Abstract
Diffusion tensor imaging (DTI) allows measuring fractional anisotropy and similar microstructural indices of the brain white matter. Lower than normal fractional anisotropy as well as higher than normal diffusivity is associated with loss of microstructural integrity and neurodegeneration. Previous DTI studies in Parkinson's disease (PD) have demonstrated abnormal fractional anisotropy in multiple white matter regions, particularly in the dopaminergic nuclei and dopaminergic pathways. However, DTI is not considered a diagnostic marker for the earliest Parkinson's disease since anisotropic alterations present a temporally divergent pattern during the earliest Parkinson's course. This article reviews a majority of clinically employed DTI studies in PD, and it aims to prove the utilities of DTI as a marker of diagnosing PD, correlating clinical symptomatology, tracking disease progression, and treatment effects. To address the challenge of DTI being a diagnostic marker for early PD, this article also provides a comparison of the results from a longitudinal, early stage, multicenter clinical cohort of Parkinson's research with previous publications. This review provides evidences of DTI as a promising marker for monitoring PD progression and classifying atypical PD types, and it also interprets the possible pathophysiologic processes under the complex pattern of fractional anisotropic changes in the first few years of PD. Recent technical advantages, limitations, and further research strategies of clinical DTI in PD are additionally discussed.
Highlights
Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer disease
A Parkinson’s Progression Markers Initiative (PPMI) study [168] followed 423 patients from treatment beginning to year-5 and found that dopaminergic therapy provides significant improvements in the Movement Disorder Society revised Unified Parkinson’s Disease Rating Scale (UPDRS) (MDS-UPDRS) scores and the striatal dopamine transporters binding ratio (SBR) calculated from DAT-SPECT
This review outlines the clinical utilities of the low-cost, noninvasive diffusion tensor magnetic resonance imaging (MRI) for biomarker of diagnosing PD, correlating PD symptomatology, assessing PD progression, and differentiating atypical types of parkinsonism
Summary
Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer disease. - High MD of the basal ganglia regions correlated with non-motor dysfunction (UPDRS except part III) [15]. In comparison between YPD(Y0) and YHC, significantly higher FA was observed in patients in multiple brain regions, including the bilateral corticospinal tract (CST), internal capsule, striatum (the putamen, pallidum, and caudate nuclei), anterior and posterior and superior corona radiata, as well as in white matter areas that lie next to the motor and supplementary motor cortices. Different MRI scanners, field strength, and the number of diffusion directions could result in variability of the FA measurement and make group comparisons very difficult based on a multicenter population
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