Iron Deposition And Pattern In Parkinson's Disease By Quantitative Susceptibility Mapping And Its Clinical Relevance

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Iron deposition in deep brain nuclei of Parkinson's disease by quantitative susceptibility mapping and its clinical relevanceObjective:The purpose of this study was to quantify the iron deposition of deep brain nuclei in patients with Parkinson's disease(PD)using quantitative susceptibility mapping(QSM),and to further explore its clinical relevance.Materials and Methods:33 patients with PD diagnosed by neurology specialists from January 2017 to April 2018 in the Second Affiliated Hospital of Soochow University were included in this study.The diagnostic criteria were in accordance with the latest diagnostic criteria for PD(2015)by the Movement Disorders Association(MDS).At the same time,26 healthy volunteers matched for age and gender were recruited as controls.The neuropsychological scales were assessed of the PD patients,including the Simple Intelligence Status Scale(MMSE),the third part of the Parkinson's Disease Rating Scale(UPDRS-III),the modified Hoehn&Yahr stages(H&Y stage)and the Hamilton anxiety volume table(HAMA).All subjects underwent magnetic resonance imaging(MRI).QSM was reconstructed from original imaging.The differences of iron deposition in the deep brain nuclei between the PD group and the control group were compared.Correlation analysis was used to investigate the relationship between the iron deposition in the deep brain nuclei and clinical data of PD patients.Results:PD patients have increased magnetic susceptibility values in the substantia nigra compacta(SNc),internal global pallidus(GPi),red nucleus(RN),putamen(PUT)and caudate nucleus(CN)compared with the control group(163.47±49.16 vs 85.18±30.57 ppb,t=-7.10,P=0.01;112.66±29.82 vs 97.04±25.21 ppb,t=-2.10,P=0.04;136.10±40.09 vs 111.43±25.39 ppb,t=-2.73,P=0.01;65.04±17.41 vs 51.65±25.69 ppb,t=-2.28,P=0.03;55.54±14.86 vs 38.06±15.38 ppb,t=-4.40,P=0.01).The magnetic susceptibility values in the SNc of PD patients were positively correlated with the H&Y stage and UPDRS-? scores(r=0.59,P=0.01;r=0.38,P=0.03),but was not associated with the disease course(year)and HAMA scores were not(r=0.16,P=0.39;r=0.11,P=0.57);There was a positive correlation between the magnetic susceptibility values in the SN reticular(SNr)and the H&Y stage of PD patients(r=0.50,P=0.01),but was not associated with the disease course(year),UPDRS-? score and HAMA score(r=0.16,P=0.38;r=0.26,P=0.16;r=-0.02,P=0.94);There was nonsignificant correlation between the magnetic susceptibility values of other nuclei and clinical data.Conclusions:This study shows that iron deposition in the SNc is a specific imaging marker of Parkinson's disease and is significantly associated with the severity of the condition and motor symptoms of PD patients.Iron deposition of SNr is also associated with the condition of PD patients,but is not a specific imaging marker for PD.In addition to SN,PD patients have abnormal iron deposition in other deep brain nuclei,which may be related to the secondary degeneration caused by PDPart ? Iron deposition distribution pattern of fascicula nigrale in Parkinson's disease by quantitative susceptibility mappingObjective:The purpose of this study was to explore the iron deposition distribution pattern of the fascicula nigrale(FN)in patients with Parkinson's disease(PD)using quantitative susceptibility mapping(QSM)and to analyze its clinical relevance,and further to explore the deposition patterns of iron deposition in the globus pallidus(GP)-fascial nigral(FN)-substantia nigra(SN)pathway.Materials and Methods:33 patients with PD diagnosed by neurology specialists from January 2017 to April 2018 in the Second Affiliated Hospital of Soochow University were included in this study.The diagnostic criteria were in accordance with the Movement Disorders Association(MDS):The latest diagnostic criteria for PD(2015).At the same time,26 healthy volunteers matched for age and gender were recruited.General information of the subjects were collected and the neuropsychological scales of the PD patients were assessed,including the Simple Intelligence Status Scale(MMSE),the third part of the Parkinson's Disease Rating Scale(UPDRS-?),the modified Hoehn&Yahr stages(H&Y stage)and the Hamilton anxiety volume table(HAMA).All subjects underwent magnetic resonance imaging(MRI).QSM was reconstructed from original imaging.The differences of iron deposition and distribution patterns in the FN from the rostral(near GP)to the caudal(near SN)were compared between the PD group and the control group,and the correlation with clinical data were analyzed.To explore the iron deposition and its distribution pattern in the GP-FN-SN pathway of PD patients.Results:There was a significant difference of iron deposition in the FN from the rostral to the caudal between the PD group and the control group(FN1:t=-6.01,P=0.01;FN2:t=-5.03,P=0.01;FN3:t=-4.71,P=0.01;FN4:t=-4.85,P=0.01).The iron deposition in the FN of both the PD group and the control group showed an increasing pattern from the rostral to the caudal(PD group:FN2 was higher than FN1:t=6.69,p=0.01;FN3 was higher than FN2:t=-5.83,p=0.01;FN4 was higher than FN3:t=-4.86,p=0.01;control group:FN2 was higher than FN1:t=-4.94,p=0.01);FN3 was higher than FN2:t=5.06,P=0.01);FN4 was higher than FN3:t=-4.76,p=0.01).The magnetic susceptibility value of FN4 minus FN1 was nonsignificantly different between PD group and control group(133.68±40.06 vs 117.90±30.69 ppb,t=-1.66,P=0.10).There was no significant correlation between the magnetic susceptibility values in the FN of PD patients and disease course(year),UPDRS-? score,H&Y stage and HAMA score(r=0.14,P=0.46;r=0.30,P=0.09;r=0.33,P=0.07;r=-0.13,P=0.49).The iron deposition distribution pattern of the GP-FN-SN pathway showed no obvious special performance:In the control group,there was no significant difference in the magnetic susceptibility values of GP,FN and SN(GP-FN:t=-0.19,P=0.85;GP-SN:t=-0.47,P=0.64;FN-SN:t=0.66,P=0.51);In the PD group,the magnetic susceptibility values of SN and FN were significantly higher than those of GN(GP-FN:t=-3.70,P=0.01;GP-SN:t=4.22,P=0.01),however,there was nonsignificant difference in the magnetic susceptibility values between SN and FN(t=-1.19,P=0.24).The magnetic susceptibility values of FN were related to the UPDRS-? and H&Y stage(r=0.40,P=0.02;r=0.44,P=0.01),and the disease duration(year)and HAMA scores were not(r=0.18,P=0.33;r=0.10,P=0.59).Conclusions:The increased iron deposition in the FN of PD patients may be related to the degeneration of striatum system.The iron deposition in the FN of the PD group and the control group showed an increasing distribution pattern from the rostral to the caudal,indicating that there was no significant change in the iron deposition pattern of FN in PD patients.There was no obvious special manifestation of the iron deposition distribution pattern in the GP-FN-SN pathway,suggesting that there may be multiple pathways for the source of iron deposition in the SN of PD patients.