Can loss of the swallow tail sign help distinguish between Parkinson Disease and the Parkinson-Plus syndromes?

Oustwani, Christopher S.; Korutz, Alexander; Lester, Malisa S.; Kianirad, Yasaman; Simuni, Tanya; Hijaz, Tarek A.

doi:10.1016/j.clinimag.2017.04.005

Cited by 21 publications

(31 citation statements)

References 25 publications

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“…We surmised that patients exhibiting multiple system atrophy with predominant parkinsonism and progressive supranuclear palsy may also show abnormalities similar to those associated with IPD, as suggested in recent studies. 22 25 26 27 Fourth, despite its utility, the results of QSM have been shown to depend on the specific methods and parameters used in the reconstruction process. It might therefore be necessary to determine the optimal threshold if a user applies different QSM options or algorithms for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Early-Stage Idiopathic Parkinson's Disease Using High-Resolution Quantitative Susceptibility Mapping Combined with Histogram Analysis in the Substantia Nigra at 3 T

et al. 2018

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Background and PurposeTo test whether nigrosome-1 imaging using high-resolution quantitative susceptibility mapping (QSM) combined with histogram analysis can improve the diagnostic accuracy in early-stage idiopathic Parkinson's disease (IPD) patients.MethodsThree-dimensional multiecho gradient-recalled echo images (0.5×0.5×1.0 mm3) were obtained at 3 T for QSM in 38 patients with IPD and 25 healthy subjects. To segment the substantia nigra (SN), regions of interest (ROIs) were semiautomatically drawn at the location below the red nucleus, and the normal-appearing nigrosome-1 was determined by manual correction. QSM histograms were obtained within the ROI. The segmented SN regions on the right and left that had higher mean susceptibility values and fewer voxels with susceptibility values lower than 60, 65, 70, 75, and 80 ppb were chosen for comparisons between the IPD patients and healthy subjects. These results were compared with those of the visual assessments of nigrosome-1 in susceptibility map-weighted imaging (SMWI) by analyzing receiver operating characteristics curves.ResultsThe proportion of voxels with susceptibility values lower than 70 ppb showed the best diagnostic performance, with its value differing significantly between the IPD patients (median=0, interquartile range=0–0.23) and healthy subjects (median=10.67, interquartile range=5.98–21.57) (p<0.0001). The number of voxels with susceptibility values lower than 60, 65, 70, 75, and 80 ppb showed worse diagnostic performances but were still significantly better than that of the mean susceptibility value (p=0.0249, 0.0192, 0.0183, 0.0191, and 0.0186, respectively), which also differed significantly between the two groups: 125.81±16.27 ppb (mean±standard deviation) in IPD versus 98.41±11.70 ppb in healthy subjects (p<0.0001). Additionally, using the proportion of voxels with susceptibility values lower than 70 ppb provided significantly better diagnostic performance than did visual assessments of SMWI (p=0.0143).ConclusionsHigh-spatial-resolution QSM combined with histogram analysis at 3 T can improve the diagnostic accuracy of early-stage IPD.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of Early-Stage Idiopathic Parkinson's Disease Using High-Resolution Quantitative Susceptibility Mapping Combined with Histogram Analysis in the Substantia Nigra at 3 T

et al. 2018

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“…We have shown that by using susceptibility-based MRI techniques and post-processing algorithms, a high diagnostic separation of PSP from PD and MSA can be achieved [6,7]. Another T 2 *-related marker is the so-called "swallow tail sign" on susceptibility weighted imaging in parkinsonism [8,9]. MRI with neuromelanin sensitive T 1 -weighted sequences has been shown to exhibit changes in PD and atypical parkinsonism, with reduced neuromelanin signal volumes in the substantia nigra in PD, PSP, MSA and corticobasal degeneration compared to healthy controls [10,11].…”

Section: Introductionmentioning

confidence: 99%

Automated brainstem volumetry can aid in the diagnostics of parkinsonian disorders

Sjöström

Granberg

Hashim

et al. 2020

Parkinsonism & Related Disorders

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Separating progressive supranuclear palsy (PSP) from Parkinson's disease (PD) and multiple system atrophy (MSA) is often challenging in early disease but is important for appropriate management. Magnetic resonance imaging (MRI) can aid the diagnostics and manual 2D measurements are often used. However, new fully automatic brainstem volumetry could potentially be more accurate and increase availability of brainstem metrics. Methods: Clinical 3D T1-weighted MRI were obtained from 196 consecutive patients; 29 PSP, 27 MSA, 140 PD. Midbrain-pons ratio and magnetic resonance parkinsonism index (MRPI) 1.0 and 2.0 were manually calculated, and intra-rater and inter-rater reliability was assessed. FreeSurfer was used to automatically segment brainstem substructures, normalized to the intracranial volume. The robustness of the automated analysis was evaluated in 3 healthy controls. The diagnostic accuracy of the brainstem biomarkers was assessed using receiver operating characteristic curves. Results: Automatic brainstem volumetry had good repeatability/reproducibility with intra-scanner coefficient of variation 0.3-5.5% and inter-scanner coefficient of variation 0.9-8.4% in the different brainstem regions. Midbrain volume performs better than planimetric measurements in separating PSP from PD (Area under the curve (AUC) 0.90 compared with 0.81 for midbrain-pons ratio (p = 0.019), 0.77 for MRPI 1.0 (p = 0.007) and 0.81 for MRPI 2.0 (p = 0.021)). Midbrain volume performed on par with planimetry for separation between PSP and MSA. Conclusion: Automatic brainstem segmentation is robust and shows promising diagnostic performance in separating PSP from PD and MSA. If further developed, it could play a role in diagnosing PSP and could potentially be used as an outcome in clinical trials.

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“…A subsequent histology–MRI correlation study showed that the hyperintense region in the dorsal SN in SWI matched to nigrosome 1 in histology and the hyperintensity is lost in IPD [Blazejewska et al, ]. Since these pioneering works, loss of nigral hyperintensity in SWI has recently emerged as a new imaging sign for idiopathic Parkinson's disease (IPD) [Bae et al, ; Cosottini et al, ; Gao et al, ; Kim et al, ; Mahlknecht et al, ; Noh et al, ; Oh et al, ; Oustwani et al, ; Reiter et al, ; Schwarz et al, ; Sung et al, ; Wang et al, ]. In these recent studies, researchers have assessed a subregion of the substantia nigra (SN), which is located in the posterior (or dorsal) aspect of the SN, to observe the presence or absence of hyperintensity in the subregion.…”

Section: Introductionmentioning

confidence: 99%

“…In these recent studies, researchers have assessed a subregion of the substantia nigra (SN), which is located in the posterior (or dorsal) aspect of the SN, to observe the presence or absence of hyperintensity in the subregion. This subregion has been referred to as “swallow tail” appearance [Gao et al, ; Oustwani et al, ; Schwarz et al, ; Wang et al, ], “dorsolateral nigral hyperintensity” [Reiter et al, ], “hyperintensity between two hypointense regions in the dorsal SN” [Cosottini et al, ; Frosini et al, ], “nigral hyperintensity” [Bae et al, ; Kim et al, ], and “nigrosome 1 region” [Blazejewska et al, ; Meijer et al, ; Nam et al, ; Noh et al, ; Oh et al, ; Sung et al, ].…”

Section: Introductionmentioning

confidence: 99%

Differential involvement of nigral subregions in idiopathic parkinson's disease

Sung

Lee

Nam

et al. 2017

Human Brain Mapping

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In this study, the prevalence of abnormality in putative nigrosome 1 and nigrosome 4 (N1 and N4, respectively) was investigated in early versus late-stage idiopathic Parkinson's disease (IPD) patients. A total of 128 IPD patients (early stage[n 5 89]; late stage[n 5 39]) and 15 healthy subjects were scanned for high-resolution (0.5 3 0.5 3 1.0 mm 3 ) multiecho gradient-recalled echo MRI and dopamine transporter PET imaging. The MRI data were processed for susceptibility map-weighted imaging (SMWI) to improve a contrast-to-noise ratio, and the images were resliced at 0.5 mm to define N1 and N4. When each side of N1 and N4 was assessed separately for the loss of hyperintensity by two independent reviewers, the consensus review results showed that in early-stage IPD (178 substantia nigras [SNs]), the loss of hyperintensity was observed more often in only the N1 region (65.2%) when compared to in both N1 and N4 regions (34.8%). In late-stage IPD (78 SNs), on the other hand, the loss in only the N1 region (25.6%) was less prevalent than in both N1 and N4 (74.4%) (P < 0.0001). Additionally, intact SNs (both in N1 and N4) were observed 17 SNs (9.6%) of the early-stage IPD patients, whereas it was not found in any SNs of the late-stage IPD patients (P 5 0.005). Moreover, involvement of both N1 and N4 on both sides was found in 19.1% of the early-stage IPD patients, whereas its incidence was higher (61.5%) in the late-stage IPD patients (P < 0.0001), suggesting that the loss of hyperintensity in IPD progresses from N1 to N4 as the disease advances. Hum Brain Mapp 39:542-553, 2018.V C 2017 Wiley Periodicals, Inc.

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Can loss of the swallow tail sign help distinguish between Parkinson Disease and the Parkinson-Plus syndromes?

Cited by 21 publications

References 25 publications

Diagnosis of Early-Stage Idiopathic Parkinson's Disease Using High-Resolution Quantitative Susceptibility Mapping Combined with Histogram Analysis in the Substantia Nigra at 3 T

Diagnosis of Early-Stage Idiopathic Parkinson's Disease Using High-Resolution Quantitative Susceptibility Mapping Combined with Histogram Analysis in the Substantia Nigra at 3 T

Automated brainstem volumetry can aid in the diagnostics of parkinsonian disorders

Differential involvement of nigral subregions in idiopathic parkinson's disease

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