Objective: We employed Quantitative susceptibility mapping (QSM) to assess iron deposition in a larger sample size and explore whether combining QSM and NfL can improve the accuracy for distinguishing PD from multiple system atrophy (MSA), and progressive supranuclear palsy (PSP) with high sensitivity and specificity.

Background: Differential diagnosis between Parkinson’s disease (PD) and atypical parkinsonian disorders is always challenging. Thus, there is an urgent need for a highly sensitive and minimally invasive biomarker for the early diagnosis of different parkinsonism. QSM enables to reliably quantify iron deposition in the brain. However, previous studies were relatively small sample size and revealed susceptibility value of QSM provides high specificity but relatively low sensitivity to differentiate different kinds of parkinsonian disorders. In addition, neurofilament light chain (NfL) is a promising biomarker for separation parkinsonism but provide low specificity

Method: 47 PD, 28  MSA, 17 PSP and 28 healthy controls (HC) were enrolled in the study. Subjects underwent brain MRI and constructed QSM data. Susceptibility values in bilateral globus pallidus (GP), putamen (PUT), caudate nucleus (CN), red nucleus (RN), substantia nigra (STN), and dentate nucleus (DN) were obtained by QSM. Among the participants, blood samples of 47 PD, 18 MSA, 14 PSP patients and 22 HC were collected and NfL level was measured by ultra-sensitive Simoa technology.

Results: The highest diagnostic accuracy of increased susceptibility value for MSA was observed in PUT (AUC 0.831 ) with increased susceptibility values in RN and CN compared to PD and HC . Susceptibility value of the RN yielded the highest diagnostic performance for PSP (AUC 0.811) with increased in PUT, STN and DN compared to PD. Plasma NfL levels were significantly higher in the MSA and PSP groups than in the PD (MSA, P< 0.001; PSP, P= 0.021) and HC(MSA, P< 0.001; PSP, P< 0.001). In addition, combining susceptibility value of RN and plasma level of NfL improved higher diagnostic performance for PSP (AUC 0.900) whereas PUT and NfL had a higher diagnostic accuracy for MSA(AUC 0.901).

Conclusion: The present study employed QSM to indicate different patterns of iron accumulation in deep grey matter nuclei for the patients with PD, MSA, and PSP. Combining QSM and NfL may be a promising biomarker for distinguishing between Parkinsonian disorders.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quantitative-susceptibility-mapping-and-blood-neurofilament-light-chain-differentiate-between-parkinsonian-disorders/