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Updated: Apr 15, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Conventional 3T brain MRI and diffusion tensor imaging in the diagnostic workup of early stage parkinsonism
Frederick J A Meijer1, Anouke van Rumund, Anil M Tuladhar
1Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, Postbus 9101, 6500 HB, Nijmegen, The Netherlands, Anton.Meijer@radboudumc.nl.
Introduction:
The aim of this study is to evaluate whether the diagnostic accuracy of 3 T brain MRI is improved by region of interest (ROI) measures of diffusion tensor imaging (DTI), to differentiate between neurodegenerative atypical parkinsonism (AP) and Parkinson's disease (PD) in early stage parkinsonism.
Methods:
We performed a prospective observational cohort study of 60 patients presenting with early stage parkinsonism and initial uncertain diagnosis. At baseline, patients underwent a 3 T brain MRI including DTI. After clinical follow-up (mean 28.3 months), diagnoses could be made in 49 patients (30 PD and 19 AP). Conventional brain MRI was evaluated for regions of atrophy and signal intensity changes. Tract-based spatial statistics and ROI analyses of DTI were performed to analyze group differences in mean diffusivity (MD) and fractional anisotropy (FA), and diagnostic thresholds were determined. Diagnostic accuracy of conventional brain MRI and DTI was assessed with the receiver operating characteristic (ROC).
Results:
Significantly higher MD of the centrum semiovale, body corpus callosum, putamen, external capsule, midbrain, superior cerebellum, and superior cerebellar peduncles was found in AP. Significantly increased MD of the putamen was found in multiple system atrophy-parkinsonian form (MSA-P) and increased MD in the midbrain and superior cerebellar peduncles in progressive supranuclear palsy (PSP). The diagnostic accuracy of brain MRI to identify AP as a group was not improved by ROI measures of MD, though the diagnostic accuracy to identify MSA-P was slightly increased (AUC 0.82 to 0.85).
Conclusion:
The diagnostic accuracy of brain MRI to identify AP as a group was not improved by the current analysis approach to DTI, though DTI measures could be of added value to identify AP subgroups.
Insights
Diffusion tensor imaging (DTI) measures did not improve 3 T brain MRI diagnostic accuracy for differentiating atypical parkinsonism (AP) from Parkinson's disease (PD). However, DTI may help identify specific AP subgroups like MSA-P.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Differentiating early-stage atypical parkinsonism (AP) from Parkinson's disease (PD) is clinically challenging.
- 3 Tesla (3 T) brain MRI is a key diagnostic tool, but its accuracy in early stages needs enhancement.
Purpose of the Study:
- To assess if region of interest (ROI) measures from diffusion tensor imaging (DTI) improve the diagnostic accuracy of 3 T brain MRI for distinguishing AP from PD.
- To evaluate the utility of DTI in identifying specific AP subtypes.
Main Methods:
- Prospective observational cohort study of 60 early-stage parkinsonism patients with uncertain diagnoses.
- 3 T brain MRI with DTI, conventional MRI for atrophy/signal changes, and tract-based spatial statistics/ROI analyses for mean diffusivity (MD) and fractional anisotropy (FA).
- Receiver operating characteristic (ROC) analysis to determine diagnostic accuracy.
Main Results:
- Significantly higher MD in centrum semiovale, corpus callosum, putamen, external capsule, midbrain, and cerebellum in AP patients.
- Increased MD in the putamen for multiple system atrophy-parkinsonian form (MSA-P) and in the midbrain/superior cerebellar peduncles for progressive supranuclear palsy (PSP).
- ROI DTI measures did not improve overall AP diagnostic accuracy but slightly enhanced MSA-P identification (AUC 0.82 to 0.85).
Conclusions:
- Current DTI analysis approaches do not enhance the overall diagnostic accuracy of 3 T brain MRI for differentiating AP from PD.
- DTI measures show potential value for identifying specific AP subgroups, such as MSA-P.
