Motoric impairment versus iron deposition gradient in the subthalamic nucleus in Parkinson’s disease

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  • 1 Department of Radiology, Weill Medical College of Cornell University, New York;
  • 2 Departments of Neurosurgery,
  • 3 Neurology,
  • 4 Psychiatry, and
  • 5 Neuroscience, Icahn School of Medicine at Mount Sinai, New York;
  • 6 Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York; and
  • 7 Department of Radiology, Hainan General Hospital (Affiliated Hainan Hospital of Hainan Medical University), Haikou City, People’s Republic of China
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OBJECTIVE

The objective of this study was to investigate the correlation between the quantitative susceptibility mapping (QSM) signal gradient of the subthalamic nucleus (STN) and motor impairment in patients with Parkinson’s disease (PD).

METHODS

All PD patients who had undergone QSM MRI for presurgical deep brain stimulation (DBS) planning were eligible for inclusion in this study. The entire STN and its three functional subdivisions, as well as the adjacent white matter (WM), were segmented and measured. The QSM value difference between the entire STN and adjacent WM (STN-WM), between the limbic and associative regions of the STN (L-A), and between the associative and motor regions of the STN (A-M) were obtained as measures of gradient and were input into an unsupervised k-means clustering algorithm to automatically categorize the overall boundary distinctness between the STN and adjacent WM and between STN subdivisions (gradient blur [GB] and gradient sharp [GS] groups). Statistical tests were performed to compare clinical and image measurements for discrimination between GB and GS groups.

RESULTS

Of the 39 study patients, 19 were categorized into the GB group and 20 into the GS group, based on quantitative cluster analysis. The GB group had a significantly higher presurgical off-medication Unified Parkinson’s Disease Rating Scale Part III score (51.289 ± 20.741) than the GS group (38.5 ± 16.028; p = 0.037). The GB group had significantly higher QSM values for the STN and its three subdivisions and adjacent WM than those for the GS group (p < 0.01). The GB group also demonstrated a significantly higher STN-WM gradient in the right STN (p = 0.01). The GB group demonstrated a significantly lower L-A gradient in both the left and the right STN (p < 0.02).

CONCLUSIONS

Advancing PD with more severe motor impairment leads to more iron deposition in the STN and adjacent WM, as shown in the QSM signal. Loss of the STN inner QSM signal gradient should be considered as an image marker for more severe motor impairment in PD patients.

ABBREVIATIONS A-M = QSM value differences between associative and motor regions of STN; DBS = deep brain stimulation; GB = gradient blur; GRE = gradient echo; GS = gradient sharp; L-A = QSM value differences between limbic and associative regions of STN; PD = Parkinson’s disease; QSM = quantitative susceptibility mapping; RN = red nucleus; SN = substantia nigra; STN = subthalamic nucleus; STN-WM = QSM value differences between entire STN and adjacent WM; UPDRS-III = Unified Parkinson’s Disease Rating Scale Part III; WM = white matter.

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Contributor Notes

Correspondence Brian H. Kopell: Icahn School of Medicine at Mount Sinai, New York, NY. brian.kopell@mountsinai.org.

INCLUDE WHEN CITING Published online August 7, 2020; DOI: 10.3171/2020.5.JNS201163.

Disclosures Dr. Wang has direct stock ownership in Medimagemetric LLC. Dr. Kopell has been a consultant for Medtronic, Abbott, and Elekta.

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