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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

TBSS analyses of atypical parkinsonism with Parkinson’s disease and atypical parkinsonism subgroups with Parkinson’s disease. Upper row: TBSS comparison of AP (n = 19) with PD (n = 29). Brain regions with statistically significant lower FA and higher MD in AP in comparison to PD (p < 0.05). Middle row: TBSS comparison of MSA-P (n = 12) with PD (n = 29). MD of the left putamen and external capsule, and superior part of the cerebellar vermis proved to be statistically significant higher for MSA-P in comparison to PD (p < 0.05). A part of the left external capsule demonstrated significantly lower FA in MSA-P. Lower row: TBSS comparison of DLB (n = 3) with PD (n = 29). No statistically significant differences were demonstrated, while at a p value of <0.1 lower FA and higher MD in the left frontal lobe is seen for DLB in comparison PD. No differences were demonstrated in a TBSS comparison between PSP and PD. Red, lower values; blue, higher values
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Fig2: TBSS analyses of atypical parkinsonism with Parkinson’s disease and atypical parkinsonism subgroups with Parkinson’s disease. Upper row: TBSS comparison of AP (n = 19) with PD (n = 29). Brain regions with statistically significant lower FA and higher MD in AP in comparison to PD (p < 0.05). Middle row: TBSS comparison of MSA-P (n = 12) with PD (n = 29). MD of the left putamen and external capsule, and superior part of the cerebellar vermis proved to be statistically significant higher for MSA-P in comparison to PD (p < 0.05). A part of the left external capsule demonstrated significantly lower FA in MSA-P. Lower row: TBSS comparison of DLB (n = 3) with PD (n = 29). No statistically significant differences were demonstrated, while at a p value of <0.1 lower FA and higher MD in the left frontal lobe is seen for DLB in comparison PD. No differences were demonstrated in a TBSS comparison between PSP and PD. Red, lower values; blue, higher values

Mentions: Results of TBSS analyses to compare AP (n = 19) with PD (n = 29) and to compare MSA-P and DLB with PD are shown in Fig. 2. One patient diagnosed with PD had to be excluded because normalization of DTI to the MNI space failed.Fig. 2


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)

TBSS analyses of atypical parkinsonism with Parkinson’s disease and atypical parkinsonism subgroups with Parkinson’s disease. Upper row: TBSS comparison of AP (n = 19) with PD (n = 29). Brain regions with statistically significant lower FA and higher MD in AP in comparison to PD (p < 0.05). Middle row: TBSS comparison of MSA-P (n = 12) with PD (n = 29). MD of the left putamen and external capsule, and superior part of the cerebellar vermis proved to be statistically significant higher for MSA-P in comparison to PD (p < 0.05). A part of the left external capsule demonstrated significantly lower FA in MSA-P. Lower row: TBSS comparison of DLB (n = 3) with PD (n = 29). No statistically significant differences were demonstrated, while at a p value of <0.1 lower FA and higher MD in the left frontal lobe is seen for DLB in comparison PD. No differences were demonstrated in a TBSS comparison between PSP and PD. Red, lower values; blue, higher values
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig2: TBSS analyses of atypical parkinsonism with Parkinson’s disease and atypical parkinsonism subgroups with Parkinson’s disease. Upper row: TBSS comparison of AP (n = 19) with PD (n = 29). Brain regions with statistically significant lower FA and higher MD in AP in comparison to PD (p < 0.05). Middle row: TBSS comparison of MSA-P (n = 12) with PD (n = 29). MD of the left putamen and external capsule, and superior part of the cerebellar vermis proved to be statistically significant higher for MSA-P in comparison to PD (p < 0.05). A part of the left external capsule demonstrated significantly lower FA in MSA-P. Lower row: TBSS comparison of DLB (n = 3) with PD (n = 29). No statistically significant differences were demonstrated, while at a p value of <0.1 lower FA and higher MD in the left frontal lobe is seen for DLB in comparison PD. No differences were demonstrated in a TBSS comparison between PSP and PD. Red, lower values; blue, higher values
Mentions: Results of TBSS analyses to compare AP (n = 19) with PD (n = 29) and to compare MSA-P and DLB with PD are shown in Fig. 2. One patient diagnosed with PD had to be excluded because normalization of DTI to the MNI space failed.Fig. 2

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