title: Diffusion tensor imaging differentiates vascular parkinsonism from parkinsonian syndromes of degenerative origin in elderly subjects.
abstract: OBJECTIVE
  The etiologic diagnosis of parkinsonian syndromes is of particular importance when considering syndromes of vascular or degenerative origin. The purpose of this study is to find differences in the white-matter architecture between those two groups in elderly patients.
  
  
  METHODS
  Thirty-five patients were prospectively included (multiple-system atrophy, n=5; Parkinson's disease, n=15; progressive supranuclear palsy, n=9; vascular parkinsonism, n=6), with a mean age of 76 years. Patients with multiple-system atrophy, progressive supranuclear palsy and Parkinson's disease were grouped as having parkinsonian syndromes of degenerative origin. Brain MRIs included diffusion tensor imaging. Fractional anisotropy and mean-diffusivity maps were spatially normalized, and group analyses between parkinsonian syndromes of degenerative origin and vascular parkinsonism were performed using a voxel-based approach.
  
  
  RESULTS
  Statistical parametric-mapping analysis of diffusion tensor imaging data showed decreased fractional anisotropy value in internal capsules bilaterally in patients with vascular parkinsonism compared to parkinsonian syndromes of degenerative origin (p=0.001) and showed a lower mean diffusivity in the white matter of the left superior parietal lobule (p=0.01). Fractional anisotropy values were found decreased in the middle cerebellar peduncles in multiple-system atrophy compared to Parkinson's disease and progressive supranuclear palsy. The mean diffusivity was increased in those regions for these subgroups.
  
  
  CONCLUSIONS
  Clinically defined vascular parkinsonism was associated with decreased fractional anisotropy in the deep white matter (internal capsules) compared to parkinsonian syndromes of degenerative origin. These findings are consistent with previously published neuropathological data.
authors.affiliation: Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; Laboratoire Charles Coulomb, CNRS UMR 5221 - Université Montpellier II, Montpellier, France; I2FH, Institut d'Imagerie Fonctionnelle Humaine, Hôpital Gui de Chauliac, CHRU de, Montpellier, France.
authors.forename: Jérémy
authors.initials: J
authors.lastname: Deverdun
authors.affiliation: Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; Clinique du Parc, Castelnau-le-Lez, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Menjot de Champfleur
authors.affiliation: Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; I2FH, Institut d'Imagerie Fonctionnelle Humaine, Hôpital Gui de Chauliac, CHRU de, Montpellier, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Cabello-Aguilar
authors.affiliation: Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Maury
authors.affiliation: Laboratoire Charles Coulomb, CNRS UMR 5221 - Université Montpellier II, Montpellier, France; Institut de Génomique Fonctionnelle, UMR 5203 - INSERM U661 - Université Montpellier II - Université, Montpellier I, France.
authors.forename: François
authors.initials: F
authors.lastname: Molino
authors.affiliation: Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Charif
authors.affiliation: Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Leboucq
authors.affiliation: Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Ayrignac
authors.affiliation: Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Labauge
authors.affiliation: Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; I2FH, Institut d'Imagerie Fonctionnelle Humaine, Hôpital Gui de Chauliac, CHRU de, Montpellier, France; Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", U1051, Institut of Neurosciences of Montpellier, Saint Eloi Hospital, Montpellier, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bonafe
authors.affiliation: Department of Neurology, Caremeau University Hospital Center, Nîmes, France.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Castelnovo
authors.affiliation: Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; I2FH, Institut d'Imagerie Fonctionnelle Humaine, Hôpital Gui de Chauliac, CHRU de, Montpellier, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Le Bars
authors.affiliation: Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; EuroMov, 700 Avenue du Pic Saint Loup - 34090, Montpellier, France; Movement to Health (M2H), Montpellier-1 University, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Geny
authors.affiliation: Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France; I2FH, Institut d'Imagerie Fonctionnelle Humaine, Hôpital Gui de Chauliac, CHRU de, Montpellier, France; Institut de Génomique Fonctionnelle, UMR 5203 - INSERM U661 - Université Montpellier II - Université, Montpellier I, France. Electronic address: nicolasdechampfleur@orange.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Menjot de Champfleur
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016880:Anisotropy; D003937:Diagnosis, Differential; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis*; D010300:Parkinson Disease / Q000175:diagnosis* / Q000473:pathology; D020734:Parkinsonian Disorders / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis*