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Conventional Brain MRI CAN diagnose PD! Hopefully...


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#1 christie

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Posted 08 May 2014 - 05:53 PM

Most of us with PD, especially with YOPD,  had a brain MRI prior to our formal diagnosis, just to exclude other potential causes of parkinsonism, such as brain tumors, MS, etc...

 

We were also told that brain MRIs cannot diagnose PD, because..."The MRI and CAT scans of the brain of people with Parkinson's disease appear normal. The brain of people with Parkinson's disease appears normal.The brain changes that create neurodegenerative diseases such as Parkinson's are microscopic, on a chemical level, and are not revealed by these scans".........http://umm.edu/progr...ealth/diagnosis

 

Right? As it turns out, not necessarily !!

 

There may be a PD-specific sign in our brain MRIs after all...

 

The "swallow-tail" sign...Or, to be exact, the "missing swallow-tail" sign of PD!!!

 

Previous studies had shown that ultra high field 7TESLA MRI -which is not widely available and mainly used only for research purposes- may reveal characteristic structural changes in the substantia nigra, the area affected in PD.

 

However, a recent study, published in PLOS ONE PLOS ONE 9(4): e93814. doi:10.1371/journal.pone.0093814  showed  that  these  changes can also be detected using routine 3TESLA brain MRI !!!

 

http://www.futurity....ign-parkinsons/

 

 

“This is a breakthrough finding as currently Parkinson’s disease is mostly diagnosed by identifying symptoms like stiffness and tremor,” says Stefan Schwarz of the School of Medicine at the University of Nottingham"

 

“Imaging tests to confirm the diagnosis are limited to expensive nuclear medical techniques, which are not widely available and associated with potentially harmful ionizing radiation"

 

“Using magnetic resonance imaging (no ionizing radiation involved and much cheaper than nuclear medical techniques), we identified a specific imaging feature which has great similarity to a tail of a swallow and therefore decided to call it the ‘swallow tail sign.’ This sign is absent in Parkinson’s disease.”


-English is not my first language !

-Aged 39. Diagnosed at 35. On levodopa monotherapy (500mg daily).


#2 Annikin

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Posted 09 May 2014 - 05:16 PM

Too bad they cannot see it on a regular MRI - I have had so many and they date way back into my early 20's.



#3 christie

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Posted 09 May 2014 - 06:02 PM

Annikin, they CAN see it on a  regular MRI (as long as the scanner has a field strength of 3 Tesla or higher) ! That's why this new finding is so important !

 

 

 

However, a recent study, published in PLOS ONE PLOS ONE 9(4): e93814. doi:10.1371/journal.pone.0093814  showed  that  these  changes can also be detected using routine 3TESLA brain MRI !!!

 

 

 

 

 

3Tesla brain MRI is routinely used in clinical practice and is currently the diagnostic "gold standard" in neuroimaging.

 

Maybe some of your previous MRIs were done on a 3Tesla MRI scanner? ? in that case your  films could be re-evaluated.

 

The  images may be difficult to interpret, but a trained radiologist/neurologist should be able to recognize the presence  (or absence) of the "swallow-tail" sign !

 

Needless to say of course that further   studies  are warranted to confirm these  breakthrough-albeit highly preliminary- findings, but still, it's very exciting news that a standard imaging modality may be able to diagnose PD with great diagnostic accuracy.


-English is not my first language !

-Aged 39. Diagnosed at 35. On levodopa monotherapy (500mg daily).


#4 Drummergirl

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Posted 10 May 2014 - 01:13 PM

Christie,
Thanks for sharing this! What I didn't see in the article and perhaps I missed it, is the swall tail missing at YOPD? does it present that way after years? or early. Could someone be born without it and not have symptoms for years.

I shared it with my MDS, the timing may be good as I am being scheduled for an MRI soon. For other reasons then PD, but I will report if so.

Karen
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#5 christie

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Posted 10 May 2014 - 07:54 PM

Hi Karen!

 

You made a very good point !

 

According to  these recent and preliminary data, the "swallow-tail" sign is absent in PD (including both late onset and YOPD). As noted in the article: "There are two main possible mechanisms for this, increased iron content or decreased neuromelanin content with decreased iron storage capacity". This further supports previous findings suggesting that iron metabolism may be disturbed in PD ! Leading to increased iron content in the substantia nigra (the area most affected by PD).  

 

Interestingly, increased iron content in the substantia nigra (SN) can also be visualized by transcranial  ultrasound, which is another non-invasive and "patient-friendly" diagnostic technique for the early diagnosis of PD, while, as previously reported: " It is assumed that SN hyperechogenicity reflects an increased amount of iron in the SN, bound to proteins other than ferritin. It is regarded as a trait marker pointing to a predisposition for the disease not a severity marker reflecting proceeding nigral cell loss".

 

Transcranial sonography for diagnosis of Parkinson's disease, Sabine Mehnert*, Iris Reuter, Karsten Schepp, Peter Maaser, Erwin Stolz and Manfred Kaps  http://www.biomedcen.../1471-2377/10/9

 

According to another important study: "Our findings suggest that an increase in SN echogenicity, which appears to be related to an increase in tissue iron content, may point toward a susceptibility to nigrostriatal injury. This pattern of SN hyperechogenicity, similar to that found in PD, can be detected early in life. To further elucidate the significance of this finding and the relationship between SN hyperechogenicity and PD, follow-up studies with PET should clarify whether the functional impairment of the nigrostriatal system will progress in any of our subjects

 

Echogenicity of the Substantia Nigra:  Association With Increased Iron Content and Marker for Susceptibility to Nigrostriatal Injury

Daniela Berg, MD; Wolfgang Roggendorf, MD; Ute Schröder; Rüdiger Klein, MD; Thomas Tatschner, MD; Peter Benz, MD; Oliver Tucha, PhD; Michael Preier, MSc; Klaus W. Lange, MD; Karlheinz Reiners, MD; Manfred Gerlach, PhD; Georg Becker, MD       http://archneur.jama...rticleid=782224

 

Therefore,  it is possible, as you pointed out, that the MRI "missing swallow-tail" sign,  (as well as SN hyperechogenicity), may be present long before appearance of  PD symptoms, and may also be used for identification of patients at risk for future development of PD. This of course remains to be clarified.

 

These findings may be of particular significance in cases with a clinical diagnosis of PD and negative Dat or Pet scans ! Currently described as SWEDDs (scans without evidence of dopaminergic deficit). In these particular cases, MRI and/or transcranial ultrasound may help confirm the clinical diagnosis of PD, by revealing susceptibility to nigostratial injury, even in the absence of demonstrable loss of dopaminergic neurons on Dat or Pet scans.

 

Keep us posted on your results ! good luck !


Edited by christie, 10 May 2014 - 07:59 PM.

-English is not my first language !

-Aged 39. Diagnosed at 35. On levodopa monotherapy (500mg daily).


#6 Annikin

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Posted 11 May 2014 - 10:21 AM

Thanks Christie- I will mention this to my MDS as I have been having MRI's since way before my PD symptoms for another brain related issue. Might be interesting to see if they are of any research value.  Exciting stuff (that's the scientist in me speaking).

 

You mentioned iron- any connection to dietary intake mentioned?



#7 Tadpole

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Posted 11 May 2014 - 03:03 PM

Excuse me but I am not quite sure how people propose to use the information in a single study that is in a "pay to publish" journal. I sincerely hope the results reported stand up to rigorous study but I am not sure how one could use the information in it's present stage of reporting, review and acceptance.



#8 christie

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Posted 11 May 2014 - 06:22 PM

Hi Tadpole.

 

I will try to reply to your comments as accurately as possible, on the basis of my personal experience as a medical author and reviewer for PubMed journals.  

 

I agree with you that these results are highly preliminary and further confirmation is warranted.

 

Needless to say of course that further   studies  are warranted to confirm these  breakthrough-albeit highly preliminary- findings, but still, it's very exciting news that a standard imaging modality may be able to diagnose PD with great diagnostic accuracy.

 

 However:

 

The quality of a medical journal is mainly defined by it's impact factor (IF).  Not by its publication fees. There are many high quality medical journals who charge the authors for publication. That doesn't necessarily mean that these journals are of low quality.  "Clinical Infectious Diseases", for example, is a leading academic journal in the field of infectious diseases with an IF close to 10 (ranking 2nd out of 69 high quality journals) and charges the authors by page...

 

There are many reasons why authors may prefer to publish their research in an open access/high quality medical journal (such as PLOS one-the journal which published the study on the "swallow-tail" MRI sign). Just to name a few: wide dissemination of published data, fast publication, unrestricted access to the full-text paper (and not just the abstract as in most "regular" journals), etc...Especially when the publication costs are covered by the authors' institutions.

 

"PLOS one" journal has an IF close to 4, which is actually rather high. The research group  who performed the study and drafted the final manuscript has extensive experience on this issue and has published many similar articles in PubMed journals. Their leading researcher is Prof. Auer of the University of Nottingham and their work is funded by the Parkinson's Disease Society of the UK.

http://forum.parkins...e-pd-hopefully/

 

Finally, this is not the first study reporting the presence of PD-specific signs in brain MRI. Several previous studies have reported the presence of these sings in high-field MRIs. One of these studies was published in Neurology (the leading neurology journal worldwide)-by the same research group.

 

"In vivo and PM MRI with histologic correlation demonstrates that high-resolution 7 T MRI can directly visualize nigrosome 1. The absence of nigrosome 1 in the SNpc on MRI scans might prove useful in developing a neuroimaging diagnostic test for PD".

 

http://www.ncbi.nlm....pubmed/23843466


-English is not my first language !

-Aged 39. Diagnosed at 35. On levodopa monotherapy (500mg daily).


#9 Drummergirl

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Posted 20 May 2014 - 07:56 PM

Hi Christie,
I went for an'MRI last week and inquired about the 3 Tesla, which they have since I go to a teaching hospital but they wouldn't use it.
As you say it's for research only.....

Karen
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#10 christie

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Posted 20 May 2014 - 08:54 PM

Drummergirl hi !

 

7Tesla brain MRI is currently used only for research purposes.

 

however, 3Tesla brain MRI is NOT a research tool (only). It is routinely used in clinical practice.

 

For example, my latest brain MRI was done on a 3Tesla scanner ! Unfortunately, it didn't include the SWI sequence, which (may) show the PD-specific sign. What a waste of  such a superb diagnostic tool !

 

I don't know why the hospital staff told you this. I can only guess the technicians/radiologists of this hospital are not familiar with the use of this scanner (although they should be !), or that they don't use it routinely just to cut back on costs??


-English is not my first language !

-Aged 39. Diagnosed at 35. On levodopa monotherapy (500mg daily).


#11 Drummergirl

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Posted 21 May 2014 - 07:16 PM

They were surprised when I told them about the swallow tail info. ( the technicians).
The older of the two was pleased to hear this news.

Karen
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#12 EtEgr

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Posted 25 May 2014 - 05:58 PM

My last two scans were done by a 3T MRI machine, so they are in general use in at least some hospitals.






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