Classic Parkinson's Disease Imaging Features
HIDEInteractive Transcript
0:01
Let's look at the rubral nigral apparatus in
0:04
a patient with classic Parkinson's disease.
0:07
Now, we did say that one typical finding,
0:10
which you see much better with gradient echo,
0:13
perhaps with FLAIR,
0:15
and certainly with blood-sensitive
0:17
imaging or SWAN or SWI,
0:20
is the hypointensity that occurs in the
0:25
substantia nigra, will bleed into
0:28
the red nucleus and the two will come together,
0:31
and the space in between them,
0:33
which I'll depict here in blue,
0:35
is basically obliterated.
0:36
Now, that is not what I'm trying to demonstrate in this
0:39
case because sometimes when you don't have these
0:42
iron-sensitive sequences, you're not quite as
0:46
specific and detailed in mapping
0:48
out where the iron is.
0:50
And you'll often have an axial T2 spin-echo.
0:53
And on that sequence,
0:55
what you may end up seeing is the lack
0:58
of visualization of the red nucleus.
1:00
In other words, it's depigmented.
1:01
Whereas, normally, you would see something
1:03
that's round and hypointense.
1:05
You see virtually nothing there.
1:07
And then, typically, the substantia nigra,
1:10
even on a T2,
1:11
will go further out laterally than this.
1:14
I've drawn over it on both sides.
1:16
I mean, where is it over here?
1:19
It's too bright.
1:20
So, you have progressively lost the outer half to
1:24
outer one-third of the substantia nigra in this
1:28
patient with PD or Parkinson's disease.
1:31
Then I go to a very late one where a combination
1:35
of perforating vessels and a little bit of
1:38
necrosis in the mid to outer aspect of the
1:40
substantia nigra, with depigmentation,
1:43
has produced increased relaxivity.
1:46
Almost cystic change,
1:48
almost cystic necrosis in the lateral aspect
1:51
of the substantia nigra.
1:52
And once again,
1:54
depigmentation loss of crisp visualization
1:58
of the red nucleus.
1:59
You can see a little bit of it on the proton density image,
2:02
but not much.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
© 2024 MRI Online. All Rights Reserved.