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.

Classic Parkinson's Disease Imaging Features

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Interactive Transcript

Pro Tip: Click on a word in the transcript to jump to that point in the video

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.

Report

Description

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Lesson

Huntington's Chorea

Lesson

Parkinson's Disease

Lesson

Parkinson Plus Syndromes

Lesson

Clinical Implications of Huntington's Chorea

Classic Parkinson's Disease Imaging Features