Structural MRI in Idiopathic Parkinson Disease and Parkinsonism

  • Christoph MuellerEmail author
  • Klaus Seppi
  • Werner Poewe
Part of the Current Clinical Neurology book series (CCNEU, volume 44)


Parkinsonian disorders are characterized by both motor and nonmotor symptoms with varying degrees of treatment response and disability. While current conventional magnetic resonance imaging (MRI) methods are unable to confirm a diagnosis of idiopathic Parkinson disease, they may provide a means for identifying other atypical parkinsonian syndromes. This chapter will review the state of current structural MRI modalities, the structural imaging findings in various parkinsonian disorders and disease mimics, and the use of structural MRI as a biomarker of neurodegeneration. The discussion will also provide insights into the integration of high-field MRI and multimodal imaging to future clinical practice.


Fractional Anisotropy Substantia Nigra Multiple System Atrophy Dementia With Lewy Body Progressive Supranuclear Palsy 
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  1. 1.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):181–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Lee WH, Lee CC, Shyu WC, Chong PN, Lin SZ. Hyperintense putaminal rim sign is not a hallmark of multiple system atrophy at 3 T. AJNR Am J Neuroradiol. 2005 Oct;26(9):2238–42.PubMedGoogle Scholar
  3. 3.
    Hutchinson M, Raff U, Lebedev S. MRI correlates of pathology in parkinsonism: segmented inversion recovery ratio imaging (SIRRIM). Neuroimage. 2003 Nov;20(3):1899–902.PubMedCrossRefGoogle Scholar
  4. 4.
    Minati L, Grisoli M, Carella F, De Simone T, Bruzzone MG, Savoiardo M. Imaging degeneration of the substantia nigra in Parkinson disease with inversion-recovery MR imaging. AJNR Am J Neuroradiol. 2007 Feb;28(2):309–13.PubMedGoogle Scholar
  5. 5.
    Hu MT, White SJ, Herlihy AH, Chaudhuri KR, Hajnal JV, Brooks DJ. A comparison of (18) F-dopa PET and inversion recovery MRI in the diagnosis of Parkinson’s disease. Neurology. 2001 May;56(9):1195–200.PubMedCrossRefGoogle Scholar
  6. 6.
    Kwon DH, Kim JM, Oh SH, et al. Seven-Tesla magnetic resonance images of the substantia nigra in Parkinson disease. Ann Neurol. 2012 Feb;71(2):267–77.PubMedCrossRefGoogle Scholar
  7. 7.
    Muqit MM, Mort D, Miskiel KA, Shakir RA. “Hot cross bun” sign in a patient with parkinsonism secondary to presumed vasculitis. J Neurol Neurosurg Psychiatry. 2001 Oct;71(4):565–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Lee YC, Liu CS, Wu HM, Wang PS, Chang MH, Soong BW. The ‘hot cross bun’ sign in the patients with spinocerebellar ataxia. Eur J Neurol. 2009 Apr;16(4):513–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Warmuth-Metz M, Naumann M, Csoti I, Solymosi L. Measurement of the midbrain diameter on routine magnetic resonance imaging: a simple and accurate method of differentiating between Parkinson disease and progressive supranuclear palsy. Arch Neurol. 2001 Jul;58(7):1076–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Quattrone A, Nicoletti G, Messina D, et al. MR imaging index for differentiation of progressive supranuclear palsy from Parkinson disease and the Parkinson variant of multiple system atrophy. Radiology. 2008 Jan;246(1):214–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Righini A, Antonini A, De Notaris R, et al. MR imaging of the superior profile of the midbrain: differential diagnosis between progressive supranuclear palsy and Parkinson disease. AJNR Am J Neuroradiol. 2004 Jun–Jul;25(6):927–32.PubMedGoogle Scholar
  12. 12.
    Cosottini M, Ceravolo R, Faggioni L, et al. Assessment of midbrain atrophy in patients with progressive supranuclear palsy with routine magnetic resonance imaging. Acta Neurol Scand. 2007 Jul;116(1):37–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Hussl A, Mahlknecht P, Scherfler C, et al. Diagnostic accuracy of the magnetic resonance parkinsonism index and the midbrain-to-pontine area ratio to differentiate progressive supranuclear palsy from Parkinson’s disease and the Parkinson variant of multiple system atrophy. Mov Disord. 2010 Oct;25(14):2444–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Price S, Paviour D, Scahill R, et al. Voxel-based morphometry detects patterns of atrophy that help differentiate progressive supranuclear palsy and Parkinson’s disease. Neuroimage. 2004 Oct;23(2):663–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Koyama M, Yagishita A, Nakata Y, Hayashi M, Bandoh M, Mizutani T. Imaging of corticobasal degeneration syndrome. Neuroradiology. 2007 Nov;49(11):905–12.PubMedCrossRefGoogle Scholar
  16. 16.
    Burton EJ, Barber R, Mukaetova-Ladinska EB, et al. Medial temporal lobe atrophy on MRI differentiates Alzheimer’s disease from dementia with Lewy bodies and vascular cognitive impairment: a prospective study with pathological verification of diagnosis. Brain. 2009 Jan;132(Pt 1):195–203.PubMedCrossRefGoogle Scholar
  17. 17.
    Rektor I, Rektorová I, Kubová D. Vascular parkinsonism—an update. J Neurol Sci. 2006 Oct;248(1–2):185–91.PubMedCrossRefGoogle Scholar
  18. 18.
    Netravathi M, Pal PK, Bharath RD, Ravishankar S. Intracranial dural arteriovenous fistula presenting as parkinsonism and cognitive dysfunction. J Clin Neurosci. 2011 Jan;18(1):138–40.PubMedCrossRefGoogle Scholar
  19. 19.
    Miura S, Noda K, Shiramizu N, et al. Parkinsonism and ataxia associated with an intracranial dural arteriovenous fistula presenting with hyperintense basal ganglia in T1-weighted MRI. J Clin Neurosci. 2009 Feb;16(2):341–3.PubMedCrossRefGoogle Scholar
  20. 20.
    Kajitani M, Yagura H, Kawahara M, et al. Treatable fluctuating parkinsonism and dementia in a patient with a dural arteriovenous fistula. Mov Disord. 2007 Feb;22(3):437–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Stepens A, Logina I, Liguts V, et al. A Parkinsonian syndrome in methcathinone users and the role of manganese. N Engl J Med. 2008 Mar;358(10):1009–17.PubMedCrossRefGoogle Scholar
  22. 22.
    Tranchant C, Bhatia KP, Marsden CD. Movement disorders in multiple sclerosis. Mov Disord. 1995 Jul;10(4):418–23.PubMedCrossRefGoogle Scholar
  23. 23.
    Zivadinov R, Cox JL. Neuroimaging in multiple sclerosis. Int Rev Neurobiol. 2007;79:449–74.PubMedCrossRefGoogle Scholar
  24. 24.
    Folgar S, Gatto EM, Raina G, Micheli F. Parkinsonism as a manifestation of multiple sclerosis. Mov Disord. 2003;18(1):108–10.PubMedCrossRefGoogle Scholar
  25. 25.
    Schwarz ST, Rittman T, Gontu V, Morgan PS, Bajaj N, Auer DP. T1-weighted MRI shows stage-dependent substantia nigra signal loss in Parkinson’s disease. Mov Disord. 2011 Aug;26(9):1633–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Martin WR, Wieler M, Gee M. Midbrain iron content in early Parkinson disease: a potential biomarker of disease status. Neurology. 2008 Apr;70(16 Pt 2):1411–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Wild EJ, Fox NC. Serial volumetric MRI in Parkinsonian disorders. Mov Disord. 2009;24(Suppl 2):S691–8.CrossRefGoogle Scholar
  28. 28.
    Paviour DC, Price SL, Jahanshahi M, Lees AJ, Fox NC. Longitudinal MRI in progressive supranuclear palsy and multiple system atrophy: rates and regions of atrophy. Brain. 2006 Apr;129(Pt 4):1040–49.PubMedCrossRefGoogle Scholar
  29. 29.
    Burton EJ, McKeith IG, Burn DJ, O’Brien JT. Brain atrophy rates in Parkinson’s disease with and without dementia using serial magnetic resonance imaging. Mov Disord. 2005 Dec;20(12):1571–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Brenneis C, Egger K, Scherfler C, et al. Progression of brain atrophy in multiple system atrophy. A longitudinal VBM study. J Neurol. 2007 Feb;254(2):191–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Ramírez-Ruiz B, Martí MJ, Tolosa E, et al. Longitudinal evaluation of cerebral morphological changes in Parkinson’s disease with and without dementia. J Neurol. 2005 Nov;252(11):1345–2.PubMedCrossRefGoogle Scholar
  32. 32.
    Paviour DC, Price SL, Lees AJ, Fox NC. MRI derived brain atrophy in PSP and MSA-P. Determining sample size to detect treatment effects. J Neurol. 2007 Apr;254(4):478–81.PubMedCrossRefGoogle Scholar
  33. 33.
    Seppi K, Schocke MF, Mair KJ, et al. Progression of putaminal degeneration in multiple system atrophy: a serial diffusion MR study. Neuroimage. 2006 May;31(1):240–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Pellecchia MT, Barone P, Vicidomini C, et al. Progression of striatal and extrastriatal degeneration in multiple system atrophy: a longitudinal diffusion-weighted MR study. Mov Disord. 2011 Jun;26(7):1303–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Seppi K, Rascol O. Dementia with Lewy bodies and Parkinson disease with dementia: can MRI make the difference? Neurology. 2007 Aug;69(8):717–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Watson R, Blamire AM, O’Brien JT. Magnetic resonance imaging in lewy body dementias. Dement Geriatr Cogn Disord. 2009;28(6):493–506.PubMedCrossRefGoogle Scholar
  37. 37.
    Ciumas C, Montavont A, Ryvlin P. Magnetic resonance imaging in clinical trials. Curr Opin Neurol. 2008 Aug;21(4):431–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Menke RA, Scholz J, Miller KL, et al. MRI characteristics of the substantia nigra in Parkinson’s disease: a combined quantitative T1 and DTI study. Neuroimage. 2009 Aug;47(2):435–41.PubMedCrossRefGoogle Scholar
  39. 39.
    Péran P, Cherubini A, Assogna F, et al. Magnetic resonance imaging markers of Parkinson’s disease nigrostriatal signature. Brain. 2010 Nov;133(11):3423–33.PubMedCrossRefGoogle Scholar
  40. 40.
    Du G, Lewis MM, Styner M, et al. Combined R2* and diffusion tensor imaging changes in the substantia nigra in Parkinson’s disease. Mov Disord. 2011 Aug;26(9):1627–32.PubMedCrossRefGoogle Scholar
  41. 41.
    Baudrexel S, Nürnberger L, Rüb U, et al. Quantitative mapping of T1 and T2* discloses nigral and brainstem pathology in early Parkinson's disease. Neuroimage 2010;51(2):512–20.PubMedCrossRefGoogle Scholar
  42. 42.
    Gröger A, Chadzynski G, Godau J, Berg D, Klose U. Three-dimensional magnetic resonance spectroscopic imaging in the substantia nigra of healthy controls and patients with Parkinson's disease. Eur Radiol 2011;21(9):1962–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Cho ZH, Oh SH, Kim JM, et al. Direct visualization of Parkinson's disease by in vivo human brain imaging using 7.0T magnetic resonance imaging. Mov Disord 2011;26(4):713-718.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria

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