Abstract

CLINICAL PROFILE AND DIFFUSION TENSOR IMAGING IN PARKINSONIAN SYNDROMES

Author(s): S. Gopi, K. Pradeep, G. Butchiraju

BACKGROUND Advances in MRI techniques have provided new tools for the diagnosis of PD in its early stages and have discriminated it from other atypical PD syndromes. Aims and Objectives- To study the clinical profile and neuroimaging aspects of patients presenting with parkinsonian symptoms and aiding in their diagnosis and management. To explore the role of DTI in early diagnosis and its utility as a potential screening tool for parkinsonian syndromes. MATERIALS AND METHODS 50 patients aged above 18 yrs. presenting with primary parkinsonism, parkinsonism plus syndromes, predominant parkinsonism features in heredodegenerative parkinsonism groups were included. Patients were subjected to detailed case proforma questionnaires and categorized under two groups typical and atypical parkinsonism. Clinical assessment was done by Unified Parkinson’s Disease Rating Scale (UPDRS), Modified Hoehn and Yahr staging and a 750 wide bore 3 Tesla GE-made MRI with Echo planar and diffusion weighted imaging in 25 directions was used for imaging of the brain. In the present study, 25 patients and 10 controls in whom DTI was performed, fractional anisotropy (FA) values were obtained from regions of interest (ROI)- cingulate cortex, basal ganglia, corticospinal tracts, superior longitudinal fasciculus, substantia nigra, thalamus regions of brain. RESULTS In our study, male population represented higher cases than females and mean age of presentation was 49.94 yrs. Typical PD patients constituted 84% and atypical PD 16%. Median UPDRS- III motor scale for typical PD patients was 36 and atypical PD patients was 55. The mean FA values of substantia nigra regions of PD patients when compared to controls, was lower but statistically not significant (0.4256 vs 0.44801, p=0.076). None of the FA values in studied regions showed statistically significant difference between patients and controls. CONCLUSION Our study DTI findings using ROI analysis helped in differentiating typical vs atypical PD syndromes and also diagnosing PD patients at an early stage. Even though there was no statistical significance among core parameters obtained, this study reinforces the findings in terms of trends in FA values thereby establishing the role of DTI in diagnosing PD patients.