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Research ArticleBrain

Differentiation of Typical and Atypical Parkinson Syndromes by Quantitative MR Imaging

N.K. Focke, G. Helms, P.M. Pantel, S. Scheewe, M. Knauth, C.G. Bachmann, J. Ebentheuer, P. Dechent, W. Paulus and C. Trenkwalder
American Journal of Neuroradiology December 2011, 32 (11) 2087-2092; DOI: https://doi.org/10.3174/ajnr.A2865
N.K. Focke
aFrom the Department of Clinical Neurophysiology (N.K.F., P.M.P., S.S., C.G.B., W.P.)
dParacelsus Elena Klinik (N.K.F., J.E., C.T.), Specialized Movement Disorders Hospital, Kassel, Germany.
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G. Helms
bMR-Research in Neurology and Psychiatry (G.H., P.D.)
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P.M. Pantel
aFrom the Department of Clinical Neurophysiology (N.K.F., P.M.P., S.S., C.G.B., W.P.)
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S. Scheewe
aFrom the Department of Clinical Neurophysiology (N.K.F., P.M.P., S.S., C.G.B., W.P.)
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M. Knauth
cDepartment of Neuroradiology (M.K.), Georg-August University Göttingen, Göttingen, Germany
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C.G. Bachmann
aFrom the Department of Clinical Neurophysiology (N.K.F., P.M.P., S.S., C.G.B., W.P.)
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J. Ebentheuer
dParacelsus Elena Klinik (N.K.F., J.E., C.T.), Specialized Movement Disorders Hospital, Kassel, Germany.
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P. Dechent
bMR-Research in Neurology and Psychiatry (G.H., P.D.)
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W. Paulus
aFrom the Department of Clinical Neurophysiology (N.K.F., P.M.P., S.S., C.G.B., W.P.)
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C. Trenkwalder
dParacelsus Elena Klinik (N.K.F., J.E., C.T.), Specialized Movement Disorders Hospital, Kassel, Germany.
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Abstract

BACKGROUND AND PURPOSE: The differential diagnosis of Parkinson syndromes remains a major challenge. Quantitative MR imaging can aid in this classification, but it is unclear which of the proposed techniques is best suited for this task. We, therefore, conducted a head-to-head study with different quantitative MR imaging measurements in patients with IPS, MSA-type Parkinson, PSP, and healthy elderly controls.

MATERIALS AND METHODS: Thirty-one patients and 13 controls underwent a comprehensive quantitative MR imaging protocol including R2*-, R2- and R1-mapping, magnetization transfer, and DTI with manual region-of-interest measurements in basal ganglia regions. Group differences were assessed with a post hoc ANOVA with a Bonferroni error correction and an ROC.

RESULTS: The best separation of MSA from IPS in patients and controls could be achieved with R2*-mapping in the PU, with an ROC AUC of ≤0.96, resulting in a sensitivity of 77.8% (with a specificity 100%). MD was increased in patients with PSP compared with controls and to a lesser extent compared with those with IPS and MSA in the SN.

CONCLUSIONS: Among the applied quantitative MR imaging methods, R2*-mapping seems to have the best predictive power to separate patients with MSA from those with IPS, and DTI for identifying PSP.

ABBREVIATIONS

APS
atypical Parkinson syndrome
AUC
area under the curve
CN
(head of the) caudate nucleus
FA
fractional anisotropy
FLASH
fast low-angle shot
IPS
idiopathic Parkinson syndrome
MD
mean diffusivity
MPRAGE
magnetization-prepared rapid acquisition of gradient echo
MSA
multiple systems atrophy
MTR
magnetization transfer ratio
PA
globus pallidum
PSP
progressive supranuclear palsy
PU
putamen
R1
T1 relaxation rate
R2
T2 relaxation rate
R2*
T2* relaxation rate
ROC
receiver operating characteristic analysis
SN
substantia nigra
STEAM
stimulated echo acquisition mode
  • © 2011 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 32 (11)
American Journal of Neuroradiology
Vol. 32, Issue 11
1 Dec 2011
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Cite this article
N.K. Focke, G. Helms, P.M. Pantel, S. Scheewe, M. Knauth, C.G. Bachmann, J. Ebentheuer, P. Dechent, W. Paulus, C. Trenkwalder
Differentiation of Typical and Atypical Parkinson Syndromes by Quantitative MR Imaging
American Journal of Neuroradiology Dec 2011, 32 (11) 2087-2092; DOI: 10.3174/ajnr.A2865

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Differentiation of Typical and Atypical Parkinson Syndromes by Quantitative MR Imaging
N.K. Focke, G. Helms, P.M. Pantel, S. Scheewe, M. Knauth, C.G. Bachmann, J. Ebentheuer, P. Dechent, W. Paulus, C. Trenkwalder
American Journal of Neuroradiology Dec 2011, 32 (11) 2087-2092; DOI: 10.3174/ajnr.A2865
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