Preliminary Study In The Differentiation Of Parkinson’s Disease And Progressive Supranuclear Palsy Using A 3D Multi-echo Magnetization Transfer Contrast Sequence

ObjectiveThe purpose of this study was to acquire neuromelanin-sensitive magnetic resonance imaging(NM-MRI)and quantitative susceptibility mapping(QSM)by using a 3D multi-echo magnetization transfer contrast neuromelanin-sensitive(3D ME-MTC-NM)sequence,and to explore the application value of this sequence in the differentiation of Parkinson’s disease(PD)and progressive supranuclear palsy(PSP).Materials and MethodsA total of 49 patients with PD(24 males and 25 females,mean age 62.7±7.5 years)and 23 patients with PSP(11 males and 12 females,mean age 65.4±8.0 years)were recruited from outpatients and inpatients in Department of Neurology in Shandong Provincial Hospital from April 2021 to October 2022.At the same time,we also recruited 25 age-and sex-matched healthy controls(HC)(11 males,14 females,mean age 63.9±7.2 years)from the community.All subjects were examined by Philips 3.0T MRI scanner,3D ME-MTC-NM sequence images were collected and processed to acquire NM-MRI and QSM images.The boundary of the substantia nigra pars compacta(SNpc)in NM-MRI images and the boundary of red nucleus(RN)in QSM images were manually delineated by two experienced radiologists using ITK-SNAP software to measure SNpc volume and RN susceptibility value.The intraclass correlation coefficient(ICC)was used to evaluate the consistency of the measurement results between two radiologists.Kruskal-Wallis test was used to evaluate whether there were statistical differences in SNpc volume and RN susceptibility value among three groups,and Bonferroni test was used for pairwise comparison between groups.The receiver operating characteristic(ROC)curves were used to calculate the area under curve(AUC)to evaluate the diagnostic efficacy of SNpc volume and RN susceptibility value.Binary logistic regression was used to combine SNpc volume and RN susceptibility value to distinguish PD from PSP,and ROC curve was used to evaluate the diagnostic efficiency.P<0.05 was considered statistically significant.ResultThe ICC of SNpc volume and RN susceptibility value measured by two radiologists were 0.952(95%CI 0.929～0.968)and 0.991(95%CI 0.986～0.994),respectively.The SNpc volume of HC group,PD group and PSP group were 450.7±37.0mm3,314.6±59.2mm3 and 157.6±66.5mm3,respectively.There was a significant difference in SNpc volume among three groups(P<0.001).The SNpc volume of PSP group(P<0.001)and PD group(P<0.001)were significantly smaller than that of HC group;The SNpc volume in PSP group was significantly smaller than that in PD group(P<0.001).The RN susceptibility value of HC group,PD group and PSP group were 0.051±0.019ppm,0.061±0.022ppm and 0.116±0.034ppm,respectively.There was a significant difference in RN susceptibility value among three groups(P<0.001).The RN susceptibility value of PSP group was significantly higher than that of PD group(P<0.001)and HC group(P<0.001);The RN susceptibility value in PD group was higher than that in HC group,but the difference was not statistically significant(P=0.407).ROC curve results showed that,in PD and HC groups,the AUC of SNpc volume was 0.967.In PSP and HC groups,the AUC of SNpc volume and RN susceptibility value were 1.000 and 0.963,respectively.In PD and PSP groups,the AUC of SNpc volume and RN susceptibility value were 0.950 and 0.918,respectively,and the AUC of SNpc volume combined with RN susceptibility value was 0.971.ConclusionIn this study,NM-MRI and QSM images can be acquired simultaneously by a single 3D ME-MTC-NM sequence,which can reflect differences between PD and PSP from different perspectives,and have high diagnostic efficiency in the differentiation of PD and PSP.This sequence has potential clinical application value in the differentiation of PD and PSP.