It is therefore appropriate to critically review the common recommendation that brain MRI should be performed as a standard procedure in all patients presenting with a form of parkinsonism [5—8].
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At our center, we refrain from brain MRI in patients presenting with classical symptoms of idiopathic PD, i. We do perform a brain MRI in patients with an atypical disease course, since finding a specific abnormality might suggest a specific form of AP, at the same time realizing that MRI without abnormalities does not exclude any form of AP.
The added value of brain MRI is greatest in patients with a possible underlying treatablecause of their parkinsonism, such as patients suspected of having normal pressure hydrocephalus or patients who might have underlying cerebrovascular pathology.
Finally, it is necessary to briefly mention the importance of brain MRI as part of the pre-operative work-up in PD patients scheduled to undergo a deep brain surgical procedure. Appropriate patient selection for this procedure is of critical importance . Performing MRI after deep brain stimulation surgery with an implanted electrode is restricted, and feasible only under stringent conditions.
How can we increase the diagnostic value of brain MRI? A first approach is to further evaluate the merits of existing MRI protocols. Performing more longitudinal imaging studies along with detailed clinical follow-up allows us to determine when in the course of the disease specific abnormalities are likely to emerge.
High Field Brain MRI - Use in Clinical Practice | Ugo Salvolini | Springer
We used this former approach in a follow-up study of patients presenting with parkinsonism, and showed that a comprehensive set of clinical tests provides good accuracy to differentiate PD from AP, and that the added diagnostic value of brain MRI is relatively highest for those patients where the baseline clinical diagnostic certainty is lowest [28, 32].
A second approach is to deploy more advanced MRI techniques — including DTI, magnetization transfer imaging and resting state functional MRI — which have become available over the last decade for potential use in clinical practice. These advanced MRI techniques have proven to be helpful in further exploring and understanding the pathophysiologic changes, mainly in PD and to a lesser extent in AP [3, 4, 26, 27, 33].
A prerequisite for clinical application is standardized data-processing and the availability of well-defined imaging criteria. An increase in magnetic field strength enables improved tissue contrast and better spatial and temporal resolution, with reported higher accuracy in detecting more subtle pathologic changes and improved evaluation of smaller brain structures such as the substantia nigra [35, 36].
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A third approach is to combine the diagnostic value of the structural and functional imaging markers by further developing machine-learning algorithms for advanced MRI techniques. These machine-learning techniques rely on algorithms analyzing imaging data without a-priori hypotheses, based on which classifiers can be constructed for pattern recognition at the individual level [37, 38].
Compared with a single imaging technique, the advantage of using multiple techniques is to extract more features in order to more accurately profile specific neurodegenerative pathology .
Use in Clinical Practice
Finally, besides optimizing the MRI scanning protocol and applying new neuro-imaging techniques, the level of experience of the physician reading the study needs to be taken into account and optimized accordingly. We thank Yvonne Hoogeveen and Dr. Stefan Steens for proofreading of the manuscript. Expert Rev Neurother , 11 , Mov Disord , 30 , Neuroimaging Clin N Am , 20 , Neurosci Biobehav Rev , 59 , Age Ageing , 36 , Neurology , 58 , Eur J Neurol , 13 , J Neurol , , Brain , , Neurology , 64 , Neurology , 54 , J Neural Transm , , Mov Disord , 26 , Neurology , 80 , A clinicopathological reevaluation.
Ultra-high-field brain scanner receives FDA approval for clinical use
Eur Radiol , 18 , Postgrad Med J , 87 , Nat Rev Neurol , 11 , Nat Rev Neurol , 5 , Br J Radiol , 87 , Mov Disord , 24 Suppl 2 , J Neurol Sci , , Parkinsonism Relat Disord , 20 , Neuroradiol J, 27 , Neuroimage Clin , 5 , Neurology , 81 , PLoS One , 9 , e J Neurosci Methods , , At 7 Tesla, a voxel depicts just a few thousand cells, allowing scientists to study the brain with more precision and detail.
The 7T Terra is ideal for high-resolution structural and functional neuroimaging, exploration of neurodegenerative diseases such as Alzheimer's and Parkinson's, and diagnosis and treatment of other diseases that affect the brain, including multiple sclerosis, stroke and vascular dementia. They were able to localize an extremely small pituitary tumor not visible on 1. Their findings were published in March in the Journal of Neurosurgery.
It also makes it easier for neurosurgeons to selectively remove a tumor without damaging surrounding areas," said Zada, an associate professor of neurological surgery clinical scholar at the Keck School. Reconfiguring the 7T Terra for clinical use involved minor hardware and software updates to comply with FDA standards. For more information about the scanner, visit cia.
The school has more than 1, full-time faculty members and voluntary faculty of more than 2, physicians. These faculty direct the education of approximately medical students and 1, students pursuing graduate and postgraduate degrees.