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Seada SA, van der Eerden AW, Boon AJW, Hernandez-Tamames JA. Quantitative MRI protocol and decision model for a 'one stop shop' early-stage Parkinsonism diagnosis: Study design. Neuroimage Clin 2023; 39:103506. [PMID: 37696098 PMCID: PMC10500558 DOI: 10.1016/j.nicl.2023.103506] [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: 03/30/2023] [Revised: 06/21/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
Differentiating among early-stage parkinsonisms is a challenge in clinical practice. Quantitative MRI can aid the diagnostic process, but studies with singular MRI techniques have had limited success thus far. Our objective is to develop a multi-modal MRI method for this purpose. In this review we describe existing methods and present a dedicated quantitative MRI protocol, a decision model and a study design to validate our approach ahead of a pilot study. We present example imaging data from patients and a healthy control, which resemble related literature.
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Affiliation(s)
- Samy Abo Seada
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Anke W van der Eerden
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Agnita J W Boon
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Juan A Hernandez-Tamames
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Department of Imaging Physics, TU Delft, The Netherlands.
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Comparative validation of AI and non-AI methods in MRI volumetry to diagnose Parkinsonian syndromes. Sci Rep 2023; 13:3439. [PMID: 36859498 PMCID: PMC10156821 DOI: 10.1038/s41598-023-30381-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
Automated segmentation and volumetry of brain magnetic resonance imaging (MRI) scans are essential for the diagnosis of Parkinson's disease (PD) and Parkinson's plus syndromes (P-plus). To enhance the diagnostic performance, we adopt deep learning (DL) models in brain MRI segmentation and compared their performance with the gold-standard non-DL method. We collected brain MRI scans of healthy controls ([Formula: see text]) and patients with PD ([Formula: see text]), multiple systemic atrophy ([Formula: see text]), and progressive supranuclear palsy ([Formula: see text]) at Samsung Medical Center from January 2017 to December 2020. Using the gold-standard non-DL model, FreeSurfer (FS), we segmented six brain structures: midbrain, pons, caudate, putamen, pallidum, and third ventricle, and considered them as annotated data for DL models, the representative convolutional neural network (CNN) and vision transformer (ViT)-based models. Dice scores and the area under the curve (AUC) for differentiating normal, PD, and P-plus cases were calculated to determine the measure to which FS performance can be reproduced as-is while increasing speed by the DL approaches. The segmentation times of CNN and ViT for the six brain structures per patient were 51.26 ± 2.50 and 1101.82 ± 22.31 s, respectively, being 14 to 300 times faster than FS (15,735 ± 1.07 s). Dice scores of both DL models were sufficiently high (> 0.85) so their AUCs for disease classification were not inferior to that of FS. For classification of normal vs. P-plus and PD vs. P-plus (except multiple systemic atrophy - Parkinsonian type) based on all brain parts, the DL models and FS showed AUCs above 0.8, demonstrating the clinical value of DL models in addition to FS. DL significantly reduces the analysis time without compromising the performance of brain segmentation and differential diagnosis. Our findings may contribute to the adoption of DL brain MRI segmentation in clinical settings and advance brain research.
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Pérez-Millan A, Borrego-Écija S, van Swieten JC, Jiskoot L, Moreno F, Laforce R, Graff C, Masellis M, Tartaglia MC, Rowe JB, Borroni B, Finger E, Synofzik M, Galimberti D, Vandenberghe R, de Mendonça A, Butler CR, Gerhard A, Ducharme S, Le Ber I, Santana I, Pasquier F, Levin J, Otto M, Sorbi S, Tiraboschi P, Seelaar H, Langheinrich T, Rohrer JD, Sala-Llonch R, Sánchez-Valle R. Loss of brainstem white matter predicts onset and motor neuron symptoms in C9orf72 expansion carriers: a GENFI study. J Neurol 2023; 270:1573-1586. [PMID: 36443488 DOI: 10.1007/s00415-022-11435-x] [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: 08/05/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The C9orf72 expansion is the most common genetic cause of frontotemporal dementia (FTD) and/or motor neuron disease (MND). Corticospinal degeneration has been described in post-mortem neuropathological studies in these patients, especially in those with MND. We used MRI to analyze white matter (WM) volumes in presymptomatic and symptomatic C9orf72 expansion carriers and investigated whether its measure may be helpful in predicting the onset of symptoms. METHODS We studied 102 presymptomatic C9orf72 mutation carriers, 52 symptomatic carriers: 42 suffering from FTD and 11 from MND, and 75 non-carriers from the Genetic Frontotemporal dementia Initiative (GENFI). All subjects underwent T1-MRI acquisition. We used FreeSurfer to estimate the volume proportion of WM in the brainstem regions (midbrain, pons, and medulla oblongata). We calculated group differences with ANOVA tests and performed linear and non-linear regressions to assess group-by-age interactions. RESULTS A reduced WM ratio was found in all brainstem subregions in symptomatic carriers compared to both noncarriers and pre-symptomatic carriers. Within symptomatic carriers, MND patients presented a lower ratio in pons and medulla oblongata compared with FTD patients. No differences were found between presymptomatic carriers and non-carriers. Clinical severity was negatively associated with the WM ratio. C9orf72 carriers presented greater age-related WM loss than non-carriers, with MND patients showing significantly more atrophy in pons and medulla oblongata. DISCUSSION We find consistent brainstem WM loss in C9orf72 symptomatic carriers with differences related to the clinical phenotype supporting the use of brainstem measures as neuroimaging biomarkers for disease tracking.
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Affiliation(s)
- Agnès Pérez-Millan
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Department of Biomedicine, Faculty of Medicine, Institute of Neurosciences, University of Barcelona, 08036, Barcelona, Spain
| | - Sergi Borrego-Écija
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
| | - John C van Swieten
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lize Jiskoot
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, UK
| | - Fermin Moreno
- Cognitive Disorders Unit, Department of Neurology, Donostia University Hospital, San Sebastian, Gipuzkoa, Spain
- Neuroscience Area, Biodonostia Health Research Institute, San Sebastian, Gipuzkoa, Spain
| | - Robert Laforce
- Département des Sciences Neurologiques, Clinique Interdisciplinaire de Mémoire, CHU de Québec, and Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Caroline Graff
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Bioclinicum, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
- Unit for Hereditary Dementias, Theme Aging, Karolinska University Hospital, Solna, Sweden
| | - Mario Masellis
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust and Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Barbara Borroni
- Department of Clinical and Experimental Sciences, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Neurology Service, University Hospitals Leuven, Leuven, Belgium
| | | | - Chris R Butler
- Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
- Department of Geriatric Medicine and Nuclear Medicine, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
| | - Simon Ducharme
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Isabelle Le Ber
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau - ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière (DMU Neurosciences Paris 6), Paris, France
- Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière (DMU Neurosciences Paris 6), Paris, France
| | - Isabel Santana
- Neurology Service, Faculty of Medicine, University Hospital of Coimbra (HUC), University of Coimbra, Coimbra, Portugal
- Center for Neuroscience and Cell Biology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Florence Pasquier
- Univ Lille, Lille, France
- CHU, CNR-MAJ, Labex Distalz, LiCEND, Lille, France
| | - Johannes Levin
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Sandro Sorbi
- Department of Neurofarba, University of Florence, Florence, Italy
| | | | - Harro Seelaar
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Tobias Langheinrich
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, UK
| | - Roser Sala-Llonch
- Department of Biomedicine, Faculty of Medicine, Institute of Neurosciences, University of Barcelona, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain
| | - Raquel Sánchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
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Shribman S, Burrows M, Convery R, Bocchetta M, Sudre CH, Acosta-Cabronero J, Thomas DL, Gillett GT, Tsochatzis EA, Bandmann O, Rohrer JD, Warner TT. Neuroimaging Correlates of Cognitive Deficits in Wilson's Disease. Mov Disord 2022; 37:1728-1738. [PMID: 35723521 PMCID: PMC9542291 DOI: 10.1002/mds.29123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cognitive impairment is common in neurological presentations of Wilson's disease (WD). Various domains can be affected, and subclinical deficits have been reported in patients with hepatic presentations. Associations with imaging abnormalities have not been systematically tested. OBJECTIVE The aim was to determine the neuroanatomical basis for cognitive deficits in WD. METHODS We performed a 16-item neuropsychological test battery and magnetic resonance brain imaging in 40 patients with WD. The scores for each test were compared between patients with neurological and hepatic presentations and with normative data. Associations with Unified Wilson's Disease Rating Scale neurological examination subscores were examined. Quantitative, whole-brain, multimodal imaging analyses were used to identify associations with neuroimaging abnormalities in chronically treated stable patients. RESULTS Abstract reasoning, executive function, processing speed, calculation, and visuospatial function scores were lower in patients with neurological presentations than in those with hepatic presentations and correlated with neurological examination subscores. Deficits in abstract reasoning and phonemic fluency were associated with lower putamen volumes even after controlling for neurological severity. About half of patients with hepatic presentations had poor performance in memory for faces, cognitive flexibility, or associative learning relative to normative data. These deficits were associated with widespread cortical atrophy and/or white matter diffusion abnormalities. CONCLUSIONS Subtle cognitive deficits in patients with seemingly hepatic presentations represent a distinct neurological phenotype associated with diffuse cortical and white matter pathology. This may precede the classical neurological phenotype characterized by movement disorders and executive dysfunction and be associated with basal ganglia damage. A binary phenotypic classification for WD may no longer be appropriate. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Samuel Shribman
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London
| | - Maggie Burrows
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London
| | - Rhian Convery
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Martina Bocchetta
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom.,Centre for Medical Image Computing, University College London, London, United Kingdom.,Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | | | - David L Thomas
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom.,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, United Kingdom.,Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Godfrey T Gillett
- Department of Clinical Chemistry, Northern General Hospital, Sheffield, United Kingdom
| | - Emmanuel A Tsochatzis
- UCL Institute of Liver and Digestive Health and Royal Free Hospital, London, United Kingdom
| | - Oliver Bandmann
- Sheffield Institute of Translational Neuroscience, Sheffield, United Kingdom
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Thomas T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London
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Furuta M, Sato M, Tsukagoshi S, Tsushima Y, Ikeda Y. Criteria-unfulfilled multiple system atrophy at an initial stage exhibits laterality of middle cerebellar peduncles. J Neurol Sci 2022; 438:120281. [DOI: 10.1016/j.jns.2022.120281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
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Scotton WJ, Bocchetta M, Todd E, Cash DM, Oxtoby N, VandeVrede L, Heuer H, Alexander DC, Rowe JB, Morris HR, Boxer A, Rohrer JD, Wijeratne PA. A data-driven model of brain volume changes in progressive supranuclear palsy. Brain Commun 2022; 4:fcac098. [PMID: 35602649 PMCID: PMC9118104 DOI: 10.1093/braincomms/fcac098] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/08/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
The most common clinical phenotype of progressive supranuclear palsy is Richardson syndrome, characterized by levodopa unresponsive symmetric parkinsonism, with a vertical supranuclear gaze palsy, early falls and cognitive impairment. There is currently no detailed understanding of the full sequence of disease pathophysiology in progressive supranuclear palsy. Determining the sequence of brain atrophy in progressive supranuclear palsy could provide important insights into the mechanisms of disease progression, as well as guide patient stratification and monitoring for clinical trials. We used a probabilistic event-based model applied to cross-sectional structural MRI scans in a large international cohort, to determine the sequence of brain atrophy in clinically diagnosed progressive supranuclear palsy Richardson syndrome. A total of 341 people with Richardson syndrome (of whom 255 had 12-month follow-up imaging) and 260 controls were included in the study. We used a combination of 12-month follow-up MRI scans, and a validated clinical rating score (progressive supranuclear palsy rating scale) to demonstrate the longitudinal consistency and utility of the event-based model's staging system. The event-based model estimated that the earliest atrophy occurs in the brainstem and subcortical regions followed by progression caudally into the superior cerebellar peduncle and deep cerebellar nuclei, and rostrally to the cortex. The sequence of cortical atrophy progresses in an anterior to posterior direction, beginning in the insula and then the frontal lobe before spreading to the temporal, parietal and finally the occipital lobe. This in vivo ordering accords with the post-mortem neuropathological staging of progressive supranuclear palsy and was robust under cross-validation. Using longitudinal information from 12-month follow-up scans, we demonstrate that subjects consistently move to later stages over this time interval, supporting the validity of the model. In addition, both clinical severity (progressive supranuclear palsy rating scale) and disease duration were significantly correlated with the predicted subject event-based model stage (P < 0.01). Our results provide new insights into the sequence of atrophy progression in progressive supranuclear palsy and offer potential utility to stratify people with this disease on entry into clinical trials based on disease stage, as well as track disease progression.
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Affiliation(s)
- W. J. Scotton
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen
Square Institute of Neurology, University College London, London, UK
| | - M. Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen
Square Institute of Neurology, University College London, London, UK
| | - E. Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen
Square Institute of Neurology, University College London, London, UK
| | - D. M. Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen
Square Institute of Neurology, University College London, London, UK
| | - N. Oxtoby
- Centre for Medical Image Computing, Department of Computer Science, University
College London, London, UK
| | - L. VandeVrede
- Department of Neurology, Memory and Aging Center, University of
California, San Francisco, CA, USA
| | - H. Heuer
- Department of Neurology, Memory and Aging Center, University of
California, San Francisco, CA, USA
| | | | - D. C. Alexander
- Centre for Medical Image Computing, Department of Computer Science, University
College London, London, UK
| | - J. B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge
University Hospitals NHS Trust, Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge
University, Cambridge, UK
| | - H. R. Morris
- Department of Clinical and Movement Neurosciences, University College London
Queen Square Institute of Neurology, London, UK
- Movement Disorders Centre, University College London Queen Square Institute of
Neurology, London, UK
| | - A. Boxer
- Department of Neurology, Memory and Aging Center, University of
California, San Francisco, CA, USA
| | - J. D. Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen
Square Institute of Neurology, University College London, London, UK
| | - P. A. Wijeratne
- Centre for Medical Image Computing, Department of Computer Science, University
College London, London, UK
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Shribman S, Bocchetta M, Sudre CH, Acosta-Cabronero J, Burrows M, Cook P, Thomas DL, Gillett GT, Tsochatzis EA, Bandmann O, Rohrer JD, Warner TT. Neuroimaging correlates of brain injury in Wilson's disease: a multimodal, whole-brain MRI study. Brain 2022; 145:263-275. [PMID: 34289020 PMCID: PMC8967100 DOI: 10.1093/brain/awab274] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/25/2021] [Accepted: 07/04/2021] [Indexed: 11/23/2022] Open
Abstract
Wilson's disease is an autosomal-recessive disorder of copper metabolism with neurological and hepatic presentations. Chelation therapy is used to 'de-copper' patients but neurological outcomes remain unpredictable. A range of neuroimaging abnormalities have been described and may provide insights into disease mechanisms, in addition to prognostic and monitoring biomarkers. Previous quantitative MRI analyses have focused on specific sequences or regions of interest, often stratifying chronically treated patients according to persisting symptoms as opposed to initial presentation. In this cross-sectional study, we performed a combination of unbiased, whole-brain analyses on T1-weighted, fluid-attenuated inversion recovery, diffusion-weighted and susceptibility-weighted imaging data from 40 prospectively recruited patients with Wilson's disease (age range 16-68). We compared patients with neurological (n = 23) and hepatic (n = 17) presentations to determine the neuroradiological sequelae of the initial brain injury. We also subcategorized patients according to recent neurological status, classifying those with neurological presentations or deterioration in the preceding 6 months as having 'active' disease. This allowed us to compare patients with active (n = 5) and stable (n = 35) disease and identify imaging correlates for persistent neurological deficits and copper indices in chronically treated, stable patients. Using a combination of voxel-based morphometry and region-of-interest volumetric analyses, we demonstrate that grey matter volumes are lower in the basal ganglia, thalamus, brainstem, cerebellum, anterior insula and orbitofrontal cortex when comparing patients with neurological and hepatic presentations. In chronically treated, stable patients, the severity of neurological deficits correlated with grey matter volumes in similar, predominantly subcortical regions. In contrast, the severity of neurological deficits did not correlate with the volume of white matter hyperintensities, calculated using an automated lesion segmentation algorithm. Using tract-based spatial statistics, increasing neurological severity in chronically treated patients was associated with decreasing axial diffusivity in white matter tracts whereas increasing serum non-caeruloplasmin-bound ('free') copper and active disease were associated with distinct patterns of increasing mean, axial and radial diffusivity. Whole-brain quantitative susceptibility mapping identified increased iron deposition in the putamen, cingulate and medial frontal cortices of patients with neurological presentations relative to those with hepatic presentations and neurological severity was associated with iron deposition in widespread cortical regions in chronically treated patients. Our data indicate that composite measures of subcortical atrophy provide useful prognostic biomarkers, whereas abnormal mean, axial and radial diffusivity are promising monitoring biomarkers. Finally, deposition of brain iron in response to copper accumulation may directly contribute to neurodegeneration in Wilson's disease.
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Affiliation(s)
- Samuel Shribman
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
| | - Martina Bocchetta
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing, University College London, London WC1E 7HB, UK
- Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
- Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK
| | | | - Maggie Burrows
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
| | - Paul Cook
- Department of Clinical Biochemistry, Southampton General Hospital, Southampton SO16 6YD, UK
| | - David L Thomas
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Godfrey T Gillett
- Department of Clinical Chemistry, Northern General Hospital, Sheffield S5 7AU, UK
| | - Emmanuel A Tsochatzis
- UCL Institute of Liver and Digestive Health and Royal Free Hospital, London NW3 2PF, UK
| | - Oliver Bandmann
- Sheffield Institute of Translational Neuroscience, Sheffield S10 2HQ, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3AR, UK
| | - Thomas T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London WC1N 1PJ, UK
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Golan H, Volkov O, Shalom E. Nuclear imaging in Parkinson's disease: The past, the present, and the future. J Neurol Sci 2022; 436:120220. [DOI: 10.1016/j.jns.2022.120220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 01/15/2023]
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9
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Donzuso G, Sciacca G, Luca A, Cicero CE, Mostile G, Nicoletti A, Zappia M. Corticobasal syndrome and Parkinson's disease at the beginning: asymmetrical patterns of MRI and Blink Reflex for early diagnosis. J Neural Transm (Vienna) 2022; 129:1427-1433. [PMID: 36308548 PMCID: PMC9649477 DOI: 10.1007/s00702-022-02557-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023]
Abstract
Differential diagnosis between Parkinson's disease (PD) and corticobasal syndrome (CBS) could be challenging at the early stage, due to the asymmetric onset of both diseases. Despite the clinical overlap, the anatomical circuits involved in these disorders are different. We evaluated R2 Blink Reflex Recovery Cycle (R2BRRC) and cortical thickness (CTh) in drug-naïve PD and CBS patients for characterizing pathophysiological mechanisms underlying these conditions. Patients with a clinically probable diagnosis of PD and possible CBS were recruited. R2BRRC was evaluated bilaterally at interstimulus intervals (ISIs) of 100-150-200-300-400-500-750 ms. Asymmetry index (AI) of R2BRRC for each ISI was computed. Patients underwent a structural brain MRI and hemisphere CTh and AI of MRI was calculated. Fourteen drug-naïve PD patients and 10 patients with early CBS diagnosis were enrolled. R2BRRC of PD patients showed an increased brainstem excitability for less affected side (LAS) stimulation at ISIs of 100 and 150 ms (p < 0.001) compared to most affected side (MAS), whereas no differences between LAS and MAS were found in CBS. AI of R2BRRC at ISI-100 ms showed significant difference, being higher in PD. CTh analysis showed significant differences between groups in hemisphere cortical volume contralateral to MAS, and, conversely, AI of MRI was significantly higher in CBS. PD patients exhibited an asymmetric pattern of brainstem excitability, compared to CBS. Conversely, CBS patients showed an asymmetric pattern of cortical atrophy. This opposite pattern of neurophysiological and structural abnormalities involving cortical and subcortical brain structures could highlight the different pathophysiological mechanisms underlying these disorders.
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Affiliation(s)
- Giulia Donzuso
- grid.8158.40000 0004 1757 1969Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Giorgia Sciacca
- grid.8158.40000 0004 1757 1969Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Antonina Luca
- grid.8158.40000 0004 1757 1969Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Calogero E. Cicero
- grid.8158.40000 0004 1757 1969Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Giovanni Mostile
- grid.8158.40000 0004 1757 1969Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Alessandra Nicoletti
- grid.8158.40000 0004 1757 1969Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Mario Zappia
- grid.8158.40000 0004 1757 1969Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
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Vitale A, Villa R, Ugga L, Romeo V, Stanzione A, Cuocolo R. Artificial intelligence applied to neuroimaging data in Parkinsonian syndromes: Actuality and expectations. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:1753-1773. [PMID: 33757209 DOI: 10.3934/mbe.2021091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Idiopathic Parkinson's Disease (iPD) is a common motor neurodegenerative disorder. It affects more frequently the elderly population, causing a significant emotional burden both for the patient and caregivers, due to the disease-related onset of motor and cognitive disabilities. iPD's clinical hallmark is the onset of cardinal motor symptoms such as bradykinesia, rest tremor, rigidity, and postural instability. However, these symptoms appear when the neurodegenerative process is already in an advanced stage. Furthermore, the greatest challenge is to distinguish iPD from other similar neurodegenerative disorders, "atypical parkinsonisms", such as Multisystem Atrophy, Progressive Supranuclear Palsy and Cortical Basal Degeneration, since they share many phenotypic manifestations, especially in the early stages. The diagnosis of these neurodegenerative motor disorders is essentially clinical. Consequently, the diagnostic accuracy mainly depends on the professional knowledge and experience of the physician. Recent advances in artificial intelligence have made it possible to analyze the large amount of clinical and instrumental information in the medical field. The application machine learning algorithms to the analysis of neuroimaging data appear to be a promising tool for identifying microstructural alterations related to the pathological process in order to explain the onset of symptoms and the spread of the neurodegenerative process. In this context, the search for quantitative biomarkers capable of identifying parkinsonian patients in the prodromal phases of the disease, of correctly distinguishing them from atypical parkinsonisms and of predicting clinical evolution and response to therapy represent the main goal of most current clinical research studies. Our aim was to review the recent literature and describe the current knowledge about the contribution given by machine learning applications to research and clinical management of parkinsonian syndromes.
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Affiliation(s)
- Annalisa Vitale
- Department of Advanced Biomedical Sciences, University of Naples "Federico Ⅱ", Via S. Pansini 5, 80131-Naples, Italy
| | - Rossella Villa
- Department of Advanced Biomedical Sciences, University of Naples "Federico Ⅱ", Via S. Pansini 5, 80131-Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico Ⅱ", Via S. Pansini 5, 80131-Naples, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico Ⅱ", Via S. Pansini 5, 80131-Naples, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico Ⅱ", Via S. Pansini 5, 80131-Naples, Italy
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples "Federico Ⅱ", Via S. Pansini 5, 80131-Naples, Italy
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11
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Bocchetta M, Todd EG, Peakman G, Cash DM, Convery RS, Russell LL, Thomas DL, Eugenio Iglesias J, van Swieten JC, Jiskoot LC, Seelaar H, Borroni B, Galimberti D, Sanchez-Valle R, Laforce R, Moreno F, Synofzik M, Graff C, Masellis M, Carmela Tartaglia M, Rowe JB, Vandenberghe R, Finger E, Tagliavini F, de Mendonça A, Santana I, Butler CR, Ducharme S, Gerhard A, Danek A, Levin J, Otto M, Sorbi S, Le Ber I, Pasquier F, Rohrer JD. Differential early subcortical involvement in genetic FTD within the GENFI cohort. Neuroimage Clin 2021; 30:102646. [PMID: 33895632 PMCID: PMC8099608 DOI: 10.1016/j.nicl.2021.102646] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies have previously shown evidence for presymptomatic cortical atrophy in genetic FTD. Whilst initial investigations have also identified early deep grey matter volume loss, little is known about the extent of subcortical involvement, particularly within subregions, and how this differs between genetic groups. METHODS 480 mutation carriers from the Genetic FTD Initiative (GENFI) were included (198 GRN, 202 C9orf72, 80 MAPT), together with 298 non-carrier cognitively normal controls. Cortical and subcortical volumes of interest were generated using automated parcellation methods on volumetric 3 T T1-weighted MRI scans. Mutation carriers were divided into three disease stages based on their global CDR® plus NACC FTLD score: asymptomatic (0), possibly or mildly symptomatic (0.5) and fully symptomatic (1 or more). RESULTS In all three groups, subcortical involvement was seen at the CDR 0.5 stage prior to phenoconversion, whereas in the C9orf72 and MAPT mutation carriers there was also involvement at the CDR 0 stage. In the C9orf72 expansion carriers the earliest volume changes were in thalamic subnuclei (particularly pulvinar and lateral geniculate, 9-10%) cerebellum (lobules VIIa-Crus II and VIIIb, 2-3%), hippocampus (particularly presubiculum and CA1, 2-3%), amygdala (all subregions, 2-6%) and hypothalamus (superior tuberal region, 1%). In MAPT mutation carriers changes were seen at CDR 0 in the hippocampus (subiculum, presubiculum and tail, 3-4%) and amygdala (accessory basal and superficial nuclei, 2-4%). GRN mutation carriers showed subcortical differences at CDR 0.5 in the presubiculum of the hippocampus (8%). CONCLUSIONS C9orf72 expansion carriers show the earliest and most widespread changes including the thalamus, basal ganglia and medial temporal lobe. By investigating individual subregions, changes can also be seen at CDR 0 in MAPT mutation carriers within the limbic system. Our results suggest that subcortical brain volumes may be used as markers of neurodegeneration even prior to the onset of prodromal symptoms.
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Affiliation(s)
- Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Emily G Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Georgia Peakman
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Rhian S Convery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Lucy L Russell
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - David L Thomas
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Juan Eugenio Iglesias
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom; Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, USA; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, USA
| | - John C van Swieten
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, the Netherlands
| | - Lize C Jiskoot
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, the Netherlands
| | - Harro Seelaar
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, the Netherlands
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Raquel Sanchez-Valle
- Neurology Department, Hospital Clinic, Institut d'Investigacions Biomèdiques, Barcelona, Spain
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, Faculté de Médecine, Université Laval, Québec, Canada
| | - Fermin Moreno
- Hospital Universitario Donostia, San Sebastian, Spain
| | - Matthis Synofzik
- Department of Cognitive Neurology, Center for Neurology, Hertie-Institute for Clinical Brain Research, Tübingen, Germany
| | - Caroline Graff
- Karolinska Institutet, Department NVS, Division of Neurogeriatrics, Stockholm, Sweden; Unit for Hereditray Dementia, Theme Aging, Karolinska University Hospital-Solna Stockholm Sweden
| | - Mario Masellis
- Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, Toronto, ON, Canada
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust and Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
| | - Fabrizio Tagliavini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Isabel Santana
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Chris R Butler
- Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Simon Ducharme
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, United Kingdom; Departments of Geriatric Medicine and Nuclear Medicine, University of Duisburg-Essen, Germany
| | - Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich German Center for Neurodegenerative Diseases (DZNE), Munich Munich Cluster of Systems Neurology, Munich, Germany
| | - Johannes Levin
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Munich German Center for Neurodegenerative Diseases (DZNE), Munich Munich Cluster of Systems Neurology, Munich, Germany
| | - Markus Otto
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Isabelle Le Ber
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau- ICM, Inserm U1127, CNRS UMR 7225, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Centre deréférence des démences rares ou précoces, IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France; Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
| | - Florence Pasquier
- Univ Lille, France; Inserm 1172 Lille, France; CHU, CNR-MAJ, Labex Distalz, LiCENDLille, France
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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Choi JH, Kim H, Shin JH, Lee JY, Kim HJ, Kim JM, Jeon B. Eye movements and association with regional brain atrophy in clinical subtypes of progressive supranuclear palsy. J Neurol 2020; 268:967-977. [PMID: 32959131 DOI: 10.1007/s00415-020-10230-w] [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: 08/05/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate oculomotor impairment in subtypes of progressive supranuclear palsy (PSP) and its associations with clinical features and regional brain volumes in PSP. METHODS We compared the video-oculography (VOG) findings of 123 PSP patients, consisting of 66 PSP-Richardson syndrome (PSP-RS), 28 PSP-parkinsonism (PSP-P), and 29 PSP-progressive gait freezing (PSP-PGF), along with 80 Parkinson's disease (PD) patients. We also investigated the associations of the VOG results with clinical features (disease duration, PSP rating scales [PSPRS] scores for dysphagia and postural stability) in the subtypes of PSP patients and with regional volumes in the brainstem, including the midbrain, pons, medulla, and the superior cerebellar peduncle (SCP), among the patients who had MRI images at the time of VOG (30 PSP). RESULTS All of the three subtypes of PSP patients showed slower vertical saccades and smooth pursuit than that of the PD patients (adjusted p < 0.05). Among the PSP subtypes, saccadic peak velocity, saccadic accuracy, and pursuit gain were significantly decreased in patients with the PSP-RS compared to those with the PSP-PGF (adjusted p < 0.05). In multiple linear regression model, vertical saccadic velocity, latency, accuracy, and pursuit gain were associated with the PSPRS score for dysphagia (adjusted p < 0.05), and a decrease in vertical saccadic speed and accuracy was associated with SCP atrophy (corrected p < 0.05). CONCLUSIONS This study demonstrated the severity of oculomotor dysfunction in differentiating the subtypes of PSP and its significant relationships with the dysphagia symptom and SCP volume in PSP.
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Affiliation(s)
- Ji-Hyun Choi
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heejung Kim
- Department of Nuclear Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Shin
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Joon Kim
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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13
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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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