The 'Swallow Tail' Appearance of the Healthy Nigrosome - A New Accurate Test of Parkinson's Disease: A Case-Control and Retrospective Cross-Sectional MRI Study at 3T

被引:217
作者
Schwarz, Stefan T. [1 ]
Afzal, Mohammed [2 ]
Morgan, Paul S. [3 ]
Bajaj, Nin [4 ]
Gowland, Penny A. [5 ]
Auer, Dorothee P. [1 ]
机构
[1] Univ Nottingham, Sch Med, Div Clin Neurosci, Nottingham, England
[2] Nottingham Univ Hosp NHS Trust, Dept Med, Nottingham, England
[3] Nottingham Univ Hosp NHS Trust, Nottingham, England
[4] Nottingham Univ Hosp NHS Trust, Dept Neurol, Nottingham, England
[5] Sir Peter Mansfield Magnet Resonance Ctr, Sch Phys & Astron, Nottingham, England
来源
PLOS ONE | 2014年 / 9卷 / 04期
基金
英国医学研究理事会;
关键词
SUBSTANTIA-NIGRA; DIFFERENTIAL-DIAGNOSIS; CLINICAL-DIAGNOSIS; HUMAN BRAIN;
D O I
10.1371/journal.pone.0093814
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
There is no well-established in vivo marker of nigral degeneration in Parkinson's disease (PD). An ideal imaging marker would directly mirror the loss of substantia nigra dopaminergic neurones, which is most prominent in sub-regions called nigrosomes. High-resolution, iron-sensitive, magnetic resonance imaging (MRI) at 7T allows direct nigrosome-1 visualisation in healthy people but not in PD. Here, we investigated the feasibility of nigrosome-1 detection using 3T - susceptibility weighted (SWI) MRI and the diagnostic accuracy that can be achieved for diagnosing PD in a clinical population. 114 high-resolution 3T - SWI-scans were reviewed consisting of a prospective case-control study in 19 subjects ( 10 PD, 9 controls) and a retrospective cross-sectional study in 95 consecutive patients undergoing routine clinical SWI-scans (. 50 years, 9 PD, 81 non-PD, 5 non-diagnostic studies excluded). Two raters independently classified subjects into PD and non-PD according to absence or presence of nigrosome-1, followed by consensus reading. Diagnostic accuracy was assessed against clinical diagnosis as gold standard. Absolute inter-and intra-rater agreement was >= 94%(kappa >= 0.82,p < 0.001). In the prospective study 8/9 control and 8/10 PD; and in the retrospective study 77/81 non-PD and all 9 PD subjects were correctly classified. Diagnostic accuracy of the retrospective cohort was: sensitivity 100%, specificity 95%, NPV 1, PPV 0.69 and accuracy 96% which dropped to 91% when including non-diagnostic scans (`intent to diagnose'). The healthy nigrosome-1 can be readily depicted on high-resolution 3T - SWI giving rise to a `swallow tail' appearance of the dorsolateral substantia nigra, and this feature is lost in PD. Visual radiological assessment yielded a high diagnostic accuracy for PD vs. an unselected clinical control population. Assessing the substantia nigra on SWI for the typical `swallow tail' appearance has potential to become a new and easy applicable 3T MRI diagnostic tool for nigral degeneration in PD.
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