Imaging the Substantia Nigra in Parkinsonian Syndromes

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Magnetic Resonance Imaging: 2.75
Image Production: 0.75
Data Acquisition, Processing, and Storage: 0.75
Procedures: 2.00
Neurological: 2.00

Nuclear Medicine Technology: 0.25
Procedures: 0.25
Other Imaging Procedures: 0.25

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Neurological, Vascular, and Lymphatic Sections: 2.00

Outline

1. Introduction
2. Literature Search
3. Nigrosome Imaging
   1. Nigrosome Imaging in PD
   2. Nigrosome and Dopamine Transporter Imaging
   3. Nigrosome Imaging in Other Parkinsonian Syndromes
   4. Technical Improvements in Nigrosome Imaging
   5. Imaging of Nigrosomes 2-5
4. NM Imaging
   1. NM-Sensitive MRI in PD
   2. NM-Sensitive MRI and Dopamine Transporter Imaging
   3. NM-Sensitive MRI in Other Parkinsonian Syndromes
   4. Deep Learning Application in NM-Sensitive MRI
5. Quantitive Iron Mapping
   1. Relaxometry in PD
   2. QSM in PD
   3. Quantitative Iron Mapping in Other Parkinsonian Syndromes
   4. Future Use of Quantitative Iron Mapping
6. Diffusion-Tensor Imaging
   1. DTI in PD
   2. DTI and Dopamine Transporter Imaging
   3. DTI in Other Parkinsonian Syndromes
7. Volumetry
   1. Volumetry in PD
   2. Volumetry and Nonmotor Symptoms in PD
   3. Volumetry in Other Parkinsonian Syndromes
8. Conclusion

Objectives

Upon completion of this course, students will:

1. identify the neurotransmitter systems implicated in the development of nonmotor symptoms in Parkinson’s disease
2. be familiar with the use of MRI to differentiate PD from Parkinsonian syndromes
3. identify the nigrosome with the greatest depletion of dopaminergic cells in PD
4. understand the correlation between RBD and loss of nigral hyperintensity
5. be familiar with the risk of relying solely on MRI for diagnoses of nigrostriatal function
6. be familiar with 3-T SWI for differentiating drug-induced parkinsonism from idiopathic PD
7. recognize that in PSP or MSA-P there is a loss of nigral hyperintensity on 7-T gradient recalled echo imaging
8. recognize the limitations of diagnosing DLB with nigral intensity alone
9. be familiar with the advantages of employing QSM for nigrosome imaging
10. be familiar with the sensitivity and specificity reported by Schwarz et al for detecting nigral hyperintensity loss
11. understand the progression of hyperintensity loss in PD from nigrosome 1 to nigrosome 4
12. be familiar with the predominate location of NM in the brain
13. be familiar with the correlation between the volume of NM-sensitive areas in the SN and the disease duration in PD
14. be familiar with the correlations between scoring methodologies and affects of the various domains of the function in the brain in PD patients
15. identify the deposits being displayed in figure 8 of the article
16. be familiar with the reduction in NM signal in the brain reported in patients with RBD
17. be familiar with the reported hypointense signals in the SN pars compacta found in PD patients
18. be familiar with the relationship of NM-sensitive MRI and ¹²³I-FP-CIT SPECT in PD assessment
19. be familiar with the reported findings of NM-sensitive MRI with nigrosome 1 imaging in the SN for ET prediction
20. be familiar with the key findings of Ohtsuka et al in differentiating PD and Parkinson-plus syndromes
21. be familiar with the contributions of NM-sensitive MRI to the characterization of Parkinsonian syndromes such as DLB
22. recognize the segmentation techniques employed to assess the NM-positive SN pars compacta
23. be familiar with the element predominately stored as ferritin in the brain
24. identify the sequences on MRI scans affected by iron, enabling quantitative iron mapping
25. be familiar with the correlation between iron content and disease severity in PD based on MRI parameters
26. be familiar with QSM effectiveness in PD diagnosis
27. be familiar with he advantages of QSM in comparison to T2* and R2* relaxometry maps
28. identify the areas of the brain that demonstrate an increase in susceptibility values in late-stage PD
29. be familiar with significant differences observed in whole-brain voxel-based analysis in patients with ET
30. be familiar with DTI measures in tissue
31. identify the common measurements feasible with DTI
32. be familiar with the FA and MD measurements found in PD patients
33. be familiar with the use of DTI to distinguish PD from other parkinsonian syndromes
34. be familiar with the reported cognitive impairments among PD patients base on brain atrophy
35. identify the reported areas of significant volume loss reported in patients with PSP