Potential of advanced MR imaging techniques in the differential diagnosis of parkinsonism

Abstract

The clinical differentiation of parkinsonian syndromes remains challenging not only for neurologists but also for movement disorder specialists. Conventional magnetic resonance imaging (cMRI) with the visual assessment of T2- and T1-weighted imaging as well as different advanced MRI techniques offer objective measures, which may be a useful tool in the diagnostic work-up of Parkinson's disease and atypical parkinsonian disorders (APDs). In clinical practice, cMRI is a well-established method for the exclusion of symptomatic parkinsonism due to other pathologies. Over the past two decades, abnormalities in the basal ganglia and infratentorial structures have been shown especially in APDs not only by cMRI but also by different advanced MRI techniques, including methods to assess regional cerebral atrophy quantitatively such as magnetic resonance volumetry, proton magnetic resonance spectroscopy, diffusion-weighted imaging, and magnetization transfer imaging. This article aims to review recent research findings on the role of advanced MRI techniques in the differential diagnosis of neurodegenerative parkinsonian disorders.

Differentiation of Typical and Atypical Parkinson Syndromes by Quantitative MR Imaging

“…Previous studies have reported increased apparent diffusion coefficients in the basal ganglia regions, particularly in the PA/ PU, and, recently, in the superior cerebellar peduncle. 7,25,26 Although we could confirm the changes in the PA, a better separation was achieved by using the SN regions of interest; in comparison with MSA, the magnitude of differences and, thus, the predictive power was lower. In PSP, a profound volume loss in the brain stem is a typical feature and has been confirmed by volumetric MR imaging studies.…”

“…Quantitative MRI is increasingly used to investigate normal aging and neurodegeneration. So far, DTI, magnetization transfer expressed with the MTR, and T2 and T2* relaxometry have been used 7 to scrutinize the anatomic involvement and dynamics of the pathologic processes in patients with IPS and/or APS, but they are also used in clinical decision-making. To unravel which quantitative method (DTI, magnetization transfer imaging, T2/T2* relaxometry) is best suited for clinical purposes and to understand more about the differences in the underlying neurodegenerative processes, we conducted a head-to-head quantitative MR imaging study including healthy elderly controls and patients with IPS, PSP, and MSA-type Parkinson.…”

Diagnosis of multiple system atrophy

“…Cognitive impairment in MSA is also associated with specific VBM changes (Fiorenzato et al, 2017). Because it requires group comparisons using study-specific templates and sophisticated processing and analysis, VBM is not routinely applied in the clinical diagnostic work-up of patients with MSA (Hotter et al, 2009). …”

Magnetic resonance imaging for the diagnosis of Parkinson’s disease

“…Yet, these abnormalities seem to be of barely diagnostic relevance for CBD (Schrag et al 2000; Josephs et al 2004; Hotter et al 2009). Intriguingly, a review of 40 autopsy cases with life-time diagnosis of a CBD showed that neither cortical nor corpus callosum atrophy nor subcortical and periventricular white matter signal changes on MRI were specific to CBD but showed similar patterns in the patients with other neurodegenerative diseases (Josephs et al 2004).…”