Differentiation between idiopathic and atypical parkinsonian syndromes using three-dimensional magnetic resonance spectroscopic imaging
Identifieur interne : 000D74 ( Main/Corpus ); précédent : 000D73; suivant : 000D75Differentiation between idiopathic and atypical parkinsonian syndromes using three-dimensional magnetic resonance spectroscopic imaging
Auteurs : Adriane Gröger ; Benjamin Bender ; Isabel Wurster ; Grzegorz Lukasz Chadzynski ; Uwe Klose ; Daniela BergSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2013-06.
Abstract
Objectives Degeneration of dopaminergic neurons in the substantia nigra (SN) pars compacta is the primary cause of idiopathic Parkinson's disease (iPD). In early stages of disease in particular, presentation of symptoms is non-specific leading to difficulties in differentiating between iPD and atypical parkinsonian syndromes (aPS). The aim of this study was to evaluate the feasibility of three-dimensional magnetic resonance spectroscopic imaging (MRSI) of the SN region for differentiation between iPD and aPS. Methods 20 patients with iPD, 10 with aPS and 22 controls were examined on a 3 T MR scanner using three-dimensional MRSI with a voxel size of 0.252 ml and an echo time of 30 ms. Excitation volume was positioned in such a way that in each hemisphere 1 voxel defines the rostral and 1 voxel the caudal SN region. Using a fully automatic spectra evaluation, the metabolite ratios of N-acetyl aspartate/creatine (NAA/Cr) were calculated. Results In all cases spectra with good quality were obtained. Differences in rostral to caudal NAA/Cr ratios were significant between controls and iPD patients, as well as between iPD and aPS patients (p<0.001 for both). For controls, rostral NAA/Cr was greater than caudal, whereas in iPD patients this ratio was reversed. aPS patients showed similar ratios as controls. Conclusions Typical reversed rostral to caudal NAA/Cr ratios in iPD patients suggests that they could be linked to specific pathology of neuronal loss in the SN pars compacta. Therefore, the results suggest that MRSI may support the differential diagnosis of patients with clinically unclassifiable parkinsonian syndromes who do not yet fulfil the established clinical criteria.
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DOI: 10.1136/jnnp-2012-302699
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Differentiation between idiopathic and atypical parkinsonian syndromes using three-dimensional magnetic resonance spectroscopic imaging</title><author><name sortKey="Groger, Adriane" sort="Groger, Adriane" uniqKey="Groger A" first="Adriane" last="Gröger">Adriane Gröger</name><affiliation><mods:affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Bender, Benjamin" sort="Bender, Benjamin" uniqKey="Bender B" first="Benjamin" last="Bender">Benjamin Bender</name><affiliation><mods:affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Wurster, Isabel" sort="Wurster, Isabel" uniqKey="Wurster I" first="Isabel" last="Wurster">Isabel Wurster</name><affiliation><mods:affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Chadzynski, Grzegorz Lukasz" sort="Chadzynski, Grzegorz Lukasz" uniqKey="Chadzynski G" first="Grzegorz Lukasz" last="Chadzynski">Grzegorz Lukasz Chadzynski</name><affiliation><mods:affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Klose, Uwe" sort="Klose, Uwe" uniqKey="Klose U" first="Uwe" last="Klose">Uwe Klose</name><affiliation><mods:affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Berg, Daniela" sort="Berg, Daniela" uniqKey="Berg D" first="Daniela" last="Berg">Daniela Berg</name><affiliation><mods:affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:88774A2459A7B924352591CF5E31BF365095558D</idno><date when="2013" year="2013">2013</date><idno type="doi">10.1136/jnnp-2012-302699</idno><idno type="url">https://api.istex.fr/document/88774A2459A7B924352591CF5E31BF365095558D/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000D74</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Differentiation between idiopathic and atypical parkinsonian syndromes using three-dimensional magnetic resonance spectroscopic imaging</title><author><name sortKey="Groger, Adriane" sort="Groger, Adriane" uniqKey="Groger A" first="Adriane" last="Gröger">Adriane Gröger</name><affiliation><mods:affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Bender, Benjamin" sort="Bender, Benjamin" uniqKey="Bender B" first="Benjamin" last="Bender">Benjamin Bender</name><affiliation><mods:affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Wurster, Isabel" sort="Wurster, Isabel" uniqKey="Wurster I" first="Isabel" last="Wurster">Isabel Wurster</name><affiliation><mods:affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Chadzynski, Grzegorz Lukasz" sort="Chadzynski, Grzegorz Lukasz" uniqKey="Chadzynski G" first="Grzegorz Lukasz" last="Chadzynski">Grzegorz Lukasz Chadzynski</name><affiliation><mods:affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Klose, Uwe" sort="Klose, Uwe" uniqKey="Klose U" first="Uwe" last="Klose">Uwe Klose</name><affiliation><mods:affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Berg, Daniela" sort="Berg, Daniela" uniqKey="Berg D" first="Daniela" last="Berg">Daniela Berg</name><affiliation><mods:affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-06">2013-06</date><biblScope unit="volume">84</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="644">644</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">88774A2459A7B924352591CF5E31BF365095558D</idno><idno type="DOI">10.1136/jnnp-2012-302699</idno><idno type="href">jnnp-84-644.pdf</idno><idno type="ArticleID">jnnp-2012-302699</idno><idno type="PMID">23334525</idno><idno type="local">jnnp;84/6/644</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objectives Degeneration of dopaminergic neurons in the substantia nigra (SN) pars compacta is the primary cause of idiopathic Parkinson's disease (iPD). In early stages of disease in particular, presentation of symptoms is non-specific leading to difficulties in differentiating between iPD and atypical parkinsonian syndromes (aPS). The aim of this study was to evaluate the feasibility of three-dimensional magnetic resonance spectroscopic imaging (MRSI) of the SN region for differentiation between iPD and aPS. Methods 20 patients with iPD, 10 with aPS and 22 controls were examined on a 3 T MR scanner using three-dimensional MRSI with a voxel size of 0.252 ml and an echo time of 30 ms. Excitation volume was positioned in such a way that in each hemisphere 1 voxel defines the rostral and 1 voxel the caudal SN region. Using a fully automatic spectra evaluation, the metabolite ratios of N-acetyl aspartate/creatine (NAA/Cr) were calculated. Results In all cases spectra with good quality were obtained. Differences in rostral to caudal NAA/Cr ratios were significant between controls and iPD patients, as well as between iPD and aPS patients (p<0.001 for both). For controls, rostral NAA/Cr was greater than caudal, whereas in iPD patients this ratio was reversed. aPS patients showed similar ratios as controls. Conclusions Typical reversed rostral to caudal NAA/Cr ratios in iPD patients suggests that they could be linked to specific pathology of neuronal loss in the SN pars compacta. Therefore, the results suggest that MRSI may support the differential diagnosis of patients with clinically unclassifiable parkinsonian syndromes who do not yet fulfil the established clinical criteria.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Adriane Gröger</name><affiliations><json:string>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</json:string></affiliations></json:item><json:item><name>Benjamin Bender</name><affiliations><json:string>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</json:string></affiliations></json:item><json:item><name>Isabel Wurster</name><affiliations><json:string>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</json:string></affiliations></json:item><json:item><name>Grzegorz Lukasz Chadzynski</name><affiliations><json:string>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</json:string></affiliations></json:item><json:item><name>Uwe Klose</name><affiliations><json:string>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</json:string></affiliations></json:item><json:item><name>Daniela Berg</name><affiliations><json:string>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Movement disorders</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's Disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>MRS</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Objectives Degeneration of dopaminergic neurons in the substantia nigra (SN) pars compacta is the primary cause of idiopathic Parkinson's disease (iPD). In early stages of disease in particular, presentation of symptoms is non-specific leading to difficulties in differentiating between iPD and atypical parkinsonian syndromes (aPS). The aim of this study was to evaluate the feasibility of three-dimensional magnetic resonance spectroscopic imaging (MRSI) of the SN region for differentiation between iPD and aPS. Methods 20 patients with iPD, 10 with aPS and 22 controls were examined on a 3 T MR scanner using three-dimensional MRSI with a voxel size of 0.252 ml and an echo time of 30 ms. Excitation volume was positioned in such a way that in each hemisphere 1 voxel defines the rostral and 1 voxel the caudal SN region. Using a fully automatic spectra evaluation, the metabolite ratios of N-acetyl aspartate/creatine (NAA/Cr) were calculated. Results In all cases spectra with good quality were obtained. Differences in rostral to caudal NAA/Cr ratios were significant between controls and iPD patients, as well as between iPD and aPS patients (p>0.001 for both). For controls, rostral NAA/Cr was greater than caudal, whereas in iPD patients this ratio was reversed. aPS patients showed similar ratios as controls. Conclusions Typical reversed rostral to caudal NAA/Cr ratios in iPD patients suggests that they could be linked to specific pathology of neuronal loss in the SN pars compacta. Therefore, the results suggest that MRSI may support the differential diagnosis of patients with clinically unclassifiable parkinsonian syndromes who do not yet fulfil the established clinical criteria.</abstract><qualityIndicators><score>8.065</score><pdfVersion>1.6</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>3</keywordCount><abstractCharCount>1699</abstractCharCount><pdfWordCount>3565</pdfWordCount><pdfCharCount>23753</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>258</abstractWordCount></qualityIndicators><title>Differentiation between idiopathic and atypical parkinsonian syndromes using three-dimensional magnetic resonance spectroscopic imaging</title><pmid><json:string>23334525</json:string></pmid><genre><json:string>research-article</json:string></genre><host><volume>84</volume><pages><first>644</first></pages><issn><json:string>0022-3050</json:string></issn><issue>6</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-330X</json:string></eissn><title>Journal of Neurology, Neurosurgery & 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imaging</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd</publisher><availability><p>BMJ</p></availability><date>2013-01-18</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Differentiation between idiopathic and atypical parkinsonian syndromes using three-dimensional magnetic resonance spectroscopic imaging</title><author><persName><forename type="first">Adriane</forename><surname>Gröger</surname></persName><affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</affiliation></author><author><persName><forename type="first">Benjamin</forename><surname>Bender</surname></persName><affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</affiliation></author><author><persName><forename type="first">Isabel</forename><surname>Wurster</surname></persName><affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</affiliation></author><author><persName><forename type="first">Grzegorz Lukasz</forename><surname>Chadzynski</surname></persName><affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</affiliation></author><author><persName><forename type="first">Uwe</forename><surname>Klose</surname></persName><affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</affiliation></author><author><persName><forename type="first">Daniela</forename><surname>Berg</surname></persName><affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2013-06"></date><biblScope unit="volume">84</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="644">644</biblScope></imprint></monogr><idno type="istex">88774A2459A7B924352591CF5E31BF365095558D</idno><idno type="DOI">10.1136/jnnp-2012-302699</idno><idno type="href">jnnp-84-644.pdf</idno><idno type="ArticleID">jnnp-2012-302699</idno><idno type="PMID">23334525</idno><idno type="local">jnnp;84/6/644</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013-01-18</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Objectives Degeneration of dopaminergic neurons in the substantia nigra (SN) pars compacta is the primary cause of idiopathic Parkinson's disease (iPD). In early stages of disease in particular, presentation of symptoms is non-specific leading to difficulties in differentiating between iPD and atypical parkinsonian syndromes (aPS). The aim of this study was to evaluate the feasibility of three-dimensional magnetic resonance spectroscopic imaging (MRSI) of the SN region for differentiation between iPD and aPS. Methods 20 patients with iPD, 10 with aPS and 22 controls were examined on a 3 T MR scanner using three-dimensional MRSI with a voxel size of 0.252 ml and an echo time of 30 ms. Excitation volume was positioned in such a way that in each hemisphere 1 voxel defines the rostral and 1 voxel the caudal SN region. Using a fully automatic spectra evaluation, the metabolite ratios of N-acetyl aspartate/creatine (NAA/Cr) were calculated. Results In all cases spectra with good quality were obtained. Differences in rostral to caudal NAA/Cr ratios were significant between controls and iPD patients, as well as between iPD and aPS patients (p<0.001 for both). For controls, rostral NAA/Cr was greater than caudal, whereas in iPD patients this ratio was reversed. aPS patients showed similar ratios as controls. Conclusions Typical reversed rostral to caudal NAA/Cr ratios in iPD patients suggests that they could be linked to specific pathology of neuronal loss in the SN pars compacta. Therefore, the results suggest that MRSI may support the differential diagnosis of patients with clinically unclassifiable parkinsonian syndromes who do not yet fulfil the established clinical criteria.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's Disease</term></item><item><term>MRS</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2013-01-18">Created</change><change when="2013-06">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/88774A2459A7B924352591CF5E31BF365095558D/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">jnnp</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp-2012-302699</article-id><article-id pub-id-type="doi">10.1136/jnnp-2012-302699</article-id><article-id pub-id-type="other">jnnp;84/6/644</article-id><article-id pub-id-type="other">jnnp;jnnp-2012-302699</article-id><article-id pub-id-type="pmid">23334525</article-id><article-id pub-id-type="other">644</article-id><article-id pub-id-type="other">jnnp-2012-302699</article-id><article-categories><subj-group subj-group-type="heading"><subject>Movement disorders</subject></subj-group><series-title>Research paper</series-title></article-categories><title-group><article-title>Differentiation between idiopathic and atypical parkinsonian syndromes using three-dimensional magnetic resonance spectroscopic imaging</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Gröger</surname><given-names>Adriane</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Bender</surname><given-names>Benjamin</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Wurster</surname><given-names>Isabel</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Chadzynski</surname><given-names>Grzegorz Lukasz</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Klose</surname><given-names>Uwe</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Berg</surname><given-names>Daniela</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>Department of Neurodegeneration</addr-line>, <institution>Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE)</institution>, <institution>University of Tübingen</institution>, <addr-line>Tübingen</addr-line>, <country>Germany</country></aff><aff id="af2"><label>2</label><addr-line>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group</addr-line>, <institution>University Hospital Tübingen</institution>, <addr-line>Tübingen</addr-line>, <country>Germany</country></aff><author-notes><corresp><label>Correspondence to</label> Dr A Gröger, Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Hoppe-Seyler-Str 3, Tübingen 72076, Germany; <email>adriane.groeger@med.uni-tuebingen.de</email></corresp></author-notes><pub-date pub-type="ppub"><month>6</month><year>2013</year></pub-date><pub-date pub-type="epub-original"><day>18</day><month>1</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>18</day><month>1</month><year>2013</year></pub-date><volume>84</volume><volume-id pub-id-type="other">84</volume-id><volume-id pub-id-type="other">84</volume-id><issue>6</issue><issue-id pub-id-type="other">jnnp;84/6</issue-id><issue-id pub-id-type="other">6</issue-id><issue-id pub-id-type="other">84/6</issue-id><fpage>644</fpage><history><date date-type="received"><day>12</day><month>3</month><year>2012</year></date><date date-type="rev-recd"><day>28</day><month>11</month><year>2012</year></date><date date-type="accepted"><day>18</day><month>12</month><year>2012</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2013</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-84-644.pdf"></self-uri><abstract><sec><title>Objectives</title><p>Degeneration of dopaminergic neurons in the substantia nigra (SN) pars compacta is the primary cause of idiopathic Parkinson's disease (iPD). In early stages of disease in particular, presentation of symptoms is non-specific leading to difficulties in differentiating between iPD and atypical parkinsonian syndromes (aPS). The aim of this study was to evaluate the feasibility of three-dimensional magnetic resonance spectroscopic imaging (MRSI) of the SN region for differentiation between iPD and aPS.</p></sec><sec><title>Methods</title><p>20 patients with iPD, 10 with aPS and 22 controls were examined on a 3 T MR scanner using three-dimensional MRSI with a voxel size of 0.252 ml and an echo time of 30 ms. Excitation volume was positioned in such a way that in each hemisphere 1 voxel defines the rostral and 1 voxel the caudal SN region. Using a fully automatic spectra evaluation, the metabolite ratios of N-acetyl aspartate/creatine (NAA/Cr) were calculated.</p></sec><sec><title>Results</title><p>In all cases spectra with good quality were obtained. Differences in rostral to caudal NAA/Cr ratios were significant between controls and iPD patients, as well as between iPD and aPS patients (p<0.001 for both). For controls, rostral NAA/Cr was greater than caudal, whereas in iPD patients this ratio was reversed. aPS patients showed similar ratios as controls.</p></sec><sec><title>Conclusions</title><p>Typical reversed rostral to caudal NAA/Cr ratios in iPD patients suggests that they could be linked to specific pathology of neuronal loss in the SN pars compacta. Therefore, the results suggest that MRSI may support the differential diagnosis of patients with clinically unclassifiable parkinsonian syndromes who do not yet fulfil the established clinical criteria.</p></sec></abstract><kwd-group><kwd>Parkinson's Disease</kwd><kwd>MRS</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><partName>Research paper</partName><title>Differentiation between idiopathic and atypical parkinsonian syndromes using three-dimensional magnetic resonance spectroscopic imaging</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><partName>Research paper</partName><title>Differentiation between idiopathic and atypical parkinsonian syndromes using three-dimensional magnetic resonance spectroscopic imaging</title></titleInfo><name type="personal"><namePart type="given">Adriane</namePart><namePart type="family">Gröger</namePart><affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Benjamin</namePart><namePart type="family">Bender</namePart><affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Isabel</namePart><namePart type="family">Wurster</namePart><affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Grzegorz Lukasz</namePart><namePart type="family">Chadzynski</namePart><affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Uwe</namePart><namePart type="family">Klose</namePart><affiliation>Department of Diagnostic and Interventional Neuroradiology, Magnetic Resonance Research Group, University Hospital Tübingen, Tübingen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Daniela</namePart><namePart type="family">Berg</namePart><affiliation>Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Centre for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2013-06</dateIssued><dateCreated encoding="w3cdtf">2013-01-18</dateCreated><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Objectives Degeneration of dopaminergic neurons in the substantia nigra (SN) pars compacta is the primary cause of idiopathic Parkinson's disease (iPD). In early stages of disease in particular, presentation of symptoms is non-specific leading to difficulties in differentiating between iPD and atypical parkinsonian syndromes (aPS). The aim of this study was to evaluate the feasibility of three-dimensional magnetic resonance spectroscopic imaging (MRSI) of the SN region for differentiation between iPD and aPS. Methods 20 patients with iPD, 10 with aPS and 22 controls were examined on a 3 T MR scanner using three-dimensional MRSI with a voxel size of 0.252 ml and an echo time of 30 ms. Excitation volume was positioned in such a way that in each hemisphere 1 voxel defines the rostral and 1 voxel the caudal SN region. Using a fully automatic spectra evaluation, the metabolite ratios of N-acetyl aspartate/creatine (NAA/Cr) were calculated. Results In all cases spectra with good quality were obtained. Differences in rostral to caudal NAA/Cr ratios were significant between controls and iPD patients, as well as between iPD and aPS patients (p<0.001 for both). For controls, rostral NAA/Cr was greater than caudal, whereas in iPD patients this ratio was reversed. aPS patients showed similar ratios as controls. Conclusions Typical reversed rostral to caudal NAA/Cr ratios in iPD patients suggests that they could be linked to specific pathology of neuronal loss in the SN pars compacta. Therefore, the results suggest that MRSI may support the differential diagnosis of patients with clinically unclassifiable parkinsonian syndromes who do not yet fulfil the established clinical criteria.</abstract><subject><genre>Keywords</genre><topic>Parkinson's Disease</topic><topic>MRS</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">jnnp</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>84</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>644</start></extent></part></relatedItem><identifier type="istex">88774A2459A7B924352591CF5E31BF365095558D</identifier><identifier type="DOI">10.1136/jnnp-2012-302699</identifier><identifier type="href">jnnp-84-644.pdf</identifier><identifier type="ArticleID">jnnp-2012-302699</identifier><identifier type="PMID">23334525</identifier><identifier type="local">jnnp;84/6/644</identifier><accessCondition type="use and reproduction" contentType="copyright">Published by the BMJ Publishing Group Limited. 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