Abstract
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. 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. 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. 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.
Highlights
AND PURPOSE: The differential diagnosis of Parkinson syndromes remains a major challenge
At higher magnetic field strengths (3T and above), this pattern can be found in healthy elderly subjects and its utility is, debatable.[3]
No significant differences were detected in the MD/FA, magnetization transfer, MTR, R1, or R2 maps
Summary
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. Subjects Thirty-one patients (12 with IPS, 10 with MSA-type Parkinson, and 9 with PSP) and 13 healthy elderly subjects were enrolled in the study after written informed consent was obtained. Patients were recruited consecutively from in- and outpatients who fulfilled the following criteria: MSA diagnosed according to clinical consensus criteria,[4] PSP according to the criteria of Litvan et al,[6] and IPS according to UK. Demographic details of controls and patient groups No. Age (mean). Sex (female/male) Controls 67.6 Ϯ 10.5 IPS 66.3 Ϯ 7.8 MSA-P
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