PT  - JOURNAL ARTICLE
AU  - Focke, N.K.
AU  - Helms, G.
AU  - Pantel, P.M.
AU  - Scheewe, S.
AU  - Knauth, M.
AU  - Bachmann, C.G.
AU  - Ebentheuer, J.
AU  - Dechent, P.
AU  - Paulus, W.
AU  - Trenkwalder, C.
TI  - Differentiation of Typical and Atypical Parkinson Syndromes by Quantitative MR Imaging
AID  - 10.3174/ajnr.A2865
DP  - 2011 Dec 01
TA  - American Journal of Neuroradiology
PG  - 2087--2092
VI  - 32
IP  - 11
4099  - http://www.ajnr.org/content/32/11/2087.short
4100  - http://www.ajnr.org/content/32/11/2087.full
SO  - Am. J. Neuroradiol.2011 Dec 01; 32
AB  - BACKGROUND AND PURPOSE: The differential diagnosis of Parkinson syndromes remains a major challenge. Quantitative MR imaging can aid in this classification, but it is unclear which of the proposed techniques is best suited for this task. We, therefore, conducted a head-to-head study with different quantitative MR imaging measurements in patients with IPS, MSA-type Parkinson, PSP, and healthy elderly controls. MATERIALS AND METHODS: Thirty-one patients and 13 controls underwent a comprehensive quantitative MR imaging protocol including R2*-, R2- and R1-mapping, magnetization transfer, and DTI with manual region-of-interest measurements in basal ganglia regions. Group differences were assessed with a post hoc ANOVA with a Bonferroni error correction and an ROC. RESULTS: The best separation of MSA from IPS in patients and controls could be achieved with R2*-mapping in the PU, with an ROC AUC of ≤0.96, resulting in a sensitivity of 77.8% (with a specificity 100%). MD was increased in patients with PSP compared with controls and to a lesser extent compared with those with IPS and MSA in the SN. CONCLUSIONS: Among the applied quantitative MR imaging methods, R2*-mapping seems to have the best predictive power to separate patients with MSA from those with IPS, and DTI for identifying PSP. APSatypical Parkinson syndromeAUCarea under the curveCN(head of the) caudate nucleusFAfractional anisotropyFLASHfast low-angle shotIPSidiopathic Parkinson syndromeMDmean diffusivityMPRAGEmagnetization-prepared rapid acquisition of gradient echoMSAmultiple systems atrophyMTRmagnetization transfer ratioPAglobus pallidumPSPprogressive supranuclear palsyPUputamenR1T1 relaxation rateR2T2 relaxation rateR2*T2* relaxation rateROCreceiver operating characteristic analysisSNsubstantia nigraSTEAMstimulated echo acquisition mode