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Clinical utility of visualisation of nigrosome-1 in patients with Parkinson’s disease

  • Magnetic Resonance
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Abstract

Objective

To determine the diagnostic characteristics of poor visualisation of nigrosome-1 as a neuroimaging biomarker in Parkinson’s disease (PD) and to explore the relationship of poor visualisation of nigrosome-1 and clinical asymmetry.

Methods

High-resolution gradient-echo sequences of 67 patients with PD and 63 healthy controls were reviewed by two radiologists blinded to the clinical details. A three-tier classification system was used to categorise the scans based on the visualisation of nigrosome-1, and inter-rater reliability was calculated at each level of classification. Other diagnostic properties such as sensitivity, specificity and predictive values were calculated. The relationship between poor visualisation of nigrosome-1 and clinical asymmetry was also assessed.

Results

Poor visualisation of nigrosome-1 had high sensitivity (98.5%), specificity (93.6%), positive-predictive value (94.3%), negative-predictive value (98.3%), accuracy (96%) and inter-rater reliability (k = 0.75–0.92). Poorly visualised nigrosome-1 was significantly associated with higher motor asymmetry in the contralateral side in 64.8% of subjects (p = 0.004).

Conclusions

Poor visualisation of nigrosome-1 in PD had good diagnostic properties as a neuroimaging biomarker in PD. There was also a significant agreement on clinical asymmetry and poor visualisation of nigrosome-1.

Key Points

• Nigrosome-1 represents the largest collection of dopaminergic neurons in dorso-lateral substantia nigra.

• Loss of nigrosome-1 is being studied as a biomarker in Parkinson’s disease.

• Visualisation of nigrosome-1 had good diagnostic properties as a biomarker.

• There was a contralateral relationship between nigrosome-1 lateralisation and clinical asymmetry.

• We also highlight the potential limitations of nigrosome-1 visualisation as a biomarker.

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Abbreviations

3D:

3-Dimensional space

Group 1:

Well visualised on both sides

Group 2:

Poorly visualised on one or both sides

Group 2a:

Poorly visualised unilaterally

Group 2a-L:

Poorly visualised on left side

Group 2a-R:

Poorly visualised on right side

Group 2b:

Poorly visualised bilaterally

k:

Cohen’s kappa

MRI:

Magnetic resonance imaging

MSA-P:

Multisystem atrophy – Parkinsonian type

PD:

Parkinson’s disease

PSP:

Progressive supranuclear palsy

SENSE:

Sensitivity Encoding for Fast MRI

SPECT:

Single Photon Emission Computed Tomography

UPDRS III:

Unified Parkinson’s Disease Rating Scale part III

VenoBOLD sequence:

Venous blood oxygen level-dependent sequence

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Authors and Affiliations

  1. Department of Clinical Neuroscience, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India

    Albert Stezin, Ragasudha Botta & Abhishek Lenka

  2. Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, Karnataka, India

    Albert Stezin, Ra**i M. Naduthota, Ragasudha Botta, Abhishek Lenka, Ravi Yadav & Pramod Kumar Pal

  3. Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India

    Shriram Varadharajan & Jitender Saini

Authors
  1. Albert Stezin
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  2. Ra**i M. Naduthota
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  3. Ragasudha Botta
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  4. Shriram Varadharajan
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  5. Abhishek Lenka
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  6. Jitender Saini
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  7. Ravi Yadav
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  8. Pramod Kumar Pal
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Corresponding author

Correspondence to Pramod Kumar Pal.

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Guarantor

The scientific guarantor of this publication is Dr. Pramod Kumar Pal.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This work was financially supported by Department of Biotechnology (DBT), Government of India. [Grant Number: NO. BT/PR14315/MED/30/474/2010]

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

There is overlap of subjects from the following previously published reports/articles:

1. Jha M, Jhunjhunwala K, Sankara BB, Saini J, Kumar JK, Yadav R, Pal PK (2015) Neuropsychological and imaging profile of patients with Parkinson's disease and freezing of gait. Parkinsonism Relat Disord 21(10):1184-90. doi: 10.1016/j.parkreldis.2015.08.009. Epub 2015 Aug 12.

2. Naduthota RM, Bharath RD, Jhunjhunwala K, Yadav R, Saini J, Christopher R, Pal PK (2017) Imaging biomarker correlates with oxidative stress in Parkinson's disease. Neurol India(2017). 65(2):263-268. doi: 10.4103/neuroindia.NI_981_15.

Methodology

• Prospective

• Case-control study

• Performed at one institution

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Stezin, A., Naduthota, R.M., Botta, R. et al. Clinical utility of visualisation of nigrosome-1 in patients with Parkinson’s disease. Eur Radiol 28, 718–726 (2018). https://doi.org/10.1007/s00330-017-4950-5

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  • DOI: https://doi.org/10.1007/s00330-017-4950-5

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