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Conventional 3T brain MRI and diffusion tensor imaging in the diagnostic workup of early stage parkinsonism.

Meijer FJ, van Rumund A, Tuladhar AM, Aerts MB, Titulaer I, Esselink RA, Bloem BR, Verbeek MM, Goraj B - Neuroradiology (2015)

Bottom Line: Tract-based spatial statistics and ROI analyses of DTI were performed to analyze group differences in mean diffusivity (MD) and fractional anisotropy (FA), and diagnostic thresholds were determined.Significantly higher MD of the centrum semiovale, body corpus callosum, putamen, external capsule, midbrain, superior cerebellum, and superior cerebellar peduncles was found in AP.Significantly increased MD of the putamen was found in multiple system atrophy-parkinsonian form (MSA-P) and increased MD in the midbrain and superior cerebellar peduncles in progressive supranuclear palsy (PSP).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, Postbus 9101, 6500 HB, Nijmegen, The Netherlands, Anton.Meijer@radboudumc.nl.

ABSTRACT

Introduction: The aim of this study is to evaluate whether the diagnostic accuracy of 3 T brain MRI is improved by region of interest (ROI) measures of diffusion tensor imaging (DTI), to differentiate between neurodegenerative atypical parkinsonism (AP) and Parkinson's disease (PD) in early stage parkinsonism.

Methods: We performed a prospective observational cohort study of 60 patients presenting with early stage parkinsonism and initial uncertain diagnosis. At baseline, patients underwent a 3 T brain MRI including DTI. After clinical follow-up (mean 28.3 months), diagnoses could be made in 49 patients (30 PD and 19 AP). Conventional brain MRI was evaluated for regions of atrophy and signal intensity changes. Tract-based spatial statistics and ROI analyses of DTI were performed to analyze group differences in mean diffusivity (MD) and fractional anisotropy (FA), and diagnostic thresholds were determined. Diagnostic accuracy of conventional brain MRI and DTI was assessed with the receiver operating characteristic (ROC).

Results: Significantly higher MD of the centrum semiovale, body corpus callosum, putamen, external capsule, midbrain, superior cerebellum, and superior cerebellar peduncles was found in AP. Significantly increased MD of the putamen was found in multiple system atrophy-parkinsonian form (MSA-P) and increased MD in the midbrain and superior cerebellar peduncles in progressive supranuclear palsy (PSP). The diagnostic accuracy of brain MRI to identify AP as a group was not improved by ROI measures of MD, though the diagnostic accuracy to identify MSA-P was slightly increased (AUC 0.82 to 0.85).

Conclusion: The diagnostic accuracy of brain MRI to identify AP as a group was not improved by the current analysis approach to DTI, though DTI measures could be of added value to identify AP subgroups.

No MeSH data available.


Related in: MedlinePlus

Regions of interest in the bilateral putamen (a), midbrain (b), and superior cerebellar peduncles (c). Mean MD and FA of these ROIs were calculated
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Fig1: Regions of interest in the bilateral putamen (a), midbrain (b), and superior cerebellar peduncles (c). Mean MD and FA of these ROIs were calculated

Mentions: Next, a ROI analysis was performed. DTI data were normalized to the MNI space using nonlinear registration with Statistical Parametric Mapping (SPM, Trust Centre of Neuroimaging, London, UK; http://www.fil.ion.ucl.ac.uk/spm/). All images and maps were visually inspected for error or mismatch. Using the FMRIB58_FA standard-space FA template, 16-mm2 ROIs were placed in the following gray and white matter structures, which are known to be affected in the different disease entities: bilateral midbrain at the level of the substantia nigra (MNI coordinates 6 and −6, −14, −4), thalamus (10 and −10, −20, 0), putamen (28 and −28, −1,0), caudate nucleus (12 and −12, 18, 0), globus pallidus (16 and −16, 2, −2), superior cerebellar peduncle (SCP) (6 and −6, −36, −20), MCP (20 and −20, −42, −34), dentate nucleus (14 and −14, −56, −30), and the pons (0, −28, −32) (Fig. 1). Matlab (MathWorks, Natick, MA) was used to calculate MD and FA values of these ROIs. ROI placement was visually checked in correlation with conventional brain MRI for each dataset and corrected if necessary.Fig. 1


Conventional 3T brain MRI and diffusion tensor imaging in the diagnostic workup of early stage parkinsonism.

Meijer FJ, van Rumund A, Tuladhar AM, Aerts MB, Titulaer I, Esselink RA, Bloem BR, Verbeek MM, Goraj B - Neuroradiology (2015)

Regions of interest in the bilateral putamen (a), midbrain (b), and superior cerebellar peduncles (c). Mean MD and FA of these ROIs were calculated
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4495265&req=5

Fig1: Regions of interest in the bilateral putamen (a), midbrain (b), and superior cerebellar peduncles (c). Mean MD and FA of these ROIs were calculated
Mentions: Next, a ROI analysis was performed. DTI data were normalized to the MNI space using nonlinear registration with Statistical Parametric Mapping (SPM, Trust Centre of Neuroimaging, London, UK; http://www.fil.ion.ucl.ac.uk/spm/). All images and maps were visually inspected for error or mismatch. Using the FMRIB58_FA standard-space FA template, 16-mm2 ROIs were placed in the following gray and white matter structures, which are known to be affected in the different disease entities: bilateral midbrain at the level of the substantia nigra (MNI coordinates 6 and −6, −14, −4), thalamus (10 and −10, −20, 0), putamen (28 and −28, −1,0), caudate nucleus (12 and −12, 18, 0), globus pallidus (16 and −16, 2, −2), superior cerebellar peduncle (SCP) (6 and −6, −36, −20), MCP (20 and −20, −42, −34), dentate nucleus (14 and −14, −56, −30), and the pons (0, −28, −32) (Fig. 1). Matlab (MathWorks, Natick, MA) was used to calculate MD and FA values of these ROIs. ROI placement was visually checked in correlation with conventional brain MRI for each dataset and corrected if necessary.Fig. 1

Bottom Line: Tract-based spatial statistics and ROI analyses of DTI were performed to analyze group differences in mean diffusivity (MD) and fractional anisotropy (FA), and diagnostic thresholds were determined.Significantly higher MD of the centrum semiovale, body corpus callosum, putamen, external capsule, midbrain, superior cerebellum, and superior cerebellar peduncles was found in AP.Significantly increased MD of the putamen was found in multiple system atrophy-parkinsonian form (MSA-P) and increased MD in the midbrain and superior cerebellar peduncles in progressive supranuclear palsy (PSP).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, Postbus 9101, 6500 HB, Nijmegen, The Netherlands, Anton.Meijer@radboudumc.nl.

ABSTRACT

Introduction: The aim of this study is to evaluate whether the diagnostic accuracy of 3 T brain MRI is improved by region of interest (ROI) measures of diffusion tensor imaging (DTI), to differentiate between neurodegenerative atypical parkinsonism (AP) and Parkinson's disease (PD) in early stage parkinsonism.

Methods: We performed a prospective observational cohort study of 60 patients presenting with early stage parkinsonism and initial uncertain diagnosis. At baseline, patients underwent a 3 T brain MRI including DTI. After clinical follow-up (mean 28.3 months), diagnoses could be made in 49 patients (30 PD and 19 AP). Conventional brain MRI was evaluated for regions of atrophy and signal intensity changes. Tract-based spatial statistics and ROI analyses of DTI were performed to analyze group differences in mean diffusivity (MD) and fractional anisotropy (FA), and diagnostic thresholds were determined. Diagnostic accuracy of conventional brain MRI and DTI was assessed with the receiver operating characteristic (ROC).

Results: Significantly higher MD of the centrum semiovale, body corpus callosum, putamen, external capsule, midbrain, superior cerebellum, and superior cerebellar peduncles was found in AP. Significantly increased MD of the putamen was found in multiple system atrophy-parkinsonian form (MSA-P) and increased MD in the midbrain and superior cerebellar peduncles in progressive supranuclear palsy (PSP). The diagnostic accuracy of brain MRI to identify AP as a group was not improved by ROI measures of MD, though the diagnostic accuracy to identify MSA-P was slightly increased (AUC 0.82 to 0.85).

Conclusion: The diagnostic accuracy of brain MRI to identify AP as a group was not improved by the current analysis approach to DTI, though DTI measures could be of added value to identify AP subgroups.

No MeSH data available.


Related in: MedlinePlus