Imaging in Parkinson’s disease
Editor – We are grateful to Pagano et al for their compelling review of imaging in Parkinson’s disease.1 The accurate and timely diagnosis of Parkinsonian syndromes is of upmost importance for patients, carers and physicians to allow appropriate treatment, multidisciplinary intervention and precise prognostication. It was unfortunate, however, to find no mention of analysis of the nigrosome complexes on susceptibility-weighted imaging. Damier et al described patterns of dopamine-containing neuron loss in five compartments within the substantia nigra, the main of which is nigrosome-1.2 Maximal cell loss occurs in nigrosome-1 and has been identified as a pathoanatomical correlate of idiopathic Parkinson’s disease pathology on susceptibility-weighted 3T magnetic resonance imaging.
Several studies have now demonstrated a high sensitivity and specificity in the diagnosis of idiopathic Parkinson’s disease.3,4 Furthermore, in our experience the analysis of the nigrosome-1 complex on 3.0T susceptibility-weighted imaging sequences instead of DaTSCAN for supplementing clinical diagnosis of tremor-predominant idiopathic Parkinson’s disease from essential tremor is of equivalent utility. Its use beyond this indication is still under investigation.
Most centres can now more readily access a 3.0T magnetic resonance imaging scanner than molecular imaging such as DaTSCAN and avoids the risks associated with ionising radiation. Although more evidence is required to establish the full role of susceptibility-weighted imaging in Parkinsonian syndromes, it looks promising as another tool in the diagnostic arsenal of physicians to complement clinical diagnosis.
Conflicts of interest
The authors have no conflicts of interest to declare.
- © Royal College of Physicians 2017. All rights reserved.
References
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- Goa P
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- Langley J
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