title: Conventional 3T brain MRI and diffusion tensor imaging in the diagnostic workup of early stage parkinsonism.
abstract: BACKGROUND
  The aim of this study is to evaluate whether the diagnostic accuracy of 3 T brain MRI is improved by region of interest (ROI) measures of diffusion tensor imaging (DTI), to differentiate between neurodegenerative atypical parkinsonism (AP) and Parkinson's disease (PD) in early stage parkinsonism.
  
  
  METHODS
  We performed a prospective observational cohort study of 60 patients presenting with early stage parkinsonism and initial uncertain diagnosis. At baseline, patients underwent a 3 T brain MRI including DTI. After clinical follow-up (mean 28.3 months), diagnoses could be made in 49 patients (30 PD and 19 AP). Conventional brain MRI was evaluated for regions of atrophy and signal intensity changes. Tract-based spatial statistics and ROI analyses of DTI were performed to analyze group differences in mean diffusivity (MD) and fractional anisotropy (FA), and diagnostic thresholds were determined. Diagnostic accuracy of conventional brain MRI and DTI was assessed with the receiver operating characteristic (ROC).
  
  
  RESULTS
  Significantly higher MD of the centrum semiovale, body corpus callosum, putamen, external capsule, midbrain, superior cerebellum, and superior cerebellar peduncles was found in AP. Significantly increased MD of the putamen was found in multiple system atrophy-parkinsonian form (MSA-P) and increased MD in the midbrain and superior cerebellar peduncles in progressive supranuclear palsy (PSP). The diagnostic accuracy of brain MRI to identify AP as a group was not improved by ROI measures of MD, though the diagnostic accuracy to identify MSA-P was slightly increased (AUC 0.82 to 0.85).
  
  
  CONCLUSIONS
  The diagnostic accuracy of brain MRI to identify AP as a group was not improved by the current analysis approach to DTI, though DTI measures could be of added value to identify AP subgroups.
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, Postbus 9101, 6500 HB, Nijmegen, The Netherlands, Anton.Meijer@radboudumc.nl.
authors.forename: Frederick J A
authors.initials: FJ
authors.lastname: Meijer
authors.forename: Anouke
authors.initials: A
authors.lastname: van Rumund
authors.forename: Anil M
authors.initials: AM
authors.lastname: Tuladhar
authors.forename: Marjolein B
authors.initials: MB
authors.lastname: Aerts
authors.forename: Imke
authors.initials: I
authors.lastname: Titulaer
authors.forename: Rianne A J
authors.initials: RA
authors.lastname: Esselink
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
authors.forename: Marcel M
authors.initials: MM
authors.lastname: Verbeek
authors.forename: Bozena
authors.initials: B
authors.lastname: Goraj
mesh_terms: D000368:Aged; D016880:Anisotropy; D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D020734:Parkinsonian Disorders / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve
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