Gray Matter Atrophy in Parkinson's Disease and the Parkinsonian Variant of Multiple System Atrophy: A Combined ROI- and Voxel-Based Morphometric Study

Surface-Based Neuroimaging Pattern of Multiple System Atrophy

RATIONALE AND OBJECTIVES

Overlapping parkinsonism, cerebellar ataxia, and pyramidal signs render challenges in the clinical diagnosis of multiple system atrophy (MSA). The neuroimaging pattern is valuable to understand its pathophysiology and improve its diagnostic effect.

MATERIALS AND METHODS

We retrospectively obtained magnetic resonance imaging and susceptibility-weighted imaging in patients with MSA (including parkinsonian type [MSA-P] and cerebellar type [MSA-C]), Parkinson's disease, and normal controls. We quantified neuroimaging features to identify the optimal threshold for diagnosis. Furthermore, we explore neuroimaging patterns of MSA by mapping the subcortical morphological alterations and constructing a diagnostic model.

RESULTS

Compared to controls, normalized putaminal volume significantly decreased in patients with MSA-P (P < .001) and normalized pontine volume significantly decreased in patients with MSA-C (P < .001). The Youden index of the threshold-based clinical prediction model was 0.871-0.928 in patients with MSA. The neuroimaging pattern in patients with MSA was jointly located in the lateral putamen, and the neuroimaging pattern prediction model achieved a classification accuracy of 83.9%-100%.

CONCLUSION

The quantitative neuroimaging features and surface-based morphologic anomalies represent the markers of MSA and open new avenues for personalized clinical diagnosis.

White matter changes in Parkinson's disease

Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease (AD). It is characterized by a progressive loss of dopaminergic neurons in the substantia nigra pars compacta (SNc) and the formation of Lewy bodies (LBs). Although PD is primarily considered a gray matter (GM) disease, alterations in white matter (WM) have gained increasing attention in PD research recently. Here we review evidence collected by magnetic resonance imaging (MRI) techniques which indicate WM abnormalities in PD, and discuss the correlations between WM changes and specific PD symptoms. Then we summarize transcriptome and genome studies showing the changes of oligodendrocyte (OLs)/myelin in PD. We conclude that WM abnormalities caused by the changes of myelin/OLs might be important for PD pathology, which could be potential targets for PD treatment.

Quantitative MRI protocol and decision model for a 'one stop shop' early-stage Parkinsonism diagnosis: Study design

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.

Statistical shape analysis of putamen in early-onset Parkinson's disease

OBJECTIVE

To investigate the shape differences in the putamen of early-onset Parkinson's patients compared with healthy controls and to assess and to assess sub-regional brain abnormalities.

METHODS

This study was conducted using the 3-T MRI scans of 23 early-onset Parkinson's patients and age and gender matched control subjects. Landmark coordinate data obtained and Procrustes analysis was used to compare mean shapes. The relationships between the centroid sizes of the left and right putamen, and the durations of disease examined using growth curve models.

RESULTS

While there was a significant difference between the right putamen shape of control and patient groups, there was not found a significant difference in terms of left putamen. Sub-regional analyses showed that for the right putamen, the most prominent deformations were localized in the middle-posterior putamen and minimal deformations were seen in the anterior putamen.

CONCLUSION

Although they were not as pronounced as those in the right putamen, the deformations in the left putamen mimic the deformations in the right putamen which are found mainly in the middle-posterior putamen and at a lesser extend in the anterior putamen.

Subcortical grey matter changes associated with motor symptoms evaluated by the Unified Parkinson's disease Rating Scale (part III): A longitudinal study in Parkinson's disease

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Decreased grey matter volume over time suggests a subcortical alteration in PD.

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Decreased volume in the thalamus may be related to the decline in motor skills.

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Increased volume in the pallidum may contribute to motor impairment.

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Structural changes in line with the model of basal ganglia-thalamocortical circuits.

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VBM and volumetry might capture complementary aspects of structural changes in PD.

Parkinson disease (PD) is characterized by motor deficits related to structural changes in the basal ganglia-thalamocortical circuits. However, it is still unclear the exact nature of the association between grey matter alterations and motor symptoms.

Therefore, the aim of our investigation was to identify the subcortical modifications associated with motor symptoms of PD over time - adopting voxel-based morphometry (VBM) and automated volumetry methods.

We selected fifty subjects with PD from the Parkinson’s Progression Markers Initiative (PPMI) database, who performed an MRI session at two time points: at baseline (i.e. at maximum 2 years after clinical diagnosis of PD) and after 48 months. Motor symptoms were assessed using the part III of the Unified Parkinson’s Disease Rating Scale at the two time points.

Our VBM and volumetric analyses showed a general atrophy in all subcortical regions when comparing baseline with 48 months. These findings confirmed previous observations indicating a subcortical alteration over time in PD. Furthermore, our findings supported the idea that a reduced volume in the thalamus and an increased volume in pallidum may be related to the decline in motor skills. These structural modifications are in accordance with the functional model of the basal ganglia-thalamocortical circuits controlling movements. Moreover, VBM and volumetry provided partially overlapping results, suggesting that these methods might capture complementary aspects of brain degeneration in PD.