Objective: The aim of this study was to assess the diagnostic performance of 3 Tesla susceptibility-weighted MRI (3T-SWI) and the concordance between the loss of nigral hyperintensity on 3T-SWI and the nigrostriatal dopaminergic degeneration on 123I-FP-CIT SPECT in parkinsonism and idiopathic REM sleep behavior disorder (iRBD).

Background: The loss of nigral hyperintensity on 3T-SWI suggests a nigrostriatal dopaminergic degeneration in parkinsonism.

Methods: Between May 2017 and December 2017, consecutive subjects with suspected parkinsonism were evaluated with 3T-SWI and 123I-FP-CIT SPECT, and clinical diagnosis was solidified during follow-up. For 3T-SWI, we adopted a new imaging protocol modified from previous studies. Two blinded readers independently assessed the images. The performance of 3T-SWI was estimated on the basis of the clinical diagnosis and compared with 123I-FP-CIT SPECT.

Results: The study included 212 subjects (147 Parkinson’s disease, 15 multiple system atrophy, 11 progressive supranuclear palsy, 4 drug-induced parkinsonism, 14 essential tremor, 13 vascular pseudoparkinsonism, and 8 iRBD). The intra-/inter-observer agreements were excellent (κ>0.9). The sensitivity and specificity of 3T-SWI based on the clinical diagnosis was 92.6% and 93.6%, respectively. The concordance rate between 3T-SWI and 123I-FP-CIT SPECT was 95.8%.

Conclusions: With introducing a newly-designed imaging protocol, the performance of 3T-SWI was good in this study. The nigral hyperintensity on 3T-SWI may be a useful marker for presence or absence of nigrostriatal dopaminergic degeneration in the various kinds of parkinsonism and premotor stage of iRBD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/three-tesla-susceptibility-weighted-mr-imaging-of-parkinsonism-and-idiopathic-rem-sleep-behavior-disorder-comparison-with-123i-fp-cit-spect/