Review Article

Magnetic Resonance Spectroscopy: An In Vivo Molecular Imaging Biomarker for Parkinson’s Disease?

Table 2

Main results of MRS studies in Parkinson’s disease and atypical parkinsonian disorders.

MRS techniqueDiseaseMain resultsMean (SD) of metabolite ratios in controlsMean (SD) of metabolite ratios in patientsSignificant differences were indicated by the following:Reference

1HMRS
at 1.5 T
MSA-P and PD versus controlsReduction of NAA/Cr ratios in the lentiform nucleusNAA/Cr:
1.76 (0.96)
NAA/CrMSA-P:  
1.35 (0.29)  
NAA/CrPD:  
1.82 (0.28)
MSA-P versus controls PD versus controls[17]

1HMRS
at 1.5 T
PSP, CBD, MSA, and VP versus controlsReduction of NAA/Cr ratios in the more affected frontal cortexNAA/Cr:
2.1 (0.2)
NAA/CrPSP: 1.4 (0.5)  
NAA/CrCBD: 0.9 (0.4)  
NAA/CrMSA: 1.2 (0.2)  
NAA/CrVP: 1.7 (0.1)
PSP, MSA and  
VP versus controls; CBD versus controls
[37]
PSP, MSA, CBD, and PD versus controlsReduction of NAA/Cr ratios in the more affected putamenNAA/Cr:
2.2 (0.2)
NAA/CrPSP: 1.4 (0.2)  
NAA/CrCBD: 1.0 (0.4)  
NAA/CrMSA: 1.8 (0.3)  
NAA/CrPD: 1.5 (0.2)
PSP and PD versus controls;
CBD versus controls;  
MSA versus controls

Reduction of NAA levels in the putamenNAA:
7.1 (1.6) mM
NAAPSP: 5.26 (0.9) mM  
NAAMSA-P: 5.27 (0.6) mM
NAAPD: 6.88 (1.2) mM
MSA-P versus controls  
MSA-P versus PD  
PSP versus controls  
PSP versus PD
1HMRS
at 1.5 T
MSA-P and PSP versus controls and PDReduction of NAA levels in the pallidumNAA:
6.52 (1.5) mM
NAAPSP: 4.07 (1.0) mM  
NAAMSA-P: 5.54 (1.1) mM  
NAAPD: 6.36 (0.8) mM
PSP versus controls  
PSP versus PD
[38]
Reduction of NAA levels in the lentiform nucleusNAA:
6.77 (1.2) mM
NAAPSP: 4.6 (0.6) mM  
NAAMSA-P: 5.4 (0.7) mM  
NAAPD: 6.62 (0.8) mM
MSA-P versus controls  
MSA-P versus versus PD  
PSP versus controls  
PSP versus PD

1HMRS
at 1.5 T
MSA and PSP versus controls and PDReduction of NAA/Cho ratios in the lentiform nucleusNAA/Cho:
2.02 (0.43)
NAA/ChoMSA:  
1.39 (0.31)  
NAA/ChoPSP:  
1.45 (0.28)  
NAA/ChoPD:  
1.82 (0.28)
MSA versus controls  
PSP versus controls  
MSA versus PD  
PSP versus PD
[39]
1HMRS
at 1.5 T
MSA, PSP, and PD versus controls and MSA versus PDReduction of NAA/Cr ratios in the lentiform nucleusNAA/Cr:
1.86 (0.29)
NAA/CrMSA:
1.32 (0.30)
NAA/CrPSP:
1.40 (0.17)
NAA/CrPD:
1.65 (0.41)
MSA versus controls  
PSP versus controls  
PD versus controls MSA versus PD

1HMRS at 3 TMSA-C and MSA-P versus controls; MSA-P versus PDReduction of NAA/Cr ratios in the pontine basisNANA MSA-C versus controls  
MSA-P versus controls  
MSA-P versus PD
[40]
MSA-P versus controls and PDReduction of NAA/Cr ratios in the putamenNANA MSA-P versus controls  
MSA-P versus PD

3D 1HMRSI at 3 TPD versus controls and ADPsLower NAA/Cr ratios in the rostral SN regions than those in the caudal SN regions(NAA/Cr)ros: 2.56 (0.73) and
(NAA/Cr)cau: 1.85 (0.51)
In PD (NAA/Cr)ros: 1.97 (1.24) and
(NAA/Cr)cau: 3.47 (2.37).
In ADPs (NAA/Cr)ros: 2.29 (1.37) and
(NAA/Cr)cau: 2.09 (0.92)
PD versus controls; PD versus APDs [41]
APDs versus controlsLower NAA/Cr ratios in the caudal SN regions than those in the rostral SN regions(NAA/Cr)ros: 2.56 (0.73) and
(NAA/Cr)cau: 1.85 (0.51)
(NAA/Cr)ros: 2.29 (1.37) and
(NAA/Cr)cau: 2.09 (0.92)
APDs versus controls

APDs: atypical parkinsonian disorders; CBD: corticobasal degeneration; Cho: choline-containing compounds; Cr: creatine + phosphocreatine; 1HMRS: proton magnetic resonance spectroscopy; 1HMRSI: proton magnetic resonance spectroscopy imaging; MRS: magnetic resonance spectroscopy; MSA: multiple-system atrophy; MSA-C: cerebellar ataxia variant of multiple-system atrophy; MSA-P: Parkinson’s variant of multiple-system atrophy; NA: not applicable; NAA: N-acetylaspartate; PD: Parkinson’s disease; PSP: progressive supranuclear palsy; SD: standard deviation; SN: substantia nigra; T: Tesla; VP: vascular parkinsonism.