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

• Kim EY
• Sung YH
• Shin HG
• Noh Y
• Nam Y
• Lee J

• KMID: 2399604
• DOI: http://doi.org/10.3988/jcn.2018.14.1.90

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

MeSH Terms

Diagnosis*
Healthy Volunteers
Humans
Magnetic Resonance Imaging
Parkinson Disease*
Red Nucleus
ROC Curve
Substantia Nigra*

Figure

• 

  Fig. 1 Semiautomated drawing of ROIs on negative monochrome QSM images. ROIs are first drawn within the SN below the level of the inferior border of the RN on axial oblique QSM images [A, nigrosome-1 regions are hyperintense and indicated by arrowheads on axial oblique QSM images (upper two rows) and are indicated by arrows on the oblique-coronal reformatted image (lower row)]. After delimiting the SN, ROIs are drawn semiautomatically with a threshold of 80–300 ppb. The unselected regions (arrows in B and C) in the dorsolateral aspect of the SN are considered the regions that include intact nigrosome-1, and were manually identified at two different image levels below the RN in both healthy subjects (B) and earlystage idiopathic Parkinson's disease patients (C). QSM: quantitative susceptibility mapping, RN: red nucleus, ROI: region of interest, SN: substantia nigra.

• 

  Fig. 2 Mean susceptibility values and the proportions of voxels with susceptibility values lower than 70 ppb for patients with IPD and the healthy subjects. The mean susceptibility values overlapped between the two groups, whereas the proportions of voxels with susceptibility values lower than 70 ppb did not (see the inset). The horizontal lines indicate the median and interquartile-range values. IPD: idiopathic Parkinson's disease.

• 

  Fig. 3 Receiver operating characteristics curves for mean susceptibility and the proportions of voxels with susceptibility values lower than 60, 65, 70, 75, and 80 ppb.

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