Diagnostic accuracy of quantitative susceptibility mapping in multiple system atrophy: The impact of echo time and the potential of histogram analysis

Lancione, Marta; Cencini, Matteo; Costagli, Mauro; Donatelli, Graziella; Tosetti, Michela; Giannini, Giulia; Zangaglia, Roberta; Calandra‐Buonaura, Giovanna; Pacchetti, Claudio; Cosottini, Mirco

doi:10.1016/j.nicl.2022.102989

Cited by 9 publications

(12 citation statements)

References 64 publications

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“…This is probably due to the TE and magnetic field strength dependence described in the literature. 37,38 TEs in our study at 7T compared with 3T are slightly shorter than the factor 2.6, which is recommended by Lancione et al to maximize reproducibility. Also, to increase the contrast-to-noise ratio (CNR) at 3T, more TEs were acquired at 3T than at 7T due to the longer TR.…”

Section: Discussionmentioning

confidence: 53%

“…This is probably due to the TE and magnetic field strength dependence described in the literature. 37,38 Using the data derived from this study, an a priori power analysis (using G*Power) 40 suggest an n of 22 per group to be sufficient to detect differences in the SN with a power of 0.9, while for the Pu and the GP, an n of 15 and 12, respectively, would allow to detect differences with a power of 0.9. Thus, the sample size in this study is large enough to deliver robust results for the Pu and the GP at 3T, whereas the results presented for the 7T cohort and the possible MSA subgroup need to be interpreted with caution.…”

Section: Why Does 7t Mri Yield Increased Diagnostic Accuracy?mentioning

confidence: 96%

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Parkinson’s disease or multiple system atrophy: potential separation by quantitative susceptibility mapping

Marxreiter

Lambrecht

Mennecke

et al. 2023

Ther Adv Neurol Disord

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Background: Due to the absence of robust biomarkers, and the low sensitivity and specificity of routine imaging techniques, the differential diagnosis between Parkinson’s disease (PD) and multiple system atrophy (MSA) is challenging. High-field magnetic resonance imaging (MRI) opened up new possibilities regarding the analysis of pathological alterations associated with neurodegenerative processes. Recently, we have shown that quantitative susceptibility mapping (QSM) enables visualization and quantification of two major histopathologic hallmarks observed in MSA: reduced myelin density and iron accumulation in the basal ganglia of a transgenic murine model of MSA. It is therefore emerging as a promising imaging modality on the differential diagnosis of Parkinsonian syndromes. Objectives: To assess QSM on high-field MRI for the differential diagnosis of PD and MSA. Methods: We assessed 23 patients (nine PDs and 14 MSAs) and nine controls using QSM on 3T and 7T MRI scanners at two academic centers. Results: We observed increased susceptibility in MSA at 3T in prototypical subcortical and brainstem regions. Susceptibility measures of putamen, pallidum, and substantia nigra reached excellent diagnostic accuracy to separate both synucleinopathies. Increase toward 100% sensitivity and specificity was achieved using 7T MRI in a subset of patients. Magnetic susceptibility correlated with age in all groups, but not with disease duration in MSA. Sensitivity and specificity were particularly high for possible MSA, and reached 100% in the putamen. Conclusion: Putaminal susceptibility measures, in particular on ultra-high-field MRI, may distinguish MSA patients from both, PD and controls, allowing an early and sensitive diagnosis of MSA.

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Section: Discussionmentioning

confidence: 53%

Section: Why Does 7t Mri Yield Increased Diagnostic Accuracy?mentioning

confidence: 96%

Parkinson’s disease or multiple system atrophy: potential separation by quantitative susceptibility mapping

Marxreiter

Lambrecht

Mennecke

et al. 2023

Ther Adv Neurol Disord

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“…When only the positive QSM values in M1 were considered, all distribution indices (mean value, standard deviation, skewness and kurtosis) exhibited statistically significant differences between the two groups. This observation suggests that a good strategy to highlight differences between ALS patients and controls might be to direct the analysis to positive-only QSM values (as it was carried out also by Schweitzer and colleagues [ 8 ]) and to distribution indices that carry information regarding the distribution tails, such as the standard deviation, skewness and kurtosis, whose highly informative roles have been demonstrated also in recent QSM studies on Parkinson’s disease [ 26 ] and Multiple System Atrophy [ 27 ]. Another important result of this study is the demonstration that improved classification of ALS patients and controls can be achieved by leveraging on the joint use of the distribution indices of QSM values in M1.…”

Section: Discussionmentioning

confidence: 99%

Distribution Indices of Magnetic Susceptibility Values in the Primary Motor Cortex Enable to Classify Patients with Amyotrophic Lateral Sclerosis

et al. 2022

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Quantitative Susceptibility Mapping (QSM) can measure iron concentration increase in the primary motor cortex (M1) of patients with Amyotrophic Lateral Sclerosis (ALS). However, such alteration is confined to only specific regions interested by upper motor neuron pathology; therefore, mean QSM values in the entire M1 have limited diagnostic accuracy in discriminating between ALS patients and control subjects. This study investigates the diagnostic accuracy of a broader set of M1 QSM distribution indices in classifying ALS patients and controls. Mean, standard deviation, skewness and kurtosis of M1 QSM values were used either individually or as combined predictors in support vector machines. The classification performance was compared to that obtained by the radiological assessment of T2* signal hypo-intensity of M1 in susceptibility-weighted MRI. The least informative index for the classification of ALS patients and controls was the subject’s mean QSM value in M1. The highest diagnostic performance was obtained when all the distribution indices of positive QSM values in M1 were considered, which yielded a diagnostic accuracy of 0.90, with sensitivity = 0.89 and specificity = 1. The radiological assessment of M1 yielded a diagnostic accuracy of 0.79, with sensitivity = 0.76 and specificity = 0.90. The joint evaluation of QSM distribution indices could support the clinical examination in ALS diagnosis and patient monitoring.

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“…More recently, such characteristic has been shown to be more distinct in the Parkinsonian subtype of MSA compared to MSA-C. Disease-subtype-specific examination of iron dysregulation reveals distinct patterns of iron deposition in pathology-related anatomical systems (Figure 2). In MSA-P, iron accumulation is consistently most extenuated in the putamen as a disease-distinguishing pathological hallmark [168][169][170]. Moreover, subcortical regions, including the GP and the SN, are affected by greater deposition of iron compared to MSA-C brains [168,170].…”

Section: Iron Dysregulation In Msamentioning

confidence: 98%

The Irony of Iron: The Element with Diverse Influence on Neurodegenerative Diseases

Lee,

Kovacs

2024

IJMS

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Iron accumulation in the brain is a common feature of many neurodegenerative diseases. Its involvement spans across the main proteinopathies involving tau, amyloid-beta, alpha-synuclein, and TDP-43. Accumulating evidence supports the contribution of iron in disease pathologies, but the delineation of its pathogenic role is yet challenged by the complex involvement of iron in multiple neurotoxicity mechanisms and evidence supporting a reciprocal influence between accumulation of iron and protein pathology. Here, we review the major proteinopathy-specific observations supporting four distinct hypotheses: (1) iron deposition is a consequence of protein pathology; (2) iron promotes protein pathology; (3) iron protects from or hinders protein pathology; and (4) deposition of iron and protein pathology contribute parallelly to pathogenesis. Iron is an essential element for physiological brain function, requiring a fine balance of its levels. Understanding of disease-related iron accumulation at a more intricate and systemic level is critical for advancements in iron chelation therapies.

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Diagnostic accuracy of quantitative susceptibility mapping in multiple system atrophy: The impact of echo time and the potential of histogram analysis

Cited by 9 publications

References 64 publications

Parkinson’s disease or multiple system atrophy: potential separation by quantitative susceptibility mapping

Parkinson’s disease or multiple system atrophy: potential separation by quantitative susceptibility mapping

Distribution Indices of Magnetic Susceptibility Values in the Primary Motor Cortex Enable to Classify Patients with Amyotrophic Lateral Sclerosis

The Irony of Iron: The Element with Diverse Influence on Neurodegenerative Diseases

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