Mapeamento por ressonância magnética 3 tesla dos agrupamentos de neuromelanina e sua acurácia no diagnóstico da Doença de Parkinson

• Autor(a) principal: Zorzenon, Caroline De Pietro Franco [UNIFESP]
• Data de Publicação: 2020
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9691281; https://hdl.handle.net/11600/64221
• topic: Movement Disorders; Parkinson's Disease; Nigrossome 1; Neuromelanin; Tesla Magnetic Resonance; Transtornos Do Movimento; Doença De Parkinson; Nigrossomo 1; Neuromelanina; Ressonância Magnética 3 Tesla

Introduction: Parkinson’s disease (PD) is the second most common neurodegenerative disease in the world (1). However, the rate of misdiagnosis is still high even in specialized movement disorders centers. (2)(3) Objective: To evaluate the accuracy of the nigrosome 1 and midbrain’s neuromelanin in the diagnosis of PD in patients with different disease stages and if there is difference in the diagnosis accuracy between two neuroradiologists with different level of experience for these imaging technique. Methods: A case-control study was conducted between April 2017 and January 2019. We prospectively evaluated 41 PD patients and 21 controls. Participants were submitted to axial T2 multi-echo GRE and susceptibility weighted imaging (SWIp) MRI to evaluate nigrosome 1, and to axial T1 turbo spin echo magnetization transfer contrast (MTC) MRI sequence to evaluate midbrain neuromelanin, acquired at 3.0 Tesla (3T). Two experienced neuroradiologists, one of them with specific training on nigrosome and neuromelanin imaging and other without it, analyzed the images. Sensitivity, specificity and accuracy were calculated between PD groups and healthy participants and between the neuroradiologists. Interrater agreement was assessed with Kappa index. Results: The accuracy for PD diagnosis was higher to the trained neuroradiologist as compared to the other one (Multi-echo 95% X 79%, Swip 90% x 81% and T1 MTC 92% x 67%). The accuracy for PD diagnosis was lower in initial phases (stages 1 and 2 of Hoehn-Yahr) as compared to later phases (stages 3 and 4 of Hoehn-Yahr). Conclusion: Nigrosome 1 and midbrain neuromelanine are useful to help in PD diagnosis, even in the early stages of the disease. However, specific training of neuroradiologists is essential to ensure good accuracy and reproducibility.