Stefano Zanigni1, Claudia Testa1, Giovanna Calandra-Buonaura2, Luisa Sambati2, Maria Guarino3, Anna Gabellini4, Stefania Evangelisti1, Pietro Cortelli2, Raffaele Lodi5, Caterina Tonon1. 1. Functional MR Unit, Policlinico S. Orsola - Malpighi, Bologna (IT), Via Massarenti 9, 40138 Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna (IT), Via U. Foscolo 7, 40123 Bologna, Italy. 2. Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna (IT), Via U. Foscolo 7, 40123 Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna (IT), Via Altura 3, 40139 Bologna, Italy. 3. Neurology Unit, Policlinico S. Orsola - Malpighi, Bologna (IT), Via Massarenti 9, 40138 Bologna, Italy. 4. IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna (IT), Via Altura 3, 40139 Bologna, Italy; Neurology Unit, Ospedale Maggiore, Bologna (IT), Via B. Nigrisoli 2, 40133 Bologna, Italy. 5. Functional MR Unit, Policlinico S. Orsola - Malpighi, Bologna (IT), Via Massarenti 9, 40138 Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna (IT), Via U. Foscolo 7, 40123 Bologna, Italy. Electronic address: raffaele.lodi@unibo.it.
Abstract
INTRODUCTION: The in vivo differential diagnosis between idiopathic Parkinson's disease (PD) and atypical parkinsonian syndromes (PS), such as multiple system atrophy [MSA with a cerebellar (C) and parkinsonian (P) subtype] and progressive supranuclear palsy - Richardson's Syndrome (PSP-RS) is often challenging. Previous brain MR proton spectroscopy ((1)H-MRS) studies showed biochemical alterations in PS, despite results are conflicting. Cerebellum plays a central role in motor control and its alterations has been already demonstrated in atypical PS. The main aim of this study was to evaluate diagnostic accuracy of cerebellar (1)H-MRS in the differential diagnosis between PD and atypical PS. METHODS: We obtained (1)H-MRS spectra from the left cerebellar hemisphere of 57 PS (21 PD, and 36 atypical PS) and 14 unaffected controls by using a 1.5 T GE scanner. N-acetyl-aspartate (NAA)/Creatine (Cr), choline-containing compounds (Cho)/Cr, myoinositol (mI)/Cr, and NAA/mI ratios were calculated. RESULTS: NAA/Cr and NAA/mI ratios were significantly lower (p < 0.01) in atypical PS compared to PD and controls, and in MSA-C compared to PD, MSA-P, PSP-RS and controls. PSP-RS group showed reduced NAA/Cr ratios compared to PD (p < 0.05) and controls (p < 0.05), and reduced NAA/mI compared to controls (p < 0.01). NAA/Cr ratio values higher than 1.016 showed 100% sensitivity and negative predictive value, 62% positive predictive value and 64% specificity in discriminating PD. CONCLUSION: Cerebellar biochemical alterations detected by using (1)H-MRS could represent an adjunctive diagnostic tool to improve the differential diagnosis of PS.
INTRODUCTION: The in vivo differential diagnosis between idiopathic Parkinson's disease (PD) and atypical parkinsonian syndromes (PS), such as multiple system atrophy [MSA with a cerebellar (C) and parkinsonian (P) subtype] and progressive supranuclear palsy - Richardson's Syndrome (PSP-RS) is often challenging. Previous brain MR proton spectroscopy ((1)H-MRS) studies showed biochemical alterations in PS, despite results are conflicting. Cerebellum plays a central role in motor control and its alterations has been already demonstrated in atypical PS. The main aim of this study was to evaluate diagnostic accuracy of cerebellar (1)H-MRS in the differential diagnosis between PD and atypical PS. METHODS: We obtained (1)H-MRS spectra from the left cerebellar hemisphere of 57 PS (21 PD, and 36 atypical PS) and 14 unaffected controls by using a 1.5 T GE scanner. N-acetyl-aspartate (NAA)/Creatine (Cr), choline-containing compounds (Cho)/Cr, myoinositol (mI)/Cr, and NAA/mI ratios were calculated. RESULTS:NAA/Cr and NAA/mI ratios were significantly lower (p < 0.01) in atypical PS compared to PD and controls, and in MSA-C compared to PD, MSA-P, PSP-RS and controls. PSP-RS group showed reduced NAA/Cr ratios compared to PD (p < 0.05) and controls (p < 0.05), and reduced NAA/mI compared to controls (p < 0.01). NAA/Cr ratio values higher than 1.016 showed 100% sensitivity and negative predictive value, 62% positive predictive value and 64% specificity in discriminating PD. CONCLUSION: Cerebellar biochemical alterations detected by using (1)H-MRS could represent an adjunctive diagnostic tool to improve the differential diagnosis of PS.
Authors: Jennifer L Whitwell; Günter U Höglinger; Angelo Antonini; Yvette Bordelon; Adam L Boxer; Carlo Colosimo; Thilo van Eimeren; Lawrence I Golbe; Jan Kassubek; Carolin Kurz; Irene Litvan; Alexander Pantelyat; Gil Rabinovici; Gesine Respondek; Axel Rominger; James B Rowe; Maria Stamelou; Keith A Josephs Journal: Mov Disord Date: 2017-05-13 Impact factor: 10.338
Authors: Stanislav Motyka; Philipp Moser; Lukas Hingerl; Gilbert Hangel; Eva Heckova; Bernhard Strasser; Korbinian Eckstein; Simon Daniel Robinson; Benedikt A Poser; Stephan Gruber; Siegfried Trattnig; Wolfgang Bogner Journal: Magn Reson Med Date: 2019-04-01 Impact factor: 4.668