title: Drug-induced Parkinsonism versus Idiopathic Parkinson Disease: Utility of Nigrosome 1 with 3-T Imaging.
abstract: Purpose To explore the utility of nigrosome 1 with 3-T magnetic resonance (MR) imaging to differentiate idiopathic Parkinson disease (IPD) from drug-induced parkinsonism (DIP). Materials and Methods The institutional review board approved this study, and participants gave informed consent. This study enrolled patients with DIP (n = 20) and IPD (n = 29) who underwent N-3-fluoropropyl-2-β-carbomethoxy-3-β-(4-iodophenyl)nortropane ((18)F-FP-CIT) positron emission tomography (PET) and healthy participants (n = 20). All participants underwent 0.5 × 0.5 × 1.0 mm(3) oblique axial three-dimensional multiecho-data image combination imaging to view the nigrosome 1 with 3-T imaging. Two reviewers independently assessed the nigrosome 1 without clinical information. DIP was diagnosed when no abnormality was seen at (18)F-FP-CIT PET. Diagnostic sensitivity, specificity, and accuracy of the nigrosome 1 imaging were evaluated between the IPD and DIP patients and between the IPD patients and healthy participants. Interrater agreement was assessed with Cohen κ. Results Both reviewers agreed in 63 of 69 participants (91.3%) for the presence of any abnormality on either side of the nigrosome 1 (κ = 0.825). Findings in all 29 IPD patients (100%) and three of 20 DIP patients (15%) were rated as abnormal and in 17 of 20 DIP patients (85%) they were interpreted as normal on the basis of imaging of the nitgrosome 1 (sensitivity, 100% (29 of 29); specificity, 85.0% (17 of 20); accuracy, 93.9% (46 of 49) between IPD and DIP patients). Findings in 3 of 20 healthy participants (15.0%) were interpreted as abnormal on the basis of imaging the nigrosome 1 while in the other 17 of 20 healthy participants (85.0%) they were rated as normal (sensitivity, 100% [29 of 29]; specificity, 85.0% [17 of 20]; accuracy, 93.9% [46 of 49] between IPD patients and healthy participants [κ = 0.831]). Conclusion The imaging of nigrosome 1 with 3-T imaging can differentiate DIP from IPD with high accuracy and may help to screen patients who need dopamine transporter imaging in those suspected of having DIP. (©) RSNA, 2015 Online supplemental material is available for this article.
authors.affiliation: From the Departments of Neurology (Y.H.S., Y.N.) and Radiology (E.Y.K.), Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, South Korea; and Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea (J.L.).
authors.forename: Young Hee
authors.initials: YH
authors.lastname: Sung
authors.affiliation: From the Departments of Neurology (Y.H.S., Y.N.) and Radiology (E.Y.K.), Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, South Korea; and Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea (J.L.).
authors.forename: Young
authors.initials: Y
authors.lastname: Noh
authors.affiliation: From the Departments of Neurology (Y.H.S., Y.N.) and Radiology (E.Y.K.), Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, South Korea; and Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea (J.L.).
authors.forename: Jongho
authors.initials: J
authors.lastname: Lee
authors.affiliation: From the Departments of Neurology (Y.H.S., Y.N.) and Radiology (E.Y.K.), Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, South Korea; and Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea (J.L.).
authors.forename: Eung Yeop
authors.initials: EY
authors.lastname: Kim
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004298:Dopamine / Q000032:analysis*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D012680:Sensitivity and Specificity; D013378:Substantia Nigra / Q000737:chemistry*
chemical_list: D004298:Dopamine