Jo Sungyang, Suh Chong Hyun, Lee Sangjin, Lee Jihyun, Yoon MyungKi, Heo Hwon, Shim Woo Hyun, Kim Sang Joon, Kim Eung Yeop, Chung Sun Ju
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sci Rep. 2025 Jan 4;15(1):823. doi: 10.1038/s41598-024-81089-4.
Distinguishing between Parkinson's disease (PD) and essential tremor (ET) can be challenging sometimes. Although positron emission tomography can confirm PD diagnosis, its application is limited by high cost and exposure to radioactive isotopes. Patients with PD exhibit loss of the dorsal nigral hyperintensity on brain magnetic resonance imaging (MRI). Novel MRI-based approaches, including susceptibility map-weighted imaging (SMwI), allow visualization of the dorsal nigral hyperintensity at an increased resolution. Herein, we investigated the diagnostic accuracy of dorsal nigral hyperintensity evaluation on SMwI for distinguishing tremor-dominant PD from ET. Consecutive patients with tremor who underwent SMwI and were diagnosed with tremor-dominant PD or ET between July 2021 and July 2022 were enrolled. The dorsal nigral hyperintensity loss on SMwI was compared between the PD and ET groups. All 143 patients (100%) with tremor-dominant PD showed unilateral or bilateral dorsal nigral hyperintensity loss. Among 136 patients with ET, 131 (96.3%) exhibited an intact dorsal nigral hyperintensity, while 5 (3.7%) showed unilateral/bilateral dorsal nigral hyperintensity loss. SMwI discriminated between tremor-dominant PD and ET with a sensitivity and specificity of 100% and 96.3%, respectively. F-FP-CIT PET revealed normal findings in 4/5 patients with ET who had false-positive results on SMwI. These results indicate that dorsal nigral hyperintensity loss on SMwI could differentiate between tremor-dominant PD and ET with high accuracy.
有时，区分帕金森病（PD）和特发性震颤（ET）具有挑战性。尽管正电子发射断层扫描可以确诊PD，但其应用受到高成本和放射性同位素暴露的限制。PD患者在脑磁共振成像（MRI）上表现为黑质背侧高信号缺失。基于MRI的新方法，包括磁化率图加权成像（SMwI），能够以更高的分辨率显示黑质背侧高信号。在此，我们研究了SMwI上黑质背侧高信号评估对区分震颤为主型PD和ET的诊断准确性。纳入了2021年7月至2022年7月期间接受SMwI检查并被诊断为震颤为主型PD或ET的连续性震颤患者。比较了PD组和ET组在SMwI上黑质背侧高信号缺失情况。所有143例（100%）震颤为主型PD患者均表现为单侧或双侧黑质背侧高信号缺失。在136例ET患者中，131例（96.3%）黑质背侧高信号完整，而5例（3.7%）表现为单侧/双侧黑质背侧高信号缺失。SMwI区分震颤为主型PD和ET的敏感性和特异性分别为100%和96.3%。F-FP-CIT PET显示，在SMwI上出现假阳性结果的5例ET患者中有4例结果正常。这些结果表明，SMwI上黑质背侧高信号缺失能够高度准确地区分震颤为主型PD和ET。
