Parkinson’s Disease

Review Article

Brain MR Contribution to the Differential Diagnosis of Parkinsonian Syndromes: An Update

Table 3

Anatomical distribution of brain alterations in multiple system atrophy (MSA), in the cerebellar (-C) and parkinsonian (-P) MSA variants, in progressive supranuclear palsy (PSP), and in corticobasal syndrome (CBS) (results of those studies focused on the differential diagnosis between Parkinson’s disease and atypical parkinsonian syndromes).
 MSAMSA-CMSA-PPSPCBS
Basal ganglia
Putamen↓ volume [53]
↑ ADC [73]
↓ MTR [90]
↓ T2 signal intensity [91]
↓ NAA/Cr† [103]		 ↓ volume [55, 60, 83, 86, 96]
↑ ADC [61, 62, 64, 66, 73, 75, 77]
↑ rTrace(D) [63, 65, 68, 71]
↓ FA [75]
↑ MD [83, 86, 89]
↑ phase shift values [94, 95]
↑ R2 signal intensity [96]
↓ SWI signal intensity [97]
↓ NAA/Cr [105]
↓ NAA [107]		↓ volume [54, 55, 60, 86, 96]
↑ ADC [62, 66, 70, 72] ↓ T2′ time [93]
↑ MD [54] ↓ SWI signal intensity [92]
↑ phase shift values [95]
↓ NAA/Cr#† [103]↓ NAA [107] 		↑ ADC [70]
↓ NAA/Cr [103]
Globus pallidus  ↓ volume [60, 86, 96]
↑ rTrace(D) [63]
↑ ADC [66, 73]
↓ NAA [107] 		↓ volume [54, 60, 86, 96]
↑ ADC [62, 66, 73]
↑ MD [54, 79]
↓ MTR [90]
↓ T2′ time [93]
↑ phase shift values [95]
↑ R2 signal intensity [96]
↓ NAA [107] 		 
Lenticular nucleus↓ NAA/Cr [100, 102]
↓ NAA/Cho [100, 102] 		↓ NAA/Cr† [98] ↓ NAA/Cr† [98]
↓ Cho/Cr† [98] 		↓ NAA/Cr [99–102, 109]
↓ NAA/Cho [99, 100, 102] 		↓ NAA/Cho† [101]
Caudate  ↓ volume [55, 96] ↑ ADC [62, 66, 73]
↑ rTrace(D) [63] 		↓ volume [55, 96] ↑ ADC [62, 66, 73]
↓ MTR† [90]
↓ T2′ time [93]
↑ R2 signal intensity [96] 		 
Nucleus accumbens   ↓ volume [54] 
Thalamus  ↑ ADC [66]
↑ phase shift values [94]
↓ volume [96] 		↓ volume [54, 60, 84, 86, 96]
↑ ADC [66, 78]
↑ MD [54, 86]
↑ phase shift values [95] 		↓ volume [84]
Supratentorial compartment
Whole brain   ↓ volume [56]
↑ MD [54]
↓ FA [54]		↑ ADC [70]
↓ HSR [70]
Frontal lobe↓ NAA/Cr† [103]   ↓ volume [56, 59]
↑ MD [54]
↓ FA [54]
↓ MTR† [90]
↓ precentral cortices NAA/Cr† [101]
↓ NAA/Cr† [103] 		↑ ADC precentral gyrus [78]
↓ NAA/Cr [103]
Parietal lobe   ↑ MD [54]
↓ FA [54]		↓ volume [57]
↑ ADC postcentral gyrus [78]
↓ NAA/Cho† [101]
Occipital lobe    ↓ volume [57]
Corpus Callosum   ↑ ADC in CC1 and CC2 [76]
↓ FA in CC1† and CC2 [76]
↑ MD [86]
↑ RD [86]
↓ FA [86, 87] 		↓ area [57]
↑ MD [80]
↓ FA [80]
Cingulate gyrus    ↑ ADCλ anterior CG [78]
↓ apparent area coefficient [86] 		 
Hippocampus   ↓ volume [60]↓ volume [60]
↓ NAA/Cr† [107] 		 
Centrum semiovale   ↓ NAA/Cr† [101]  
Lateral ventricles   ↑ volume [54, 56, 60]  
3rd ventricle   ↑ volume [59, 60]  
4th ventricle  ↑ volume [60] ↑ volume [60]  
White matter tracts
CST  ↑ RD [86] ↑ MD [86]  
DRTT   ↑ MD [88]
↓ FA [88] 		 
Infratentorial compartment
Whole  ↓ volume† [54]
↑ MD [81]		↓ volume† [54]
↑ MD [81] 		↓ volume [55, 57, 60]
↑ MCP/SCP [37, 54]
↓ M/P [47, 50, 52]
↑ P/M [37, 54]
↑ MRPI [37, 50, 52, 54]
↑ MD [54, 81]
↓ FA [54]		 
Midbrain  ↓ area [49]
↓ volume† [59] 		↓ area [37, 46, 47, 49, 52, 54, 88]
↓ volume [59]
↑ ADC [73]
↑ MD [88, 89]
↓ FA [54]
↓ NAA/Cho [106] 		 
Substantia Nigra↓ FA [53]
↓ MTR† [90] 		  ↑ MD [79]
↓ MTR† [90]
↓ SWI signal intensity [92] 		 
Red nucleus   ↑ phase shift values [95] ↑ phase shift values [95]
↓ SWI signal intensity [92]		 
Pons↓ anteroposterior diameter [53]
↓ volume [53]
↑ ADC [73]
↓ NAA/Cr† [105] 		↓ area [49]
↑ MD [74] 		↓ area [37, 47, 49]
↓ volume [59]
↑ ADC [55, 59, 75]
↓ FA [75]
↑ MD [88]
↓ NAA/Cr [105]		↓ area [46, 49, 52, 54] 
Brainstem ↓ volume† [55]
↑ MD [81]		↓ volume [55, 60]
↑ MD [81] 		↑ MD [54, 55, 81]
↓ FA [54]
↓ volume [54]
↓ NAA/Cr† [101]
SCP ↓ diameter [49] ↑ MD [89] ↓ width [37]
↓ diameter [49, 52, 54]
↓ volume [59]
↑ ADC [69, 70, 73, 78]
↑ MD [54, 74, 89]
↓ FA [54, 74] 		 
MCP↓ mean width [53]
↑ MD [53, 74]
↓ FA [53, 74, 85]
↑ ADC [73, 85] 		↓ diameter [49]
↑ trace(D)°† [71] 		↓ width [37, 48]
↓ diameter [49]
↑ ADC [48, 67, 77] 		↓ diameter [49, 52, 54]
↓ FA [85]
↑ ADC [85] 		 
Cerebellum ↓ volume [53]
↑ ADC [73]
↓ FA [53] 		↓ volume† [54]
↑ trace(D) [71] 		↓ volume [54, 59, 60]
↑ ADC [75]
↓ FA [75] 		↓ volume (cortex) [60] 
Cerebellar vermis ↑ MD [81] ↑ MD [81]↑ MD [81]  
Cerebellar hemispheres ↑ MD [81]
↓ NAA/Cr [108]		↑ MD [81] ↑ MD [54]
↓ NAA/Cr [108]
↓ NAA/mI† [108]		 
ADC: apparent diffusion coefficient; MTR: magnetization transfer; rTrace(D): trace of diffusion tensor; NAA: N-acetyl-aspartate; CR: creatine; FA: fractional anisotropy; MD: mean diffusivity; SWI: susceptibility weighted imaging; HSR: hemispheric symmetry ratio; Cho: choline; CC: corpus callosum; RD: radial diffusivity; CST: corticospinal tract; DRTT: dentatorubrothalamic-tract; MCP: middle cerebellar peduncle; SCP: superior cerebellar peduncle; M: midbrain; P: pons; MRPI: MR parkinsonism index.
versus PD; versus PSP; °versus MSA-P; versus MSA-C; #versus MSA; λversus CBS; †versus HC.