The contribution of cerebellar proton magnetic resonance spectroscopy in the differential diagnosis among parkinsonian syndromes. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Zanigni, Stefano; Testa, Claudia; Calandra-Buonaura, Giovanna; Sambati, Luisa; Guarino, Maria; Gabellini, Anna; Evangelisti, Stefania; Cortelli, Pietro; Lodi, Raffaele; Tonon, Caterina
• Is Part Of: Parkinsonism & related disorders. Volume 21:Issue 8(2015)
• Page Start: 929
• Page End: 937
• Publication Date: 2015-08
• Subjects: Parkinson's disease -- MRS -- Cerebellum -- Progressive supranuclear palsy -- Multiple system atrophy; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2015.05.025
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Introduction: The in vivo differential diagnosis between idiopathic Parkinson's disease (PD) and atypical parkinsonian syndromes (PS), such as multiple system atrophy [MSA with a cerebellar (C) and parkinsonian (P) subtype] and progressive supranuclear palsy – Richardson's Syndrome (PSP-RS) is often challenging. Previous brain MR proton spectroscopy ( 1 H-MRS) studies showed biochemical alterations in PS, despite results are conflicting. Cerebellum plays a central role in motor control and its alterations has been already demonstrated in atypical PS. The main aim of this study was to evaluate diagnostic accuracy of cerebellar 1 H-MRS in the differential diagnosis between PD and atypical PS. Methods: We obtained 1 H-MRS spectra from the left cerebellar hemisphere of 57 PS (21 PD, and 36 atypical PS) and 14 unaffected controls by using a 1.5 T GE scanner. N-acetyl-aspartate (NAA)/Creatine (Cr), choline-containing compounds (Cho)/Cr, myoinositol (mI)/Cr, and NAA/mI ratios were calculated. Results: NAA/Cr and NAA/mI ratios were significantly lower (p < 0.01) in atypical PS compared to PD and controls, and in MSA-C compared to PD, MSA-P, PSP-RS and controls. PSP-RS group showed reduced NAA/Cr ratios compared to PD (p < 0.05) and controls (p < 0.05), and reduced NAA/mI compared to controls (p < 0.01). NAA/Cr ratio values higher than 1.016 showed 100% sensitivity and negative predictive value, 62% positive predictive value and 64% specificity in discriminating PD. Conclusion: Cerebellar biochemical alterations detected by using 1 H-MRS could represent an adjunctive diagnostic tool to improve the differential diagnosis of PS. Highlights: The in vivo differential diagnosis of parkinsonian syndromes is often challenging. 1 H-MRS technique is able to detect biochemical alterations in living tissues. We found cerebellar biochemical neurodegenerative alterations in atypical pakinsonisms. Cerebellar 1 H-MRS could represent a diagnostic tool for atypical parkinsonisms.