J Clin Neurol.  2018 Jan;14(1):90-97. 10.3988/jcn.2018.14.1.90.

Diagnosis of Early-Stage Idiopathic Parkinson's Disease Using High-Resolution Quantitative Susceptibility Mapping Combined with Histogram Analysis in the Substantia Nigra at 3 T

Affiliations
  • 1Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea.
  • 2Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea.
  • 3Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea. jonghoyi@snu.ac.kr
  • 4Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea. yhnam83@gmail.com

Abstract

BACKGROUND
AND PURPOSE: To test whether nigrosome-1 imaging using high-resolution quantitative susceptibility mapping (QSM) combined with histogram analysis can improve the diagnostic accuracy in early-stage idiopathic Parkinson's disease (IPD) patients.
METHODS
Three-dimensional multiecho gradient-recalled echo images (0.5×0.5×1.0 mm³) were obtained at 3 T for QSM in 38 patients with IPD and 25 healthy subjects. To segment the substantia nigra (SN), regions of interest (ROIs) were semiautomatically drawn at the location below the red nucleus, and the normal-appearing nigrosome-1 was determined by manual correction. QSM histograms were obtained within the ROI. The segmented SN regions on the right and left that had higher mean susceptibility values and fewer voxels with susceptibility values lower than 60, 65, 70, 75, and 80 ppb were chosen for comparisons between the IPD patients and healthy subjects. These results were compared with those of the visual assessments of nigrosome-1 in susceptibility map-weighted imaging (SMWI) by analyzing receiver operating characteristics curves.
RESULTS
The proportion of voxels with susceptibility values lower than 70 ppb showed the best diagnostic performance, with its value differing significantly between the IPD patients (median=0, interquartile range=0-0.23) and healthy subjects (median=10.67, interquartile range=5.98-21.57) (p < 0.0001). The number of voxels with susceptibility values lower than 60, 65, 70, 75, and 80 ppb showed worse diagnostic performances but were still significantly better than that of the mean susceptibility value (p=0.0249, 0.0192, 0.0183, 0.0191, and 0.0186, respectively), which also differed significantly between the two groups: 125.81±16.27 ppb (mean±standard deviation) in IPD versus 98.41±11.70 ppb in healthy subjects (p < 0.0001). Additionally, using the proportion of voxels with susceptibility values lower than 70 ppb provided significantly better diagnostic performance than did visual assessments of SMWI (p=0.0143).
CONCLUSIONS
High-spatial-resolution QSM combined with histogram analysis at 3 T can improve the diagnostic accuracy of early-stage IPD.

Keyword

Parkinson's disease; magnetic resonance imaging; substantia nigra; pars compacta; ROC curve
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