Classic Parkinson's Disease Imaging Features
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Let's look at the rubral nigral apparatus in
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a patient with classic Parkinson's disease.
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Now, we did say that one typical finding,
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which you see much better with gradient echo,
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perhaps with FLAIR,
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and certainly with blood-sensitive
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imaging or SWAN or SWI,
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is the hypointensity that occurs in the
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substantia nigra, will bleed into
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the red nucleus and the two will come together,
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and the space in between them,
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which I'll depict here in blue,
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is basically obliterated.
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Now, that is not what I'm trying to demonstrate in this
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case because sometimes when you don't have these
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iron-sensitive sequences, you're not quite as
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specific and detailed in mapping
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out where the iron is.
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And you'll often have an axial T2 spin-echo.
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And on that sequence,
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what you may end up seeing is the lack
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of visualization of the red nucleus.
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In other words, it's depigmented.
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Whereas, normally, you would see something
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that's round and hypointense.
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You see virtually nothing there.
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And then, typically, the substantia nigra,
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even on a T2,
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will go further out laterally than this.
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I've drawn over it on both sides.
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I mean, where is it over here?
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It's too bright.
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So, you have progressively lost the outer half to
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outer one-third of the substantia nigra in this
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patient with PD or Parkinson's disease.
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Then I go to a very late one where a combination
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of perforating vessels and a little bit of
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necrosis in the mid to outer aspect of the
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substantia nigra, with depigmentation,
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has produced increased relaxivity.
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Almost cystic change,
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almost cystic necrosis in the lateral aspect
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of the substantia nigra.
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And once again,
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depigmentation loss of crisp visualization
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of the red nucleus.
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You can see a little bit of it on the proton density image,
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but not much.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
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