Rationale and Objectives
Early-stage diagnosis of Parkinson’s disease (PD) is essential in making decisions related to treatment and prognosis. However, there is no specific diagnostic test for the diagnosis of PD. The aim of this study was to evaluate the role of texture analysis (TA) of magnetic resonance images in detecting subtle changes between the hemispheres in various brain structures in patients with early symptoms of parkinsonism. In addition, functional TA parameters for detecting textural changes are presented.
Materials and Methods
Fifty-one patients with symptoms of PD and 20 healthy controls were imaged using a 3-T magnetic resonance device. Co-occurrence matrix–based TA was applied to detect changes in textures between the hemispheres in the following clinically interesting areas: dentate nucleus, basilar pons, substantia nigra, globus pallidus, thalamus, putamen, caudate nucleus, corona radiata, and centrum semiovale. The TA results were statistically evaluated using the Mann-Whitney U test.
Results
The results showed interhemispheric textural differences among the patients, especially in the area of basilar pons and midbrain. Concentrating on this clinically interesting area, the four most discriminant parameters were defined: co-occurrence matrix correlation, contrast, difference variance, and sum variance. With these parameters, differences were also detected in the dentate nucleus, globus pallidus, and corona radiata.
Conclusions
On the basis of this study, interhemispheric differences in the magnetic resonance images of patients with PD can be identified by the means of co-occurrence matrix–based TA. The detected areas correlate with the current pathophysiologic and neuroanatomic knowledge of PD.
Parkinson’s disease (PD) is a progressive disorder of the central nervous system. Signs of PD include rest tremor, bradykinesia, rigidity, and the loss of postural reflexes . There is no specific diagnostic test for PD, and therefore the disease is diagnosed on the basis of clinical symptoms. Early-stage diagnosis of PD or other degenerative causes of parkinsonism is essential for deciding on treatment and prognosis, but early-stage disease may be difficult to recognize because it usually begins subtly. In addition, diagnosis is complicated because symptoms of other neurologic conditions resemble those of PD.
Among other symptoms, PD is characterized pathophysiologically by the loss of dopaminergic neurons in the substantia nigra (SN) pars compacta . The structure participates in controlling voluntary movements, and when information transfer is disturbed by the loss of neurotransmitter dopamine, the consequences can be seen as symptoms of PD . The identification of the midbrain dopaminergic regions is useful for evaluating the structural changes associated with PD .
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Materials and methods
Patients and Controls
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MRI
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Table 1
MRI Sequences and Imaging Parameters for Patients and Controls at 3 T
Sequence TR (ms) TE (ms) TI (ms) Slice Thickness (mm)/Slice Gap (mm) Matrix Size (Pixels) FOV (mm) Flip Angle (°) Axial T2-weighted SPACE 3200 354 — 3.0/0 384 × 290 230 120 Axial 3D SWI 27 20 — 1.5/0 256 × 128 230 15
FOV, field of view; MRI, magnetic resonance imaging; SPACE, sampling perfection with application-optimized contrasts using different flip-angle evolutions; SWI, susceptibility-weighted imaging; TE, echo time; TI, inversion time; TR, repetition time.
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Image Selection
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Region of Interest (ROI) Localization
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Table 2
Image Levels and ROIs
Level ROI 1 ROI 2 ROI 3 ROI 4 ROI 5 ROI 6 ROI 7 ROI 8 Axial 1 Dentate nucleus dex Dentate nucleus sin Axial 2 Basilar pons dex Basilar pons sin Axial 3 SN pars reticulata dex SN pars reticulata sin SN pars compacta dex SN pars compacta sin Red nucleus dex Red nucleus sin Axial 4 Putamen dex Putamen sin Globus pallidus dex Globus pallidus sin Thalamus ant dex Thalamus ant sin Thalamus post dex Thalamus post sin Axial 5 Caudate nucleus dex Caudate nucleus sin Axial 6 Corona radiata ant dex Corona radiata ant sin Corona radiata post dex Corona radiata post sin Axial 7 Centrum semiovale ant dex Centrum semiovale ant sin Centrum semiovale med dex Centrum semiovale med sin Centrum semiovale post dex Centrum semiovale post sin
Ant, anterior; dex, dexter; post, posterior; ROI, region of interest; sin, sinister; SN, substantia nigra.
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TA
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Statistical Analysis
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Results
Textural Differences Between Hemispheres Using All COM Parameters
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Table 3
Occurrence of Significant P Values (P < .01) When Comparing Tissues Between Hemispheres Using COM Parameters Calculated in Different Directions Among Patients (n = 51)
Structure SPACE SWI Horizontal and Vertical Diagonals Horizontal and Vertical Diagonals_n_ Occurrence of Significant P Values_n_ Occurrence of Significant P Values_n_ Occurrence of Significant P Values_n_ Occurrence of Significant P Values Dentate nucleus 110 ○ 66 ○ 110 ○ 66 ○ Basilar pons 110 ○ 110 ● 110 ○ 110 ○ SN pars reticulata 44 ○ 66 ○ 110 ○ 66 ○ SN pars compacta 110 ○ 22 ● 44 ○ 22 ● Red nucleus 110 ○ 66 ○ 110 ○ 66 ○ Putamen 110 ○ 110 ○ 110 ○ 110 ○ Globus pallidus 110 ○ 110 ○ 110 ○ 110 ○ Thalamus ant 110 ○ 110 ○ 110 ○ 110 ● Thalamus post 110 ○ 110 ○ 110 ○ 110 ○ Caudate nucleus 110 ○ 110 ● 110 ○ 110 ○ Corona radiata ant 44 ○ 22 ○ 44 ○ 22 ○ Corona radiata post 44 ○ 22 ○ 44 ○ 22 ○ Centrum semiovale ant 110 ○ 110 ○ 110 ○ 110 ○ Centrum semiovale med 110 ○ 110 ○ 110 ○ 110 ○ Centrum semiovale post 110 ○ 110 ○ 110 ○ 110 ○
In structures marked with black circles (●), ≥40% of the evaluated parameters had P values < .01. White circles (○) indicate that <40% of the parameters showed significant changes in the region.
Ant, anterior; co-occurrence matrix; n , number of analyzed texture parameters; post, posterior; SN, substantia nigra; SPACE, sampling perfection with application-optimized contrasts using different flip-angle evolutions; SWI, susceptibility-weighted imaging.
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TA Results From Clinically Significant Areas in Patient Images
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Table 4
Occurrence of Significant P Values (P < .01) When Comparing Tissues Between Hemispheres Using Selected COM Parameters Calculated in Diagonal Directions Among Patients (n = 51)
Structure_n_ SPACE SWI Occurrence of Significant P Values Correlation Contrast Difference Variance Sum Variance Correlation Contrast Difference Variance Sum Variance Dentate nucleus 6 ● ● ● ○ ○ ○ ○ ○ Basilar pons 10 ● ● ● ● ○ ● ● ○ SN pars reticulata 6 ● ● ○ ○ ● ● ● ● SN pars compacta 2 ● ● ● ● ● ○ ● ● Red nucleus 6 ○ ○ ○ ○ ● ● ○ ● Putamen 10 ○ ○ ○ ○ ○ ○ ○ ○ Globus pallidus 10 ● ● ○ ● ○ ○ ○ ○ Thalamus ant 10 ● ● ● ● ● ● ● ● Thalamus post 10 ○ ○ ○ ○ ○ ○ ○ ○ Caudate nucleus 10 ● ● ● ● ○ ○ ○ ○ Corona radiata ant 2 ○ ○ ○ ○ ○ ○ ○ ○ Corona radiata post 2 ○ ○ ○ ○ ● ● ● ● Centrum semiovale ant 10 ○ ○ ○ ○ ○ ○ ○ ○ Centrum semiovale med 10 ○ ○ ○ ○ ○ ○ ○ ○ Centrum semiovale post 10 ○ ○ ○ ○ ○ ○ ○ ○
In structures marked with black circles (●), ≥40% of the evaluated parameters had P values < .01. White circles (○) indicate that <40% of the parameters showed significant changes in the region.
Ant, anterior; co-occurrence matrix; n , number of analyzed texture parameters; post, posterior; SN, substantia nigra; SPACE, sampling perfection with application-optimized contrasts using different flip-angle evolutions; SWI, susceptibility-weighted imaging.
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TA Results From the Control Group Using the Four Most Discriminative Parameters
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Table 5
Occurrence of Significant P Values (P < .01) When Comparing Tissues Between Hemispheres Using Selected COM Parameters Calculated in Diagonal Directions Among Healthy Controls (n = 20)
Structure_n_ SPACE SWI Occurrence of Significant P Values Correlation Contrast Difference Variance Sum Variance Correlation Contrast Difference Variance Sum Variance Dentate nucleus 6 ○ ● ○ ○ ○ ○ ○ ○ Basilar pons 10 ● ● ● ● ○ ○ ○ ○ SN pars reticulata 6 ○ ○ ○ ○ ○ ● ○ ○ SN pars compacta 2 ● ● ● ● ● ● ● ● Red nucleus 6 ○ ○ ○ ○ ○ ○ ○ ○ Putamen 10 ○ ○ ○ ○ ○ ○ ○ ○ Globus pallidus 10 ○ ○ ○ ○ ○ ○ ○ ○ Thalamus ant 10 ○ ○ ○ ○ ● ● ● ○ Thalamus post 10 ○ ○ ○ ○ ○ ● ○ ○ Caudate nucleus 10 ● ● ● ● ○ ○ ○ ○ Corona radiata ant 2 ○ ○ ○ ○ ○ ○ ○ ○ Corona radiata post 2 ● ○ ○ ● ○ ○ ○ ○ Centrum semiovale ant 10 ○ ○ ○ ○ ○ ○ ○ ○ Centrum semiovale med 10 ○ ○ ○ ○ ○ ○ ○ ○ Centrum semiovale post 10 ○ ○ ○ ○ ○ ○ ○ ○
In structures marked with black circles (●), ≥40% of the evaluated parameters had P values < .01. White circles (○) indicate that <40% of the parameters showed significant changes in the region.
Ant, anterior; co-occurrence matrix; n , number of analyzed texture parameters; post, posterior; SN, substantia nigra; SPACE, sampling perfection with application-optimized contrasts using different flip-angle evolutions; SWI, susceptibility-weighted imaging.
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Discussion
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Conclusions
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