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Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
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Diffusion tensor imaging of sequential neuropathological patterns in progressive supranuclear palsy.

Lavinia A Bârlescu1, Günter U Höglinger2,3,4, Heiko Volkmann1

  • 1Department of Neurology, University Hospital Ulm, Ulm, Germany.

Frontiers in Aging Neuroscience
|June 23, 2025
PubMed
Summary

Diffusion tensor imaging (DTI) mapped progressive supranuclear palsy (PSP) stages in vivo. This region/tract of interest (ROI/TOI) approach identified sequential brain alterations, supporting DTI as a marker for PSP progression.

Keywords:
diffusion tensor imaging (DTI)neuropathologyprogressive supranuclear palsysequential patterntau protein

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Area of Science:

  • Neuroimaging
  • Neuropathology
  • Diffusion Tensor Imaging (DTI)

Background:

  • Progressive Supranuclear Palsy (PSP) is characterized by tau inclusions that may follow a sequential regional pattern.
  • Understanding the in vivo progression of PSP is crucial for diagnosis and treatment.
  • Existing neuropathological staging concepts require validation with in vivo imaging techniques.

Purpose of the Study:

  • To develop a hypothesis-guided region/tract of interest-based (ROI/TOI) approach using DTI.
  • To analyze in vivo the brain regions involved at each neuropathological stage of PSP.
  • To validate the proposed neuropathological staging concept of PSP using DTI.

Main Methods:

  • Analysis of two cohorts (cohort A: 78 PSP patients, 63 controls; cohort B: 66 PSP patients, 44 controls) with 3.0T and 1.5T MRI scans.
  • Longitudinal follow-up scans obtained for a subset of patients and controls in cohort A.
  • Application of Whole Brain-Based Spatial Statistics (WBSS) and a combined ROI/TOI approach to identify and analyze brain alterations.

Main Results:

  • WBSS revealed significant alterations in the brainstem/midbrain, basal ganglia, and frontal lobe in PSP patients compared to controls.
  • Alterations were more pronounced in longitudinal data, indicating disease progression.
  • Statistical analysis of ROIs/TOIs demonstrated a sequential pattern of affected structures aligning with defined neuropathological steps.

Conclusions:

  • The combined ROI/TOI DTI approach successfully mapped PSP disease stages in vivo, both cross-sectionally and longitudinally.
  • DTI serves as a valuable technical marker for imaging PSP progression according to established neuropathological stages.
  • This DTI-based approach holds potential for stratifying PSP patients in future MRI and autopsy-controlled studies.