Diagnosis of Parkinson's disease by biomedical imaging methods on the example of a clinical case

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Abstract

Worldwide, Parkinson's disease (PD; primary Parkinsonism) is ahead of other neurological disorders in terms of the growth rate of disability and mortality. Despite significant progress in the study of the etiopathogenesis of PD, early diagnosis is a difficult clinical task. The long latent phase of the disease and the absence of reliable laboratory markers often cause a delay in diagnostic neuroimaging, which, together with the potential unwillingness of the radiologist to see changes characteristic of the neurodegenerative process, leads to untimely diagnosis and, as a consequence, a delay in the appointment of therapy.

This article provides a literary review of generally recognized visualization patterns of the disease in accordance with modern concepts, and also discusses the issues of differential diagnosis of PD with the most common Parkinsonism-plus syndromes. A clinical case of the diagnosis of Parkinson's disease in a 93-year-old patient by structural magnetic resonance imaging is presented.

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About the authors

V. V. Ryazanov

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Author for correspondence.
Email: val9126@mail.ru
ORCID iD: 0000-0002-0037-2854

Doctor of Medical Sciences, Associate Professor

Russian Federation, Saint Petersburg

V. P. Kutsenko

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val9126@mail.ru
ORCID iD: 0000-0001-9755-1906

Candidate of Medical Sciences

Russian Federation, Saint Petersburg

R. A Postanogov

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val9126@mail.ru
ORCID iD: 0000-0002-0523-9411
Russian Federation, Saint Petersburg

P. V. Seliverstov

V.A. Almazov National Medical Research Center; S.M. Kirov Military Medical Academy

Email: val9126@mail.ru
ORCID iD: 0000-0001-5623-4226

Candidate of Medical Sciences

Russian Federation, Saint Petersburg; Saint Petersburg

M. R. Gafiatulin

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val9126@mail.ru
ORCID iD: 0000-0002-5224-1717
Russian Federation, Saint Petersburg

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2. Fig. 1. Anatomical formations of the midbrain are normal (macropreparation): 1 – the reticular part of the substantia nigra; 2 – the compact part of the substantia nigra; 3 – the red nucleus; 4 – the motor nucleus of the oculomotor nerve; 5 – gray matter near the aqueduct; 6 – the Sylvian aqueduct; 7 – the medial longitudinal bundle; 8 – the superior colliculus quadrilateral; 9 – the spinothalamic tract; 10 – the medial lemniscus; 11 – medial geniculate body; 12 – the legs of the brain

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3. Fig. 2. Dovetail symptom (diagram): 1 – nigrosome 1; 2 – substantia nigra; 3 – medial lemniscus; 4 – red nucleus; 5 – mastoid bodies; 6 – interpeduncular fossa (Selikhova M.V., Katunina E.A., Voun A., 2019)

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4. Fig. 3. MRI of the brain of patient Z.: a – T2 FLAIR WI, axial section at the level of semioval centers: small single lacunae (arrows), drain hyperintensive zones in white matter (asterisks); б – T2 WI, axial section at the level of basal nuclei: multiple expanded perivascular spaces (arrows), expansion liquor spaces of a substitutive nature (asterisks); в – T2 FLAIR WI, axial section at the level of the legs of the brain: smoothness of differentiation of the compact part of the emergency, a decrease in the intensity of the MR signal from it, more to the left (arrow) with a preserved volume of midbrain structures; г – T2 WI, axial section at the level of the legs of the brain: similar changes (arrow) with a preserved volume of structures the midbrain

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