Direct Visualization of Parkinson's Disease by In Vivo Human Brain Imaging Using 7.0T Magnetic Resonance Imaging

Neuroscience Research Institute, Gachon University of Medicine and Science, Namdong-gu, Incheon, South Korea.
Movement Disorders (Impact Factor: 5.68). 03/2011; 26(4):713-8. DOI: 10.1002/mds.23465
Source: PubMed


Parkinson's disease (PD) is a neurodegenerative disorder resulting from progressive loss of dopaminergic neurons in the substantia nigra (SN) pars compacta. Therefore, imaging of the SN has been regarded to hold greatest potential for use in the diagnosis of PD. At the 7.0T magnetic resonance imaging (MRI), it is now possible to delineate clearly the shapes and boundaries of the SN. We scanned eight early and two advanced PD patients, along with nine age-matched control subjects, using a 7.0T MRI in an attempt to directly visualize the SN and quantify the differences in shape and boundaries of SN between PD subjects in comparison with the normal control subjects. In the normal controls, the boundaries between the SN and crus cerebri appear smooth, and clean "arch" shapes that stretch ventrally from posterior to anterior. In contrast, these smooth and clean arch-like boundaries were lost in PD subjects. The measured correlation analyses show that, in PD patients, there is age-dependent correlation and substantially stronger UPDRS motor score-dependent correlation. These results suggest that, by using 7.0T MRI, it appears possible to use these visible and distinctive changes in morphology as a diagnostic marker of PD.

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Available from: Se-Hong Oh, Jan 02, 2015
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    • "Significantly reduced volumes of the whole SN in PD have also been reported at 3T [Menke et al., 2009], but with limited specificity for diagnostic potential. Recently, two promising studies carried out at 7T field strength detected nigral boundary and volumetric differences in small samples of PD patients and controls [Cho et al., 2011; Kwon et al., 2012], suggesting that to date clinically elusive ultra-high field structural MRI that enables excellent visualization of the SN may be able to provide a diagnostic marker for PD in the future. "
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    ABSTRACT: Previous imaging studies that investigated morphometric group differences of subcortical regions outside the substantia nigra between non-demented Parkinson's patients and controls either did not find any significant differences, or reported contradictory results. Here, we performed a comprehensive morphometric analysis of 20 cognitively normal, early-stage PD patients and 19 matched control subjects. In addition to relatively standard analyses of whole-brain grey matter volume and overall regional volumes, we examined subtle localized surface shape differences in striatal and limbic grey matter structures and tested their utility as a diagnostic marker. Voxel-based morphometry and volumetric comparisons did not reveal significant group differences. Shape analysis, on the other hand, demonstrated significant between-group shape differences for the right pallidum. Careful diffusion tractography analysis showed that the affected parts of the pallidum are connected subcortically with the subthalamic nucleus, the pedunculopontine nucleus, and the thalamus and cortically with the frontal lobe. Additionally, microstructural measurements along these pathways, but not along other pallidal connections, were significantly different between the two groups. Vertex-wise linear discriminant analysis, however, revealed limited accuracy of pallidal shape for the discrimination between patients and controls. We conclude that localized disease-related changes in the right pallidum in early Parkinson's disease, undetectable using standard voxel-based morphometry or volumetry, are evident using sensitive shape analysis. However, the subtle nature of these changes makes it unlikely that shape analysis alone will be useful for early diagnosis. Hum Brain Mapp, 2013. © 2013 Wiley-Periodicals, Inc.
    Human Brain Mapping 04/2014; 35(4). DOI:10.1002/hbm.22282 · 5.97 Impact Factor
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    • "This was followed by Gorell et al. in 1995 who utilized T2 and T2* imaging of the substantia nigra and showed a separation between those with PD from control participants by using a change in relaxation time constants as a surrogate for increased iron in PD [3]. The focus on T2*or its reciprocal R2*has remained an important aspect of nigral imaging protocols, and an excellent demonstration of macroscopic nigral changes attributable to iron was shown by Cho et al. in their 7 Tesla (T) imaging study [4]. One crucial assumption about “iron” based imaging is that the methods reflect upon non-heme iron as opposed to heme-iron, and that while the small pool of free labile iron may be pathogenic - imaging methods are presently sensitive to the more prevalent bound iron that is stored as ferritin or neuromelanin [5]. "
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    ABSTRACT: Recent developments in brain imaging methods are on the verge of changing the evaluation of people with Parkinson's disease (PD). This includes an assortment of techniques ranging from diffusion tensor imaging (DTI) to iron-sensitive methods such as T2 (*), as well as adiabatic methods R1ρ and R2ρ, resting-state functional MRI, and magnetic resonance spectroscopy (MRS). Using a multi-modality approach that ascertains different aspects of the pathophysiology or pathology of PD, it may be possible to better characterize disease phenotypes as well as provide a surrogate of disease and a potential means to track disease progression.
    03/2013; Suppl 1:001. DOI:10.4172/2161-0460.S1-001
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    ABSTRACT: The authors reviewed 70 publications on MR imaging-based targeting techniques for identifying the subthalamic nucleus (STN) for deep brain stimulation in patients with Parkinson disease. Of these 70 publications, 33 presented quantitatively validated results. There is still no consensus on which targeting technique to use for surgery planning; methods vary greatly between centers. Some groups apply indirect methods involving anatomical landmarks, or atlases incorporating anatomical or functional data. Others perform direct visualization on MR imaging, using T2-weighted spin echo or inversion recovery protocols. The combined studies do not offer a straightforward conclusion on the best targeting protocol. Indirect methods are not patient specific, leading to varying results between cases. On the other hand, direct targeting on MR imaging suffers from lack of contrast within the subthalamic region, resulting in a poor delineation of the STN. These deficiencies result in a need for intraoperative adaptation of the original target based on test stimulation with or without microelectrode recording. It is expected that future advances in MR imaging technology will lead to improvements in direct targeting. The use of new MR imaging modalities such as diffusion MR imaging might even lead to the specific identification of the different functional parts of the STN, such as the dorsolateral sensorimotor part, the target for deep brain stimulation.
    Journal of Neurosurgery 07/2011; 115(5):971-84. DOI:10.3171/2011.6.JNS101571 · 3.74 Impact Factor
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