title: Brain MR Contribution to the Differential Diagnosis of Parkinsonian Syndromes: An Update.
abstract: Brain magnetic resonance (MR) represents a useful and feasible tool for the differential diagnosis of Parkinson's disease. Conventional MR may reveal secondary forms of parkinsonism and may show peculiar brain alterations of atypical parkinsonian syndromes. Furthermore, advanced MR techniques, such as morphometric-volumetric analyses, diffusion-weighted imaging, diffusion tensor imaging, tractography, proton MR spectroscopy, and iron-content sensitive imaging, have been used to obtain quantitative parameters useful to increase the diagnostic accuracy. Currently, many MR studies have provided both qualitative and quantitative findings, reflecting the underlying neuropathological pattern of the different degenerative parkinsonian syndromes. Although the variability in the methods and results across the studies limits the conclusion about which technique is the best, specific radiologic phenotypes may be identified. Qualitative/quantitative MR changes in the substantia nigra do not discriminate between different parkinsonisms. In the absence of extranigral abnormalities, the diagnosis of PD is more probable, whereas basal ganglia changes (mainly in the putamen) suggest the diagnosis of an atypical parkinsonian syndrome. In this context, changes in pons, middle cerebellar peduncles, and cerebellum suggest the diagnosis of MSA, in midbrain and superior cerebellar peduncles the diagnosis of PSP, and in whole cerebral hemispheres (mainly in frontoparietal cortex with asymmetric distribution) the diagnosis of Corticobasal Syndrome.
authors: IRCCS Istituto delle Scienze Neurologiche, Bellaria Hospital, Bologna, Italy; Neurology Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors: Giovanni
authors: 0000-0002-9718-2044
authors: G
authors: Rizzo
authors: Functional MR Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors: Stefano
authors: 0000-0003-4071-0886
authors: S
authors: Zanigni
authors: Department of Diagnostic Imaging, Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy.
authors: Roberto
authors: R
authors: De Blasi
authors: Department of Diagnostic Imaging, Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy.
authors: Daniela
authors: D
authors: Grasso
authors: Department of Neurology, King's College NHS Foundation Trust, London, UK; Department of Neurology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK.
authors: Davide
authors: 0000-0001-5169-3669
authors: D
authors: Martino
authors: Department of Neurology and Health Science Research, Mayo Clinic, Rochester, MN, USA.
authors: Rodolfo
authors: R
authors: Savica
authors: Department of Clinical Research in Neurology, University of Bari, Pia Fondazione di Culto e Religione "Card. G. Panico", Tricase, Italy; Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy.
authors: Giancarlo
authors: 0000-0003-0423-3242
authors: G
authors: Logroscino