Role of MRI in the differential diagnosis of Parkinson Disease and Parkinson Plus Syndromes

Congress:

ECR 2019

Poster Number:

C-2501

Type:

Educational Exhibit

Keywords:

MR, Neuroradiology brain, CNS, Imaging sequences, Education and training

Authors:

T. Tsochatzis¹, G. Velonakis¹, P. Toulas², M. A. Papathanasiou¹, E. Karavasilis¹, V. Pantoleon¹, I. Pantou¹, E. Martzoukos³, N. L. Kelekis¹; ¹Athens/GR, ²Pallini/GR, ³Maroussi/GR

DOI:

10.26044/ecr2019/C-2501

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2501

Fig. 1: Axial FLAIR (A) and T2(B) images of a PD patient, show blurring and thinning of...

Fig. 2: Normal substantia nigra anatomy on axial SWI slice at the level of nigrosome-1...

Fig. 3: Abnormal substantia nigra on axial SWI images in a patient with Parkinson...

Fig. 4: Axial SWI image of a MSA-P patient shows reversal of the expected magnetic...

Learning objectives

The purpose of the e-poster is to: illustrate the spectrum of MRI findings in Parkinson Disease (PD) and Parkinson plus syndromes (Pps). pinpoint the role of MRI in the differential diagnosis. analyze the possible differential diagnoses and summarize the key points useful to give an accurate diagnosis. discuss the potential future role of advanced imaging techniques.

Background

Parkinson disease (PD) is a multisystem neurodegenerative disorder affecting diverse neural pathways and several neurotransmitter circuits [1]. PD is characterized by bradykinesia, shuffling gait, rigidity and involuntary tremors. Dementia, when occurs, is a late phenomenon [2]. PD is a synucleinopathy. The term “Parkinson plus syndrome” (Pps) refers to the combination of PD with other clinical symptoms. Pps include multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) [3]. Multiple system atrophy (MSA) includes three subtypes MSA-P, MSA-C, and MSA-A. MSA-P displays more...

Findings and procedure details

DATscan is a valuable tool for evaluating patients with parkinsonian symptoms. Normal DATscan shows two symmetric crescent shaped regions (comma). DATscan is normal in essential tremor or drug induced parkinsonian symptoms, because these disorders are not related to nigro-striatal dopamine transporter loss. PD and Pps have DAT degeneration, which results in an abnormal DATscan . However, extensive overlapping in DATscan findings does not allow discrimination between PD and Pps [7]. Structural magnetic resonance imaging plays a crucial role in the diagnostic workup of neurodegenerative disorders....

Conclusion

MRI is a useful tool, supplementary to the clinical findings and the DATscan for the differential diagnosis of PD and Pps. MRI can exclude causes of secondary parkinsonism. The absence of the shallow tail sign is the most accurate finding in patients with PD. SWI/T2* putaminal hypointensity due to iron deposition is the main imaging feature of MSA-P. Pons and cerebellum atrophy, as well as the “hot cross bun" sign, are the imaging hallmarks of MSA-C. PSP is characterized by midbrain atrophy. Asymmetric frontoparietal –...

Personal information

References

1.Osborn,Anne G. Brain Osborn’s Brain: Imaging,Pathology and Anatomy.1sted: Amirsyr Publishing,Inc;2013:978-991. 2.Rohini Nadgir, David M.Yousem.Neuroradiology.4thed.The Requisites;2017:243-246. 3. Olfati N, Shoeibi A, Litvan I. Progress in the treatment of Parkinson-Plus syndromes. Parkinsonism RelatDisord. 2018 Oct 3. pii: S1353-8020(18)30432-2. 4. Flabeau O, Meissner WG, Tison F. Multiple system atrophy: current and future approaches to management. TherAdvNeurolDisord. 2010;3(4):249-63. 5. Boxer AL, Yu JT, Golbe LI, Litvan I, Lang AE, Höglinger GU. Advances in progressive supranuclear palsy: new diagnostic criteria, biomarkers,and therapeutic approaches. Lancet Neurol. 2017 Jul;16(7):552-563. 6. Armstrong MJ....