Choi
- From the Departments of Radiology (Y.J.B., B.S.C., S.J.C., J.H.K.), Neurology (J.M.K., J.H.C.), and Nuclear Medicine (Y.S.S.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; Departments of Radiology (C.H.S.) and Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea (Y.N.)
| | - Yoo Sung Song
- From the Departments of Radiology (Y.J.B., B.S.C., S.J.C., J.H.K.), Neurology (J.M.K., J.H.C.), and Nuclear Medicine (Y.S.S.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; Departments of Radiology (C.H.S.) and Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea (Y.N.)
| | - Yoonho Nam
- From the Departments of Radiology (Y.J.B., B.S.C., S.J.C., J.H.K.), Neurology (J.M.K., J.H.C.), and Nuclear Medicine (Y.S.S.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; Departments of Radiology (C.H.S.) and Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea (Y.N.)
| | - Se Jin Cho
- From the Departments of Radiology (Y.J.B., B.S.C., S.J.C., J.H.K.), Neurology (J.M.K., J.H.C.), and Nuclear Medicine (Y.S.S.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; Departments of Radiology (C.H.S.) and Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea (Y.N.)
| | - Beomseok Jeon
- From the Departments of Radiology (Y.J.B., B.S.C., S.J.C., J.H.K.), Neurology (J.M.K., J.H.C.), and Nuclear Medicine (Y.S.S.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; Departments of Radiology (C.H.S.) and Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea (Y.N.)
| | - Jae Hyoung Kim
- From the Departments of Radiology (Y.J.B., B.S.C., S.J.C., J.H.K.), Neurology (J.M.K., J.H.C.), and Nuclear Medicine (Y.S.S.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; Departments of Radiology (C.H.S.) and Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea (Y.N.)
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13
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Neuroimaging Assessment of Nigrosome 1 with a Multiecho Gre Magnetic Resonance Sequence in the Differentiation Between Parkinsons Disease from Essential Tremor and Healthy Individuals. Tremor Other Hyperkinet Mov (N Y) 2021; 11:17. [PMID: 34046247 PMCID: PMC8139290 DOI: 10.5334/tohm.604] [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] [Indexed: 11/20/2022] Open
Abstract
Background and purpose Parkinsonism is commonly seen in many clinical conditions, and the establishment of its etiology may take many years. The possible development of neuroprotective treatments for Parkinsons disease (PD) in the near future will require correct and early diagnosis. This study aims to analyze the accuracy of a low-cost MRI sequence to differentiate PD from patients with essential tremor (ET) and healthy control (HC) individuals. Material and methods We recruited 70 individuals with clinical diagnoses of PD (38 patients), ET (11 patients) and healthy volunteers (21 individuals), all of whom underwent 3T MRI multiecho GRE sequence. Two blinded neuroradiologists independently evaluated the presence or absence of nigrosome-1(N1). We considered the unilateral or bilateral absence of nigrosome 1 signal as indicative of PD. Results The absence of at least one N1 could differentiate with 98% accuracy patients with clinical established PD from healthy controls. The presence of both nigrosomes was 96% accurate as a sign to differentiate PD from ET patients. Conclusion The 3T MRI with multiecho GRE is a simple and universally available technique and it can be used as a good auxiliary tool to differentiate PD from ET patients and controls.
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Pietracupa S, Bologna M, Tommasin S, Elifani F, Vasselli F, Paparella G, Petsas N, Berardelli A, Pantano P. No evidence of iron deposition in essential tremor: a susceptibility-weighted imaging study. Neurol Sci 2021; 42:4667-4672. [PMID: 33721138 DOI: 10.1007/s10072-021-05173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 03/06/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the role of iron deposition in subcortical nuclei of patients with essential tremor (ET). METHODS Twenty-three patients with ET underwent a standardized 3T-MRI protocol. We specifically assessed iron deposition using susceptibility-weighted angiography (SWAN) images in seven specific regions of interest (ROIs): the thalamus, putamen, globus pallidus, caudate nucleus, substantia nigra, red nucleus, and dentate nucleus. Tremor in ET patients was clinically assessed using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). ET patient data were compared with data obtained from 23 Parkinson's disease (PD) patients and 14 healthy subjects (HS). RESULTS No differences in iron deposition in the seven ROIs were found between ET patients and HS. Conversely, PD patients showed increased iron deposition in the substantia nigra in comparison with both ET patients and HS. CONCLUSIONS Our results indicate the absence of iron deposition in subcortical nuclei of ET patients, which is generally considered a marker of neurodegeneration.
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Affiliation(s)
- Sara Pietracupa
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.
| | - Matteo Bologna
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Elifani
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Federica Vasselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Paparella
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Nikolaos Petsas
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Alfredo Berardelli
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- Department of Neurology, Neuromed Institute IRCCS, Via Atinense, 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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15
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Haller S, Haacke EM, Thurnher MM, Barkhof F. Susceptibility-weighted Imaging: Technical Essentials and Clinical Neurologic Applications. Radiology 2021; 299:3-26. [PMID: 33620291 DOI: 10.1148/radiol.2021203071] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Susceptibility-weighted imaging (SWI) evolved from simple two-dimensional T2*-weighted sequences to three-dimensional sequences with improved spatial resolution and enhanced susceptibility contrast. SWI is an MRI sequence sensitive to compounds that distort the local magnetic field (eg, calcium and iron), in which the phase information can differentiate. But the term SWI is colloquially used to denote high-spatial-resolution susceptibility-enhanced sequences across different MRI vendors and sequences even when phase information is not used. The imaging appearance of SWI and related sequences strongly depends on the acquisition technique. Initially, SWI and related sequences were mostly used to improve the depiction of findings already known from standard two-dimensional T2*-weighted neuroimaging: more microbleeds in patients who are aging or with dementia or mild brain trauma; increased conspicuity of superficial siderosis in Alzheimer disease and amyloid angiopathy; and iron deposition in neurodegenerative diseases or abnormal vascular structures, such as capillary telangiectasia. But SWI also helps to identify findings not visible on standard T2*-weighted images: the nigrosome 1 in Parkinson disease and dementia with Lewy bodies, the central vein and peripheral rim signs in multiple sclerosis, the peripheral rim sign in abscesses, arterial signal loss related to thrombus, asymmetrically prominent cortical veins in stroke, and intratumoral susceptibility signals in brain neoplasms.
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Affiliation(s)
- Sven Haller
- From the CIRD Centre d'Imagerie Rive Droite, Geneva, Switzerland (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Surgical Sciences, Division of Radiology, Uppsala University, Uppsala, Sweden (S.H.); CIMC Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.) Departments of Neurology and Radiology, Wayne State University, Detroit, Mich (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria (M.M.T.); Queen Square Institute of Neurology, University College London, London, England (F.B.); Centre for Medical Image Computing (CMIC), Institute of Healthcare Engineering, University College London, London, England (F.B.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
| | - E Mark Haacke
- From the CIRD Centre d'Imagerie Rive Droite, Geneva, Switzerland (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Surgical Sciences, Division of Radiology, Uppsala University, Uppsala, Sweden (S.H.); CIMC Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.) Departments of Neurology and Radiology, Wayne State University, Detroit, Mich (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria (M.M.T.); Queen Square Institute of Neurology, University College London, London, England (F.B.); Centre for Medical Image Computing (CMIC), Institute of Healthcare Engineering, University College London, London, England (F.B.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
| | - Majda M Thurnher
- From the CIRD Centre d'Imagerie Rive Droite, Geneva, Switzerland (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Surgical Sciences, Division of Radiology, Uppsala University, Uppsala, Sweden (S.H.); CIMC Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.) Departments of Neurology and Radiology, Wayne State University, Detroit, Mich (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria (M.M.T.); Queen Square Institute of Neurology, University College London, London, England (F.B.); Centre for Medical Image Computing (CMIC), Institute of Healthcare Engineering, University College London, London, England (F.B.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
| | - Frederik Barkhof
- From the CIRD Centre d'Imagerie Rive Droite, Geneva, Switzerland (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Surgical Sciences, Division of Radiology, Uppsala University, Uppsala, Sweden (S.H.); CIMC Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.) Departments of Neurology and Radiology, Wayne State University, Detroit, Mich (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria (M.M.T.); Queen Square Institute of Neurology, University College London, London, England (F.B.); Centre for Medical Image Computing (CMIC), Institute of Healthcare Engineering, University College London, London, England (F.B.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
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16
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Michler E, Kaiser D, Eleftheriadou K, Falkenburger B, Kotzerke J, Hoberück S. Comparison of 6-[ 18F]FDOPA PET with Nigrosome 1 detection in patients with parkinsonism. EJNMMI Res 2021; 11:16. [PMID: 33590381 PMCID: PMC7884547 DOI: 10.1186/s13550-021-00758-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background The functional 6-[18F]FDOPA positron emission tomography (PET) can be a helpful tool in differentiating parkinsonism with dopaminergic deficiency from clinically similar differential diagnoses. Furthermore, in T2*/susceptibility-weighted imaging (SWI) magnetic resonance imaging (MRI) sequences the structural integrity of the Nigrosome 1 (N1) can be assessed by checking the presence of the swallow tail sign (STS). We therefore retrospectively compared the performance of the 6-[18F]FDOPA PET with the N1 detection in patients suspected with parkinsonian diseases. Forty-three consecutive patients (m: 23, f: 20, mean age: 63 ± 12 years) were included in the study. They underwent clinically indicated 6-[18F]FDOPA PET/MRI scans as part of their neurological evaluation of uncertain parkinsonian syndromes. Visual and semi-quantitative PET imaging results were statistically compared with visual N1 assessment on 3 T SWI. As the gold standard, we defined the clinical diagnosis at the last follow-up, which included idiopathic Parkinson syndrome (IPS; n = 18), atypical parkinsonian syndromes (APS; n = 9) and other neurological diseases without dopaminergic deficit (n = 16). Results Thirty-five of 43 patients (81%, Kappa 0.611) had corresponding results in 6-[18F]FDOPA PET and SWI. Seven of the remaining 8 patients were correctly diagnosed by 6-[18F]FDOPA PET alone. Sensitivity, specificity and accuracy for 6-[18F]FDOPA and N1 imaging were 93%, 94%, 93% and 82%, 75%, 79%, respectively. Conclusions 6-[18F]FDOPA PET and Nigrosome 1 evaluation had an overall good intermodality agreement. Diagnostic agreement was very good in cases of clinically suspected idiopathic Parkinson syndrome and fair in atypical parkinsonian syndromes, but poor in patients with non-parkinsonian disorders. 6-[18F]FDOPA PET showed higher sensitivity, specificity and accuracy in discriminating parkinsonian syndromes from non-parkinsonian disorders than the N1 evaluation. In summary, the additional benefit of N1 assessment in patients with APS or parkinsonism without dopaminergic deficit needs to be proven by prospective studies.
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Affiliation(s)
- Enrico Michler
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
| | - Daniel Kaiser
- Department of Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Kiriaki Eleftheriadou
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Björn Falkenburger
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Jörg Kotzerke
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Sebastian Hoberück
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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17
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Diagnostic performance of loss of nigral hyperintensity on susceptibility-weighted imaging in parkinsonism: an updated meta-analysis. Eur Radiol 2021; 31:6342-6352. [PMID: 33449183 DOI: 10.1007/s00330-020-07627-6] [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: 08/19/2020] [Revised: 11/21/2020] [Accepted: 12/10/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate diagnostic performance of loss of nigral hyperintensity on SWI in differentiating idiopathic Parkinson's disease (IPD) or primary parkinsonism (including IPD and Parkinson-plus syndrome) from healthy/disease controls. METHODS MEDLINE/PubMed and EMBASE databases were searched to identify original articles investigating the diagnostic performance of loss of nigral hyperintensity for differentiating IPD or primary parkinsonism from healthy/disease control, up to April 3, 2020. Pooled sensitivity and specificity were calculated using a bivariate random-effects model. The proportion of nondiagnostic scan, inter- and intrareader agreement, and the proportion of concordance between clinical laterality and imaging asymmetry were also pooled. RESULTS Nineteen articles covering 2125 patients (1097 with primary parkinsonism, 1028 healthy/disease controls) were included. For discrimination between IPD and healthy/disease controls, pooled sensitivity and specificity were 0.96 (95% CI, 0.91-0.98) and 0.95 (95% CI, 0.92-0.97). For discrimination between primary parkinsonism and healthy/disease controls, pooled sensitivity and specificity were 0.87 (95% CI, 0.75-0.94) and 0.93 (95% CI, 0.85-0.97). The pooled proportion of non-diagnostic scans on random-effects modeling was 4.2% (95% CI, 2.5-6.9%). The inter- and intrareader agreements were almost perfect, with the pooled coefficients being 0.84 (95% CI, 0.78-0.89) and 0.96 (95% CI, 0.89-0.99), respectively. The pooled proportion of concordant cases was 69.3% (95% CI, 58.4-78.4%). CONCLUSIONS Loss of nigral hyperintensity on SWI can differentiate IPD or primary parkinsonism from a healthy/disease control group with high accuracy. However, the proportion of non-diagnostic scans is not negligible and must be taken into account. KEY POINTS • For discrimination between idiopathic Parkinson's disease and healthy/disease controls, pooled sensitivity and specificity of loss of nigral hyperintensity were 0.96 and 0.95. • For discrimination between primary parkinsonism and healthy/disease controls, pooled sensitivity and specificity of loss of nigral hyperintensity were 0.87 and 0.93. • The pooled proportion of non-diagnostic scans on random-effects modeling was 4.2%.
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18
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Hernadi G, Pinter D, Nagy SA, Orsi G, Komoly S, Janszky J, Kovacs N, Perlaki G. Fast 3 T nigral hyperintensity magnetic resonance imaging in Parkinson's disease. Sci Rep 2021; 11:1179. [PMID: 33441889 PMCID: PMC7806895 DOI: 10.1038/s41598-020-80836-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022] Open
Abstract
The absence of nigral hyperintensity is a promising MR marker for Parkinson’s disease (PD), but its small size imposes limitations on its routine use. Our aim was to compare Multi Echo Data Image Combination (MEDIC), segmented echo-planar imaging (EPISEG) and fluid-attenuated inversion recovery (FLAIR) sequences, as well as both magnitude (MAG) and susceptibility-weighted imaging (SWI) reconstructions of single-echo gradient echo for nigral hyperintensity imaging. Twenty-five healthy and twenty PD subjects were included. Sensitivity to motion artefacts, confidence of the radiologist in interpretation, rate of nondiagnostic scans and diagnostic accuracy were assessed. EPISEG was less motion-sensitive than MEDIC, MAG, and SWI, while FLAIR was less motion-sensitive than MAG and SWI. The reviewers were more confident when using EPISEG compared to any other techniques and MEDIC was superior to FLAIR. The proportions of nondiagnostic scans were lower for EPISEG than for other sequences. The best diagnostic performance was achieved for EPISEG (sensitivity = 65%, specificity = 96%). Using EPISEG, the absence of nigral hyperintensity in PD was associated with higher Hoehn-Yahr stage and MDS-UPDRS II + III. Nigral hyperintensity may be intact at the very early stages of PD. The promising properties of EPISEG may help the transfer of nigral hyperintensity imaging into daily clinical practice.
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Affiliation(s)
| | - David Pinter
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
| | - Szilvia Anett Nagy
- Pecs Diagnostic Centre, Pecs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary.,Neurobiology of Stress Research Group, Szentagothai Research Center, University of Pecs, Pecs, Hungary.,Department of Laboratory Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Gergely Orsi
- Pecs Diagnostic Centre, Pecs, Hungary.,Department of Neurology, Medical School, University of Pecs, Pecs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
| | - Samuel Komoly
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
| | - Jozsef Janszky
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
| | - Norbert Kovacs
- Department of Neurology, Medical School, University of Pecs, Pecs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
| | - Gabor Perlaki
- Pecs Diagnostic Centre, Pecs, Hungary. .,Department of Neurology, Medical School, University of Pecs, Pecs, Hungary. .,MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary.
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Kathuria H, Mehta S, Ahuja CK, Chakravarty K, Ray S, Mittal BR, Singh P, Lal V. Utility of Imaging of Nigrosome-1 on 3T MRI and Its Comparison with 18F-DOPA PET in the Diagnosis of Idiopathic Parkinson Disease and Atypical Parkinsonism. Mov Disord Clin Pract 2020; 8:224-230. [PMID: 33553492 DOI: 10.1002/mdc3.13091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022] Open
Abstract
Background Loss of nigrosome-1 on 3T and 7T magnetic resonance imaging (MRI) is a recently explored imaging biomarker in the diagnosis of neurodegenerative parkinsonism. Objectives This study was undertaken to evaluate the utility of imaging of nigrosome in the diagnosis of neurodegenerative parkinsonism on 3T MRI. Methods An institution-based prospective case-control study was conducted at a tertiary care center in North India. 3T venous blood oxygen level-dependent (VenoBOLD) and high-resolution susceptibility-weighted imaging (SWI) imaging sequences in MRI were performed in 100 patients with parkinsonism (56 with idiopathic Parkinson's disease [IPD], 30 with young onset Parkinson's disease [YOPD], 12 with progressive supranuclear palsy, and 2 patients with multiple system atrophy) and 15 controls. Grading of nigrosome was done in both the sequences. Each patient underwent 18F-DOPA positron emission tomography (PET), detailed neurological examination including Hoen and Yahr (H&Y) staging and Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scoring. Results The diagnostic sensitivity and specificity of the detection of loss of nigrosome-1 on VenoBOLD and SWI sequence at 3T MR imaging were 90% and 66.7% and 94% and 80%, respectively. A weak negative correlation was found between the grading of the nigrosome and clinical parameters (H&Y and UPDRS III). There was no correlation between the side of nigrosome loss and clinical asymmetry. However, nigrosome imaging was not able to differentiate between Parkinson's disease and atypical parkinsonism. Conclusions The loss of nigrosome-1 on 3T MRI on SWI and VenoBOLD sequences may serve as a potential imaging marker in the diagnosis of degenerative parkinsonian syndromes. However, it cannot differentiate between idiopathic Parkinson's disease and atypical parkinsonian syndromes.
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Affiliation(s)
- Heena Kathuria
- Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Sahil Mehta
- Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Chirag K Ahuja
- Department of Radiodiagnosis Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Kamalesh Chakravarty
- Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Sucharita Ray
- Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Paramjeet Singh
- Department of Radiodiagnosis Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Vivek Lal
- Department of Neurology Post Graduate Institute of Medical Education and Research Chandigarh India
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Diagnostic accuracy of the appearance of Nigrosome-1 on magnetic resonance imaging in Parkinson's disease: A systematic review and meta-analysis. Parkinsonism Relat Disord 2020; 78:12-20. [DOI: 10.1016/j.parkreldis.2020.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/04/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023]
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The clinical application of nigrosome 1 detection on high-resolution susceptibility-weighted imaging in the evaluation of suspected Parkinsonism: The real-world performance and pitfalls. PLoS One 2020; 15:e0231010. [PMID: 32240236 PMCID: PMC7117705 DOI: 10.1371/journal.pone.0231010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/13/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the real-world diagnostic performance of high-resolution susceptibility-weighted imaging (HR-SWI) and investigate whether the reader’s predictions can be used to find cases where HR-SWI finding and final clinical diagnosis matched. Methods This retrospective study enrolled patients with suspected Parkinsonism (n = 48) or volunteers with other intracranial pathologies (n = 31) who underwent brain magnetic resonance imaging (MRI) including HR-SWI, which was used to evaluate nigrosome 1 (NG1). All patients with suspected Parkinsonism underwent N-3-fluoropropyl-2-carbomethoxy-3-4-iodophenyl nortropane (FP-CIT) positron emission tomography and a clinical diagnosis was made by a neurologist. The HR-SWI data were qualitatively analyzed by two independent reviewers. A consensus reading was performed and a diagnostic confidence score was assigned. According to final clinical diagnosis, diagnostic sensitivity, specificity, and accuracy were calculated. Receiver operating characteristic (ROC) curve analysis was used to examine whether the diagnostic confidence score could be used to identify HR-SWI finding—final clinical diagnosis matched cases. Results Of the 48 patients with suspected Parkinsonism, 31 were diagnosed with idiopathic Parkinson’s disease, and three with multiple system atrophy. The remaining 14 patients were included in the disease control group. Of the 31 volunteers, 10 subjects were excluded due to possibility of nigrostriatal degeneration and finally 21 subjects were enrolled as controls with non-Parkinsonism pathology (non-PD control). After consensus reading, 25 subjects were classified as true positive and 28 as true negative, according to HR-SWI findings. The calculated diagnostic sensitivity, specificity, and accuracy were 73.5%, 80.0%, and 76.8%, respectively. With using diagnostic concordance score, the area under the ROC curve for the detection of concordance case was 0.83 (95% CI: 0.72–0.91, p < 0.05). Conclusion The diagnostic performance of NG1 detection using HR-SWI with 3T MRI was within acceptable range. Using the reader's diagnostic confidence could be helpful to find cases which HR-SWI finding and final clinical conclusion match. So HR-SWI may be of added value in the evaluation of suspected Parkinsonism.
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Arribarat G, Péran P. Quantitative MRI markers in Parkinson's disease and parkinsonian syndromes. Curr Opin Neurol 2020; 33:222-229. [DOI: 10.1097/wco.0000000000000796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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