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Visualizing Neuromelanin in Parkinson’s disease in the presence of motion
Mikael Skorpil1, Henric Rydén2, Per Svenningsson2, and Adam van Niekerk2
1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden, 2Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Synopsis

Keywords: Parkinson's Disease, Motion Correction

Neuromelanin-MRI can detect reductions in volume and intensity of the substantia nigra in Parkinson’s disease (PD). High-resolution magnetization transfer (MT) contrast T1-weighted sequences are used, and the MT pulse is time-consuming. We evaluated the degree of motion during a long (~ 12 min) scan in a PD patient and a healthy volunteer, and the effect of motion correction using a wireless RF-triggered acquisition device (WRAD) developed in our group. Despite only minor motion, for both participants, motion correction improved image quality.

Introduction

Parkinson’s disease (PD) is a neurodegenerative disorder with resting tremor, muscular rigidity and bradykinesia, in which symptoms can overlap with other diseases such as progressive supranuclear palsy and multiple system atrophy. The pathology process involves loss of dopaminergic cells and reduction of neuromelanin in the substantia nigra (SN), as well as accumulation of iron (1-3). There is no specific test for PD, and it is a clinical diagnosis based on symptoms and neurological examination. However, structural MRI of the SN is now showing promising results in diagnosing PD. Susceptibility weighted imaging (SWI) can detect iron accumulation in a small area in the SN, the nigrosome 1, with localized loss of hyperintensity in PD, which is the same as disappearance of the ’swallow tail sign’ (4-6). However, in a 7T study it was found that the hyperintensity was not fully correlated to nigrosome 1 (7). Additionally, high-resolution magnetization transfer (MT) contrast T1-weighted images of the SN, neuromelanin-magnetic resonance imaging (NM-MRI), shows reduction in volume and intensity in PD, which also correlates with disease severity (8-13). Due to the MT pulse, NM-MRI is time-consuming. In a recent review of NM-MRI, scan times were: 12.5-9.5 min, 12 min, 12 min, 9.6 min, 8 min, 8 min, 7.45-7.25 min, 6.9 min, 4.5 min and 4.25 min (14).

Our group is currently developing a wearable battery operated device called a WRAD, a wireless RF-triggered acquisition device (figure 1), which is effective for prospective motion correction in conventional sequences (15). In this study, we investigated if WRAD could correct for small involuntary motion during a long NM-MRI acquisition.

Methods

Two imaging sessions were performed each with informed consent and approval from the local ethics review board. One on a patient diagnosed with Parkinson's disease in 2019 Hoehn & Yahr stage 2 (PD patient), and the second on a healthy volunteer (Healthy). Each session consisted of three scans. A 3D 0.7 mm isotropic susceptibility weighted EPI pulse sequence - included for diagnostic reasons - and two acquisitions of a 0.8 mm isotropic 3D magnetisation transfer (MT) weighted (300 degree flip angle 8 ms long Fermi pulse at 1.2 kHz off-resonance) spoiled gradient echo pulse sequence (MT-SPGR). For both MT-SPGR acquisitions the subject’s motion was tracked by mounting a WRAD to their forehead (figure 1). For one of the scans the motion parameters were used to perform prospective motion correction (co), and for the other no updates of the FOV were applied (noco).

For these scan parameters the TR (18.9 ms) of the MT-SPGR was SAR limited, the WRAD navigators (2.4 ms) therefore had no impact on the scan duration (~ 12 min). For the Healthy scan, WRAD navigators were played out in opposing polarity and then combined, as described in (15). This improves the precision of the estimates at the cost of reducing the update frequency by a factor of two (1 / 2TR). For the PD patient scan, one estimate was generated for each navigator resulting in an update frequency of (1 / TR). Prospective updates, when enabled, were applied to the following TR without any temporal smoothing/filtering in each case.

Results

Neuromelanin in the SN was successfully visualized with a 12 minutes long MT-SPGR scan. When the WRAD was used for motion correction, SN was better delineated with improved contrast versus adjacent hypointense midbrain structures (figure 2). Although motion plots (figure 3) revealed minor motion of just a few millimeters, in both the non-corrected and motion corrected scans for the PD patient and the healthy volunteer, the effect of motion correction was distinct on SN and cortical gray-white matter interface.

Discussion

The PD patient had mild symptoms and a short disease duration of 3 years, and as expected only minor signs of loss of NM posterolateral in the SN was seen (figure 2) (16). NM-MRI images in our study were reformatted in 3 mm slices, as a review has indicated that ≥ 2mm are preferable, where factors attributed to heterogeneity in diagnostic performance were slice thickness, SN volumes or signal intensities, segmentation methods and disease duration (14).

For diagnostic reasons, a high-resolution isotropic 3D SWI was also included, with images reformatted along with and orthogonal to the long axis of the midbrain, to evaluate the ’swallow tail sign’, which was lost in the PD patient (figure 4) (7, 17). The SWI sequence was not motion corrected, since this is a non-trivial problem due to motion induced changes in the B0 magnetic field (18).

Conclusion

Even minor motion can affect image quality in neuromelanin-MRI, which was improved by motion correction using a wireless RF-triggered acquisition device (WRAD).

Acknowledgements

No acknowledgement found.

References

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Figures

Figure 1) A WRAD device shown mounted to the subject’s forehead.

Figure 2) NM-MRI. Reformatted axial slices along the AC-PC line (anterior commissure - posterior commissure) and orthogonal coronal 3 mm slices in a healthy volunteer and PD patient, without (noco) and with motion correction (co). SN is better delineated with better contrast versus adjacent hypointense midbrain structures in the motion corrected images. Cortical gray-white matter interface is also better delineated with motion correction. In the PD patient, the posterolateral volume and signal intensity of both sides of SN was decreased compared to a healthy volunteer (arrows).

Figure 3) A-D. Motion plots of the pose for the healthy volunteer (top row) and a PD patient (bottom row). The left column shows the motion data that was used for prospective motion correction during the corrected scans (co). The right column is the motion data captured by the WRAD in an identical sequence, however in this case the updates were not applied (noco). In each case the subject was asked to lie as still as possible. For the Healthy session A was acquired first and then B. For the PD session D was acquired first and then C. In both sessions the subject drifted more during the first scan.

Figure 4) 3D SWI. Axial and coronal planes, reformatted along with and orthogonal to the long axis of the midbrain, in a healthy volunteer and PD patient. Loss of the ‘swallow tail sign’ is seen in the PD patient in both planes (arrows).

Proc. Intl. Soc. Mag. Reson. Med. 31 (2023)
1394
DOI: https://doi.org/10.58530/2023/1394