Susceptibility-Weighted Imaging Improves the Diagnostic Accuracy of 3T Brain MRI in the Work-Up of Parkinsonism

Abstract

BACKGROUND AND PURPOSE:The differentiation between Parkinson disease and atypical parkinsonian syndromes can be challenging in clinical practice, especially in early disease stages. Brain MR imaging can help to increase certainty about the diagnosis. Our goal was to evaluate the added value of SWI in relation to conventional 3T brain MR imaging for the diagnostic work-up of early-stage parkinsonism.

Magnetic resonance imaging for the diagnosis of Parkinson’s disease

“…Decreased putaminal hypointensity using SWI reflecting increased iron levels in MSA-P vs. PD was also reported by other reports (Lee and Baik 2011; Han et al 2013). Decreased mean SWI signal intensities of the red and dentate nuclei were reported to occur in patient with PSP compared to PD patients in one study (Meijer et al 2015a), while another reported decreased mean SWI signal intensities in the red nucleus and putamen. Mean phase shift values in different subcortical regions (including red nucleus, SN, caudate nucleus, globus pallidus, putamen, and thalamus) were analysed in a further study of 11 patients with PSP, 12 patients with MSA-P, 15 patients with PD, and 20 controls.…”

“…Patients with atypical parkinsonism due to PSP and MSA often show putaminal changes using iron-sensitive MRI sequences to a degree that they are of significant diagnostic yield (Arabia et al 2010; Gupta et al 2010; Haller et al 2012, 2013; Wadia et al 2013; Feng et al 2015; Meijer et al 2015a; Yoon et al 2015; Barbagallo et al 2016; Sakurai et al 2017). SWI phase images were applied for the determination of different iron-deposition patterns in several grey nuclei in 16 patients with PD, 8 patients with MSA-P and 44 age-matched healthy controls (Wang et al 2012b).…”

“…More recently, high-field SWI at 3.0 T was analysed by an ROI method of different brain structures in 13 controls and 65 patients presenting with clinically uncertain parkinsonism and a disease duration of less than 3 years, of whom probable diagnoses could be made in 56 patients (PD in 38, DLB and PSP in 3 each and MSA in 12) (Meijer et al 2015a). Disease-specific scores of conventional MRI-based well-known MR abnormalities had a high specificity for atypical parkinsonism (80–90%), but sensitivity was limited (50–80%), while the presence of severe dorsal putaminal hypointensity improved the accuracy of brain MR imaging with increasing the AUC from 0.75 to 0.83 for identifying MSA-P and from 0.76 to 0.82 for identifying atypical parkinsonism as a group, respectively (Meijer et al 2015a).…”

“…Disease-specific scores of conventional MRI-based well-known MR abnormalities had a high specificity for atypical parkinsonism (80–90%), but sensitivity was limited (50–80%), while the presence of severe dorsal putaminal hypointensity improved the accuracy of brain MR imaging with increasing the AUC from 0.75 to 0.83 for identifying MSA-P and from 0.76 to 0.82 for identifying atypical parkinsonism as a group, respectively (Meijer et al 2015a). Decreased putaminal hypointensity using SWI reflecting increased iron levels in MSA-P vs. PD was also reported by other reports (Lee and Baik 2011; Han et al 2013).…”

Differentiation of Parkinsonism-Predominant Multiple System Atrophy from Idiopathic Parkinson Disease Using 3T Susceptibility-Weighted MR Imaging, Focusing on Putaminal Change and Lesion Asymmetry

“…This finding was not clearly indicated by previous imaging studies, even those that used 3T imaging or 3T SWI. 18,23 Our quantitative measurement method was not a volumetric method and did not include all putaminal areas or consider the high-iron-deposition area that was proposed to be meaningful by previous publications. 11,13 Haacke et al 11 demonstrated that putative iron deposition in the high-iron-content region increases with age.…”