title: Volume of Interest Analysis of Spatially Normalized PRESTO Imaging to Differentiate between Parkinson Disease and Atypical Parkinsonian Syndrome.
abstract: OBJECTIVE
  Various magnetic resonance imaging (MRI) techniques including T2*-weighted imaging, susceptibility-weighted imaging, and MR relaxometry had been performed to evaluate different patterns of brain iron depositions in Parkinsonian syndrome. The aim of the present study was to evaluate the diagnostic value of a volume of interest (VOI) analysis on the principles of echo shifting with a train of observations (PRESTO) imaging using the statistical parametric mapping (SPM) 8 and the WFU PickAtlas program for the diagnosis of Parkinsonian syndrome.,Methods: Fifty subjects, including 13 with the Parkinsonian variant of multiple system atrophy (MSA-P), 12 with progressive supranuclear palsy (PSP), 12 with Parkinson's disease (PD) and 13 controls were evaluated in this study. After the spatial normalization of PRESTO images on SPM8, the WFU PickAtlas program was performed to create target VOIs in the putamen, red nucleus, substantia nigra, subthalamic nucleus, and dentate nucleus. The signal intensity ratio (SIR) was calculated by normalizing the signal of each VOI to that of the cerebrospinal fluid space. These SIRs were used as determinants in receiver operating characteristic (ROC) analyses.
  
  
  RESULTS
  SIR of the putamen was significantly lower in MSA-P than in PSP (P = 0.0051) and controls (P = 0.0004). In contrast, SIR of the red nucleus was significantly lower in PSP than in MSA-P (P = 0.0003), PD (P = 0.0029), and controls (P = 0.0011). In ROC analyses, SIR of the putamen exhibited the highest areas under the curves (AUCs) of 0.83 (vs. PSP) and 0.91 (vs. controls) in the diagnosis of MSA-P. On the other hand, SIR of the red nucleus exhibited the highest AUCs of 0.87 (vs. MSA-P), 0.90 (vs. PD), and 0.89 (vs. controls) in the diagnosis of PSP.
  
  
  CONCLUSIONS
  The VOI analysis based on spatially normalized PRESTO images may be useful for depicting hypointensity, indicative of abnormal iron depositions, of the putamen and red nucleus in the diagnosis of MSA-P and PSP.
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences.
authors.forename: Keita
authors.initials: K
authors.lastname: Sakurai
authors.forename: Etsuko
authors.initials: E
authors.lastname: Imabayashi
authors.forename: Aya M
authors.initials: AM
authors.lastname: Tokumaru
authors.forename: Kimiteru
authors.initials: K
authors.lastname: Ito
authors.forename: Keigo
authors.initials: K
authors.lastname: Shimoji
authors.forename: Motoo
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ozawa
authors.forename: Masashi
authors.initials: M
authors.lastname: Shimohira
authors.forename: Masaki
authors.initials: M
authors.lastname: Ogawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Morimoto
authors.forename: Ikuko
authors.initials: I
authors.lastname: Aiba
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Matsukawa
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D001931:Brain Mapping / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000000981:diagnostic imaging* / Q000473:pathology; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000473:pathology; D020734:Parkinsonian Disorders / Q000000981:diagnostic imaging* / Q000473:pathology; D012372:ROC Curve; D012189:Retrospective Studies; D013494:Supranuclear Palsy, Progressive / Q000000981:diagnostic imaging* / Q000473:pathology