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Neuroradiology
Published in: Neuroradiology 7/2015

Open Access 01-07-2015 | Diagnostic Neuroradiology

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

Authors: Frederick J. A. Meijer, Anouke van Rumund, Anil M. Tuladhar, Marjolein B. Aerts, Imke Titulaer, Rianne A. J. Esselink, Bastiaan R. Bloem, Marcel M. Verbeek, Bozena Goraj

Published in: Neuroradiology | Issue 7/2015

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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.
Appendix
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Metadata
Title
Conventional 3T brain MRI and diffusion tensor imaging in the diagnostic workup of early stage parkinsonism
Authors
Frederick J. A. Meijer
Anouke van Rumund
Anil M. Tuladhar
Marjolein B. Aerts
Imke Titulaer
Rianne A. J. Esselink
Bastiaan R. Bloem
Marcel M. Verbeek
Bozena Goraj
Publication date
01-07-2015
Publisher
Springer Berlin Heidelberg
Published in
Neuroradiology / Issue 7/2015
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-015-1515-7

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