Contribution of routine brain MRI to the differential diagnosis of parkinsonism: a 3-year prospective follow-up study

Various signs on routine brain MRI can help differentiate between Parkinson’s disease (PD) and the various forms of atypical parkinsonism (AP). Here, we evaluate what routine brain MRI contributes to the clinical diagnosis, in both early and advanced disease stages. We performed a prospective observational study in 113 patients with parkinsonism, but without definite diagnosis upon inclusion. At baseline, patients received a structured interview, comprehensive and standardized neurological assessment, and brain MRI. The silver standard diagnosis was made after 3 years of follow-up (PD n = 43, AP n = 57), which was based on disease progression, repeat standardized neurological examination and response to treatment. The clinical diagnosis was classified as having either ‘low certainty’ (lower than 80%) or ‘high certainty’ (80% or higher). The added diagnostic yield of baseline MRI results were then studied relative to clinical neurological evaluation at presentation, and at follow-up. Sensitivity and specificity for separating AP from PD were calculated for all potentially distinguishing MRI abnormalities described previously in the literature. MRI abnormalities showed moderate to high specificity but limited sensitivity for the diagnosis of AP. These MRI abnormalities contributed little over and above the clinically based diagnosis, except when the clinical diagnosis was uncertain. For these patients, presence of putaminal or cerebellar atrophy was particularly indicative of AP. Routine brain MRI has limited added value for differentiating between PD and AP when clinical certainty is already high, but has some diagnostic value when the clinical diagnosis is still uncertain

Contribution of routine brain MRI to the differential diagnosis of parkinsonism: a 3-year prospective follow-up study

Abstract Various signs on routine brain MRI can help differentiate between Parkinson's disease (PD) and the various forms of atypical parkinsonism (AP). Here, we evaluate what routine brain MRI contributes to the clinical diagnosis, in both early and advanced disease stages. We performed a prospective observational study in 113 patients with parkinsonism, but without definite diagnosis upon inclusion. At baseline, patients received a structured interview, comprehensive and standardized neurological assessment, and brain MRI. The silver standard diagnosis was made after 3 years of follow-up (PD n = 43, AP n = 57), which was based on disease progression, repeat standardized neurological examination and response to treatment. The clinical diagnosis was classified as having either 'low certainty' (lower than 80%) or 'high certainty' (80% or higher). The added diagnostic yield of baseline MRI results were then studied relative to clinical neurological evaluation at presentation, and at follow-up. Sensitivity and specificity for separating AP from PD were calculated for all potentially distinguishing MRI abnormalities described previously in the literature. MRI abnormalities showed moderate to high specificity but limited sensitivity for the diagnosis of AP. These MRI abnormalities contributed little over and above the clinically based diagnosis, except when the clinical diagnosis was uncertain. For these patients, presence of putaminal or cerebellar atrophy was particularly indicative of AP. Routine brain MRI has limited added value for differentiating between PD and AP when clinical certainty is already high, but has some diagnostic value when the clinical diagnosis is still uncertain

Magnetization transfer imaging in chronic schizophrenia

BACKGROUND: It has recently been suggested that new imaging methods such as magnetization transfer imaging (MTI) may play an important role in detecting subtle gray- and white-matter abnormalities in schizophrenia. The aim of the study was to investigate whether MTI, analyzed on a voxel-by-voxel basis, could identify areas of abnormal magnetization transfer ratio (MTR) in patients with schizophrenia. MATERIAL/METHODS: Twenty schizophrenic patients and 23 healthy controls matched for handedness and demographic variables underwent MTI and T1-weighted structural MRI in a 3-tesla scanner. Post-processing was performed with SPM99 and included co-registration of the MT-weighted and non-MT-weighted images, calculation of the MTR maps, spatial normalization, and smoothing. Differences in the MTR maps between groups were assessed using two-sample t-tests. Significant changes in MTR were detected at an individual voxel threshold of p < 0.05. RESULTS: Group comparisons revealed no significant MTR changes, although there was a trend towards MTR reduction in the left superior temporal gyrus, in the right occipital cortex, and left periventricular white matter in patients compared with controls prior to correction for multiple comparisons (p < 0.001, uncorrected). CONCLUSIONS: MTI and voxel-by-voxel statistical analysis used in the study failed to identify regions of significant MTR reductions in schizophrenic patients. Our results disagree with findings of widespread MTR abnormalities reported in recent literature.status: publishe

Amygdala volume marks the acute state in the early course of depression

The amygdala and hippocampus play a key role in the neural circuitry mediating depression. It remains unclear how much structural and functional changes of amygdala and hippocampus reflect the acute state of depression or an underlying neurobiological trait marker of depression. High-resolution anatomical images were acquired in 20 medication-naïve major depressive disorder (MDD) patients with a current first episode, 20 medication-free patients recovered from a first episode of MDD, and 20 healthy control subjects that were matched for age, gender, and level of education. Manual volumetry of amygdala and hippocampus was performed on coronal images. Volumetric measurements of brain volume and intracranial volume were acquired with automatic segmentation procedures. Both amygdalae were significantly enlarged in currently depressed patients, whereas there was no significant difference between recovered patients and control subjects. The amygdala enlargement correlated positively with the severity of depressive state but with no other clinical or neuropsychological variable. The hippocampal volume did not differ between groups. A state related increase of amygdala volume can be detected early in the course of MDD. Neurotoxic effects might account for the fact that state-related amygdala enlargement has not been found in recurrent depression with relative long illness duratio