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Free water imaging in Parkinson’s disease and atypical parkinsonian disorders

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Abstract

Background

Free water (FW)-corrected diffusion measures are more precise compared to standard diffusion measures. This study comprehensively evaluates FW and corrected diffusion metrics for whole brain white and deep gray matter (WM, GM) structures in patients with Parkinson’s disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) and attempts to ascertain the probable patterns of WM abnormalities.

Method

Diffusion MRI was acquired for subjects with PD (n = 133), MSA (n = 25), PSP (n = 30) and matched healthy controls (HC) (n = 99, n = 24, n = 12). Diffusion metrics of FA, MD, AD, RD were generated and FW, corrected FA maps were calculated using a bi-tensor model. TBSS was carried out at 5000 permutations with significance at p < 0.05. For GM, diffusivity maps were extracted from the basal ganglia, and analyzed at an FDR with p < 0.05.

Results

Compared to HC, PD showed focal changes in FW. MSA showed changes in the cerebellum and brainstem, and PSP showed increase in FW involving supratentorial WM and midbrain. All three showed increased substantia nigra FW. MSA, PSP demonstrated increased FW in bilateral putamen. PD showed increased FW in left GP externa, and bilateral thalamus. Compared to HC, MSA had increased FW in bilateral GP interna, and left thalamic. PSP had an additional increase in FW of the right GP externa, right GP interna, and bilateral thalamus.

Conclusion

The present study demonstrated definitive differences in the patterns of FW alterations between PD and atypical parkinsonian disorders suggesting the possibility of whole brain FW maps being used as markers for diagnosis of these disorders.

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Data availability

Data will be shared upon reasonable request.

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Acknowledgements

Shweta Prasad is currently supported by the DBT/ Wellcome Trust India Alliance Early Career Fellowship (IA/CPHE/21/1/505953).

Funding

Dept. of Biotechnology (DBT), Govt. of India (BT/PR14315/MED/30/474/2010); Indian Council of Medical Research (ICMR) (ICMR/003/304/2013/00694).

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Authors and Affiliations

  1. Symbiosis Center for Medical Image Analysis and Symbiosis Institute of Technology, Symbiosis International University, Lavale, Mulshi, Pune, 412115, Maharashtra, India

    Apurva Shah & Madhura Ingalhalikar

  2. Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, Karnataka, India

    Shweta Prasad, Abhilasha Indoria & Jitender Saini

  3. Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bengaluru, 560029, Karnataka, India

    Pramod Kumar Pal

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Correspondence to Madhura Ingalhalikar.

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An institutional ethical committee waiver was obtained to utilise previously acquired imaging in future studies (NIMHANS/IEC/2019-20).

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Shah, A., Prasad, S., Indoria, A. et al. Free water imaging in Parkinson’s disease and atypical parkinsonian disorders. J Neurol 271, 2521–2528 (2024). https://doi.org/10.1007/s00415-024-12184-9

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  • DOI: https://doi.org/10.1007/s00415-024-12184-9

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