The Applied Value in Brain Gray Matter Nuclei of Patients with Early-stage Parkinson’s Disease : A Study Based on Multiple Magnetic Resonance Imaging Techniques
Authors: Meng Heng , Zhang Duo , Sun Qiyuan 
Published: December 2022

Purpose
To evaluate the application value of MR susceptibility weighted imaging (SWI), quantitative susceptibility imaging (QSM), diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) in the combined diagnosis of micro-structural changes in early Parkinson's disease (PD) patients with brain gray matter nuclei and to provide objective basis for clinical diagnosis.
Methods
Totally 20 early-stage PD patients (8 males and 12 females; aged 66.50 ± 9.65 years) and their disease courses are about 0.5-6 years. The third part of UPDRS scored as (18.4 ± 9.4).And 20 healthy controls (HC) (13 males and 7 females; aged 61.25 ± 6.87 years) were included in this study. All the subjects were informed of the purpose of this study. And the study was approved by the Ethics Committee of Beihua University Hospital, Jinlin, China. In this study, These images were acquired based on a 3T MR scanner (Ingenia; Philips, Best, the Netherlands) and measured the imaging parameters of gray matter nuclei in early Parkinson's disease by SWI, QSM, DTI and DKI techniques. Then the parameters were obtained by Philips post-processing work station, DKE, MEDI and other software.These ROIs including the substantia nigra, red nucleus, head of caudate nucleus, putamen and thalamus were manually drawn on each parameter mapping images by two MRI physicians. Finally, SPSS 21.0 statistical software is used for data analysis.
Results
Based on SWI, 15 PD patients and 6 healthy volunteers were diagnosed correctly. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic coincidence rate were 75.0%, 30.0%, 51.7%, 54.5% and 52.5% about the diagnosis of Nigrosome-one on imaging. Based on QSM, 19 PD patients and 11 healthy volunteers were diagnosed correctly. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic coincidence rate were 95.0%, 55.0%, 67.9%, 91.7% and 75.0% about the diagnosis of Nigrosome-one on imaging. In HC group, there was no significant difference in any DKI-derived parameters between DKI3b and DKI5b (P > 0.05). Compared with HC group, the MK value increased within both the substantia nigra and thalamus in PD group(P < 0.05),the MD increased witnin both the substantia nigra and the head of caudate nucleus in PD group(P < 0.05). Compared with HC group,the susceptibility values within the substantia nigra, red nucleus, head of caudate nucleus and putamen increased in PD group(P < 0.05). Identifying HC and PD, the MD value in substantia nigra has the best diagnostic efficiency. The maximum area under ROC curve (AUC) of the MD value was 0.823, the sensitivity was 70.0%, the specificity was 85.0%, and the diagnostic threshold was 0.414. The diagnostic efficiency of MK value in substantia nigra was next, the area under ROC curve (AUC) of the MK value was 0.695, the sensitivity was 95.0%, the specificity was 50.0%, and the diagnostic threshold was 0.667. Both of them had statistical significance (P < 0.05).
Conclusions
In the early diagnosis of Parkinson's disease, QSM is more effective than SWI in observing swallowtail sign in substantia nigra.In the early diagnosis of Parkinson's disease, MD and MK values of substantia nigra in DKI parameters have higher diagnostic efficiency. The combination scanning of DKI and QSM has the highest diagnostic efficiency and provides imaging basis for clinical diagnosis of early Parkinson's disease.