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Differential diagnosis of parkinsonism by a combined use of diffusion kurtosis imaging and quantitative susceptibility mapping

  • Diagnostic Neuroradiology
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Abstract

Purpose

We investigated whether diffusion kurtosis imaging (DKI) and quantitative susceptibility mapping (QSM) could detect pathological changes that occur in Parkinson’s disease (PD), multiple system atrophy with predominant parkinsonism (MSA-P) or predominant cerebellar ataxia (MSA-C), and progressive supranuclear palsy syndrome (PSPS) and thus be used for differential diagnosis that is often difficult.

Methods

Seventy patients (41 with PD, 6 with MSA-P, 7 with MSA-C, 16 with PSPS) and 20 healthy controls were examined using a 3.0 T MRI scanner. From DKI and QSM data, we automatically obtained mean kurtosis (MK), fractional anisotropy (FA), and mean diffusivity (MD) values of the midbrain tegmentum (MBT), pontine crossing tract (PCT), and superior/middle cerebellar peduncles (CPs), which were used to calculate diffusion MBT/PCT ratios (dMPRs) and diffusion superior/middle CP ratios (dCPRs), as well as MS (magnetic susceptibility) values of the anterior/posterior putamen (PUa and PUp) and globus pallidus (GP).

Results

dMPRs of MK were significantly decreased in PSPS and increased in MSA-C compared with the other groups, while dCPRs of MK showed significant differences only between MSA-C and PD, PSPS, or control. MS values were significantly increased in the PUp of MSA-P and in the PUa and GP of PSPS compared with those in PD. The combined use of MK-dMPR and MS-PUp showed sensitivities of 83–100% and specificities of 81–100% for discriminating among the disease groups, respectively.

Conclusion

A quantitative assessment using DKI and QSM analyses, particularly MK-dMPR and MS-PUp values, can readily identify patients with parkinsonism.

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Authors and Affiliations

  1. Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, 2-1-1 Nishitokuta, Yahaba, Iwate, 028-3694, Japan

    Kenji Ito & Makoto Sasaki

  2. Department of Neurology and Gerontology, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, Japan

    Chigumi Ohtsuka & Yasuo Terayama

  3. Department of Radiology, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, Japan

    Kunihiro Yoshioka

  4. Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, Hokkaido, Japan

    Hiroyuki Kameda

  5. Research & Development Group, Hitachi, Ltd., 1-280 Higashi-Koigakubo, Kokubunji, Tokyo, Japan

    Suguru Yokosawa & Ryota Sato

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  1. Kenji Ito
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  2. Chigumi Ohtsuka
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  3. Kunihiro Yoshioka
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  4. Hiroyuki Kameda
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  5. Suguru Yokosawa
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  6. Ryota Sato
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  7. Yasuo Terayama
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  8. Makoto Sasaki
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Corresponding author

Correspondence to Kenji Ito.

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Funding

This study was partly funded by a Grant-in-Aid (Nanchi-030) from the Ministry of Health, Labor and Welfare of Japan, a Grant-in-Aid for Strategic Medical Science Research (S1491001) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan, and JSPS KAKENHI (16K19520, 25861119, 25461325).

Conflict of interest

SY and RS are employees of Hitachi, Ltd. MS has received an honorarium and research grants from Hitachi Medical Corp.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ito, K., Ohtsuka, C., Yoshioka, K. et al. Differential diagnosis of parkinsonism by a combined use of diffusion kurtosis imaging and quantitative susceptibility mapping. Neuroradiology 59, 759–769 (2017). https://doi.org/10.1007/s00234-017-1870-7

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  • DOI: https://doi.org/10.1007/s00234-017-1870-7

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