Objectives: To assess the diagnostic performance of nigrosome-1 degeneration on imaging by quantitative susceptibility mapping (QSM) for Parkinson's Disease (PD). Methods: Two cohorts (Cohort Ⅰ and Cohort Ⅱ) of patients were analyzed retrospectively in this study. For Cohort Ⅰ, forty-four early idiopathic PD patients and 35 age-and gender- matched healthy controls were recruited,and a three-dimensional 8-echo GRE sequence was acquired on a 3T MR scanner. For Cohort Ⅱ, 43 patients with idiopathic PD and 48 healthy gender- and age-matched controls were recruited. For each subject, a three-dimensional 16-echo GRE sequence was scanned. Then QSM was reconstructed from GRE data for all the subjects. Two neuro-radiologists who were blind to the diagnosis evaluated separately the visibility of nigrosome-1 on quantitative susceptibility mapping. There were three presenting types: present, possible present, and absent. Then all the subjects were classified into three groups based on the visibility of nigrosome-1: normal group, PD group, and non-diagnostic group. Clinical diagnosis was taken as the gold standard, and diagnostic performance of QSM for PD was assessed. Results: For Cohort Ⅰ, 42/44 PD and 10/35 controls were correctly classified, while there were 42/43 PD and 29/48 controls correctly classified in Cohort Ⅱ. Sensitivity of nigrosome-1 degeneration on imaging by QSM for diagnosing PD was 95.5%, specificity was 28.6%, positive predictive value (PPV) was 65.6%, negative predictive value (NPV) was 100% and accuracy rate was 66.0% in Cohort Ⅰ. While for cohort Ⅱ, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 97.7%, 60.4%, 75.0%, 100 % and 78.0%, respectively. Conclusions: QSM imaging could be used as a diagnostic tool for PD, which is feasible to assess the nigrosome-1 degeneration with a high negative predictive value.
HE Naying, XU Hongmin, HUANG Pei, CHEN Shengdi, YAN Fuhua, LING Huawei
. Study of nigrosome-1 degeneration on imaging by quantitative susceptibility mapping in Parkinson's disease patients[J]. Journal of Diagnostics Concepts & Practice, 2017
, 16(02)
: 147
-151
.
DOI: 10.16150/j.1671-2870.2017.02.005
[1] Hornykiewicz O.The discovery of dopamine deficiency in the parkinsonian brain[J]. J Neural Transm Suppl,2006,(70):9-15.
[2] Oakley AE, Collingwood JF, Dobson J, et al.Individual dopaminergic neurons show raised iron levels in Parkinson disease[J]. Neurology,2007,68(21):1820-1825.
[3] Dusek P, Jankovic J, Le W.Iron dysregulation in movement disorders[J]. Neurobiol Dis,2012,46(1):1-18.
[4] Blazejewska AI, Schwarz ST, Pitiot A, et al.Visualization of nigrosome 1 and its loss in PD: pathoanatomical correlation and in vivo 7 T MRI[J]. Neurology,2013,81(6):534-540.
[5] Schwarz ST, Afzal M, Morgan PS, et al.The 'swallow tail' appearance of the healthy nigrosome-a new accurate test of Parkinson's disease: a case-control and retrospective cross-sectional MRI study at 3T[J]. PLoS One,2014,9(4):e93814.
[6] Li J, Chang S, Liu T, et al.Reducing the object orientation dependence of susceptibility effects in gradient echo MRI through quantitative susceptibility mapping[J]. Magn Reson Med,2012,68(5):1563-1569.
[7] Li W, Wang N, Yu F, et al.A method for estimating and removing streaking artifacts in quantitative susceptibility mapping[J]. Neuroimage,2015,108:111-22.
[8] Hughes AJ, Daniel SE, Kilford L, et al. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases[J]. J Neurol Neurosurg Psychiatry.1992 Mar;55(3):181-184.
[9] Hughes CP, Berg L, Danziger WL, et al.A new clinical scale for the staging of dementia[J]. Br J Psychiatry,1982,140:566-572.
[10] Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician[J]. J Psychiatr Res,1975,12(3):189-198.
[11] Hoehn MM, Yahr MD.Parkinsonism: onset, progression and mortality[J]. Neurology,1967,17(5):427-442.
[12] Movement Disorder Society Task Force on Rating Scales for Parkinson's Disease. The Unified Parkinson's Disease Rating Scale (UPDRS): status and recommendations[J]. Mov Disord,2003,18(7):738-750.
[13] Li W, Wu B, Liu C.Quantitative susceptibility mapping of human brain reflects spatial variation in tissue composition[J]. Neuroimage,2011,55(4):1645-1656.
[14] Schweser F, Deistung A, Lehr BW, et al.Quantitative imaging of intrinsic magnetic tissue properties using MRI signal phase: an approach to in vivo brain iron metabolism?[J]. Neuroimage,2011,54(4):2789-2807.
[15] Zecca L, Casella L, Albertini A, et al.Neuromelanin can protect against iron-mediated oxidative damage in system modeling iron overload of brain aging and Parkinson's disease[J]. J Neurochem,2008,106(4):1866-1875.
[16] Zucca FA, Segura-Aguilar J, Ferrari E, et al. Interactions of iron, dopamine and neuromelanin pathways in brain aging and Parkinson's disease[J]. Prog Neurobiol,2015,pii:S0301-S0382.