title: Correlation of 3D FLAIR and Dopamine Transporter Imaging in Patients With Parkinsonism.
abstract: OBJECTIVE
  The purpose of this study is to evaluate direct in vivo visualization of nigrosome-1 in substantia nigra (SN) with 3D FLAIR imaging and its diagnostic value in predicting the intactness of presynaptic dopaminergic function of the nigrostriatal pathway.
  
  
  METHODS
  Forty-five patients showing parkinsonism who underwent both 3D FLAIR and dopamine transporter (DAT) imaging were recruited. In total, 90 SNs were reviewed on axial 3D FLAIR images. We regarded oval or linear hyperintensities on the posterolateral side of SN as intact nigrosome-1. Two neuroradiologists independently evaluated the appearance of nigrosome-1, and disagreements were settled by consensus. Kappa values for interrater agreement were calculated. Diagnostic performances of the appearance of nigrosome-1 for predicting presynaptic dopaminergic function on DAT imaging and Parkinson disease (PD) were calculated.
  
  
  RESULTS
  The diagnostic performances of a loss of nigrosome-1 on 3D FLAIR images were sensitivity of 85.7%, specificity of 85.4%, positive predictive value (PPV) of 83.7%, and negative predictive value (NPV) of 87.2% for predicting impaired presynaptic dopaminergic function on DAT imaging, and sensitivity of 94.7%, specificity of 76.9%, PPV of 85.7%, and NPV of 90.9% for predicting PD. When only oval hyperintensity was considered as intact nigrosome-1, its sensitivity and NPV were increased up to 95.2% and 91.7%, respectively, for predicting impaired presynaptic dopaminergic function on DAT imaging, and both increased to 100% for predicting PD. Interobserver agreement for the appearance of nigrosome-1 on 3D FLAIR images was substantial (κ = 0.625).
  
  
  CONCLUSIONS
  Nigrosome-1 could be visualized on 3D FLAIR images, and its loss can be used to predict presynaptic dopaminergic function and to diagnose PD with high accuracy.
authors.affiliation: 1 Department of Radiology, Soonchunhyang University Cheonan Hospital, Dongnam-gu, Cheonan-si, Chungcheongnam-do, Korea.
authors.forename: Se Won
authors.initials: SW
authors.lastname: Oh
authors.affiliation: 2 Department of Radiology, Ewha Woman's University School of Medicine, 911-1 Mokdong, Yangcheon-gu, Seoul 158-710, Korea.|3 Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Na-Young
authors.initials: NY
authors.lastname: Shin
authors.affiliation: 4 Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Jung
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: 3 Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung-Koo
authors.initials: SK
authors.lastname: Lee
authors.affiliation: 4 Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Phil Hyu
authors.initials: PH
authors.lastname: Lee
authors.affiliation: 2 Department of Radiology, Ewha Woman's University School of Medicine, 911-1 Mokdong, Yangcheon-gu, Seoul 158-710, Korea.
authors.forename: Soo Mee
authors.initials: SM
authors.lastname: Lim
authors.affiliation: 5 Department of Radiology, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Korea.
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012189:Retrospective Studies; D013378:Substantia Nigra / Q000737:chemistry* / Q000000981:diagnostic imaging*
chemical_list: D050483:Dopamine Plasma Membrane Transport Proteins
keywords: 3D FLAIR; Parkinson disease; dopamine transporter imaging; nigrosome-1; parkinsonism