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Utility of susceptibility-weighted MRI in differentiating Parkinson’s disease and atypical parkinsonism

  • Diagnostic Neuroradiology
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Abstract

Introduction

Neuropathological studies report varying patterns of brain mineralization in Parkinson’s diseases (PD), progressive supranuclear palsy (PSP), and Parkinson variant of multiple system atrophy (MSA-P). Susceptibility-weighted imaging (SWI) is the ideal magnetic resonance imaging (MRI) technique to detect mineralization of the brain. The purpose of this study was to test if SWI can differentiate PD, PSP, and MSA-P.

Methods

Eleven patients with PD, 12 with PSP, 12 with MSA-P, and 11 healthy controls underwent SWI of the brain. Hypointensity of putamen, red nucleus, substantia nigra, and dentate nucleus in all groups were measured using an objective grading scale and scored from 0 to 3.

Results

In PSP, hypointensity score of red nucleus was higher than that in MSA-P (p = 0.001) and PD (p = 0.001), and a score of ≥2 differentiated the PSP group from the PD and MSA-P groups. Putaminal hypointensity score was higher in PSP when compared to that in PD (p = 0.003), and a score of ≥2 differentiated PSP from PD groups. SWI hypointensity scores of red nucleus and putamen had an excellent intrarater and interrater correlation. Substantia nigra hypointensity score of the PSP group was higher than that of the MSA-P (p = 0.004) and PD (p = 0.006) groups, but the scores had only a moderate intrarater and interrater correlation.

Conclusions

SWI shows different patterns of brain mineralization in clinically diagnosed groups of PD, PSP, and MSA-P and may be considered as an additional MR protocol to help differentiate these conditions.

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Abbreviations

ANOVA:

One-way analysis of variance

CSF:

Cerebrospinal fluid

DTI:

Diffusion tensor imaging

DWI:

Diffusion-weighted imaging

FA:

Fractional anisotropy

FSE:

Fast spin echo

GE:

Gradient echo imaging

ICCs:

Intraclass correlation coefficients

MCP:

Middle cerebellar peduncles

MMSE:

Mini-Mental Status Examination

MSA-P:

Multiple system atrophy–Parkinson variant

NA:

Not applicable

PD:

Parkinson’s disease

PSP:

Progressive supranuclear palsy

rADC:

Regional apparent coefficient of diffusion

ROI:

Regions of interest

SI:

Signal intensity

SWI:

Susceptibility-weighted imaging

UPDRS:

Unified Parkinson Disease Rating Scale

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Acknowledgments

This study was partially funded by the authors’ institute (project number 5181).

We thank Mr. Gangadhara Sarma for the assistance in co-coordinating the study.

We thank the subjects for their participation in the study.

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, 695011, Kerala, India

    Deepak Gupta & Asha Kishore

  2. Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India

    Jitender Saini & Chandrasekharan Kesavadas

  3. Achutha Menon Centre for Health Sciences, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India

    P. Sankara Sarma

  4. Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, 695011, Kerala, India

    Asha Kishore

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  1. Deepak Gupta
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  2. Jitender Saini
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  3. Chandrasekharan Kesavadas
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Correspondence to Asha Kishore.

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Gupta, D., Saini, J., Kesavadas, C. et al. Utility of susceptibility-weighted MRI in differentiating Parkinson’s disease and atypical parkinsonism. Neuroradiology 52, 1087–1094 (2010). https://doi.org/10.1007/s00234-010-0677-6

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  • DOI: https://doi.org/10.1007/s00234-010-0677-6

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