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Drug-induced Parkinsonism versus Idiopathic Parkinson Disease: Utility of Nigrosome 1 with 3-T Imaging

Dec. 2015

Abstract

Imaging nigrosome 1 with 3-T MR can differentiate drug-induced parkinsonism (DIP) from idiopathic Parkinson disease with an accuracy of 93.9% and no false negative result, which suggests that it can be used to screen patients who need further diagnostic imaging tests such as dopamine transporter imaging in those suspected of having DIP.


Purpose

To explore the utility of nigrosome 1 with 3-T magnetic resonance (MR) imaging to differentiate idiopathic Parkinson disease (IPD) from drug-induced parkinsonism (DIP).


Materials and Methods

The institutional review board approved this study, and participants gave informed consent. This study enrolled patients with DIP (n = 20) and IPD (n = 29) who underwent N-3-fluoropropyl-2-β-carbomethoxy-3-β-(4-iodophenyl)nortropane (18F-FP-CIT) positron emission tomography (PET) and healthy participants (n = 20). All participants underwent 0.5 × 0.5 × 1.0 mm3 oblique axial three-dimensional multiecho-data image combination imaging to view the nigrosome 1 with 3-T imaging. Two reviewers independently assessed the nigrosome 1 without clinical information. DIP was diagnosed when no abnormality was seen at 18F-FP-CIT PET. Diagnostic sensitivity, specificity, and accuracy of the nigrosome 1 imaging were evaluated between the IPD and DIP patients and between the IPD patients and healthy participants. Interrater agreement was assessed with Cohen κ.


Results

Both reviewers agreed in 63 of 69 participants (91.3%) for the presence of any abnormality on either side of the nigrosome 1 (κ = 0.825). Findings in all 29 IPD patients (100%) and three of 20 DIP patients (15%) were rated as abnormal and in 17 of 20 DIP patients (85%) they were interpreted as normal on the basis of imaging of the nitgrosome 1 (sensitivity, 100% (29 of 29); specificity, 85.0% (17 of 20); accuracy, 93.9% (46 of 49) between IPD and DIP patients). Findings in 3 of 20 healthy participants (15.0%) were interpreted as abnormal on the basis of imaging the nigrosome 1 while in the other 17 of 20 healthy participants (85.0%) they were rated as normal (sensitivity, 100% [29 of 29]; specificity, 85.0% [17 of 20]; accuracy, 93.9% [46 of 49] between IPD patients and healthy participants [κ = 0.831]).


Conclusion

The imaging of nigrosome 1 with 3-T imaging can differentiate DIP from IPD with high accuracy and may help to screen patients who need dopamine transporter imaging in those suspected of having DIP.

  • Link

    https://doi.org/10.1148/radiol.2015151466

  • Author

    Young Hee Sung, Young Noh, Jongho Lee, Eung Yeop Kim

  • Keywords

    drug-induced parkinsonism(DIP), idiopathic Parkinson disease(IPD), nigrosome, 3T MRI

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