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MRI Test Could Be Parkinson’s Breakthrough

May 1, 2014
Written by: , Filed in: Diagnostic Imaging, Neuroradiology
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United Kingdom researchers think they’ve found an easy, accurate, relatively inexpensive test for Parkinson’s disease: 3 tesla susceptibility-weighted MRI brain scans.

SPECT can be used for diagnosing Parkinson’s, but the researchers wanted something cheaper and more widely available. They’ve learned that neuron loss in a small subregion of the midbrain called the substantia nigra occurs early in Parkinson’s. The new research, published online last month in PLOS ONE, pinpoints a sub-subregion called nigrosome-1 as a telltale marker.

Stefan Schwarz, MD, lead author of the PLOS ONE article, characterized the importance of his team’s research:

This is a breakthrough finding, as currently Parkinson’s disease is mostly diagnosed by identifying symptoms like stiffness and tremor. Imaging tests to confirm the diagnosis are limited to expensive nuclear medical techniques, which are not widely available and associated with potentially harmful ionizing radiation.

Dr. Schwarz is an academic radiology clinical lecturer  at the University of Nottingham School of Medicine in Nottingham, United Kingdom. He was quoted in a university news release.

The test involves looking for what the researchers call a swallowtail nigrosome-1 shape on the MRI scan. It’s a forked shape that, frankly, looks more like a crab claw to us, but “swallowtail” works too.

“Using magnetic resonance imaging (no ionizing radiation involved and much cheaper than nuclear medical techniques), we identified a specific imaging feature which has great similarity to a tail of a swallow,” Dr. Schwarz said, “and therefore decided to call it the ‘swallowtail sign.’ This sign is absent in Parkinson’s disease.”

The researchers applied the swallowtail test prospectively to 19 subjects (10 diagnosed with Parkinson’s and 9 controls) and retrospectively to 90 others (not counting 15 subjects initially included but eventually excluded for various reasons). Nine of the retrospective subjects had been diagnosed with Parkinson’s, and the other 81 exhibited no Parkinson’s symptoms.

The swallowtail test correctly classified 8 of the 9 controls and 8 of the 10 Parkinson’s patients in the prospective study. In the retrospective study, it correctly classified 77 of the 81 non-Parkinson’s subjects and all 9 of the Parkinson’s subjects.

The PLOS ONE article concludes that the swallowtail test “has potential to become a new and easy applicable 3T MRI diagnostic tool for nigral degeneration in PD.”

Related CME seminar (up to 33.5 AMA PRA Category 1 credits): Neuroradiology Review

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