Imaging software focusing on white matter may aid Parkinson’s diagnosis

Changes on MRI scans distinguish Parkinson's disease, atypical parkinsonism

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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A doctor is shown looking at MRI scans of a person's brain.

Imaging software developed by Braintale may distinguish Parkinson’s disease from atypical parkinsonism based on measures of early changes in the brain’s white matter, aiding in better diagnoses and disease treatment development.

That’s according to initial results from a study into biomarkers on magnetic resonance imaging (MRI) scans of patients with symptoms, such as tremor, caused by either Parkinson’s or atypical parkinsonism, also called parkinsonian syndromes.

“These initial results obtained in patients with Parkinson’s syndromes monitored prospectively [before outcomes are known] confirm the value of these biomarkers for differentiating tremor etiologies,” Stéphane Lehéricy, MD, PhD, who led the study, said in a company press release.

“In the long term, this could lead to improved management of such patients, particularly when symptoms are equivocal,” added Lehéricy, who heads the neuroradiology department of Paris Region Greater Hospitals in France.

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The study,“Evaluation of a clinically validated digital platform to provide diffusion MRI biomarkers in Parkinsonian syndromes” (page 271), was presented as a poster at the European Academy of Neurology held July 1-4 in Budapest, Hungary, and the World Parkinson Congress held July 4-7 in Barcelona, Spain.

Parkinson’s is caused by damage that can kill nerve cells in the brain. While many areas are affected, the disease’s hallmark symptoms arise from nerve cell loss in a specific area of gray matter, brain tissue that’s responsible for processing information.

Atypical parkinsonism resembles Parkinson’s in many ways, but it arises from distinct causes. Distinguishing them can be difficult and require extensive testing, while an accurate diagnosis is essential for proper treatment and care.

“Differential diagnosis of these disorders in clinical routine is crucial to adapt treatments,” the researchers wrote.

Deeper within the brain lies white matter, a complex network of interconnected nerve fibers or axons. Unlike its counterpart, white matter appears to be less affected than gray matter in diseases such as Parkinson’s, and as such overlooked in disease-related brain research.

Changes in white matter microstructure, however, are linked to poorer motor control and executive function in Parkinson’s patients.

By measuring the movement of water molecules in the brain on diffusion-weighted MRI scans, the imaging software — called Braintale-care — was designed to detect early, small-scale changes in white matter integrity that can serve as diagnostic biomarkers or in monitoring disease progression or response to treatment.

To find out if these biomarkers could help doctors distinguish Parkinson’s from atypical parkinsonism, researchers looked at MRI scans of 81 patients from two previous prospective studies (NCT00465790 and NCT01085253), both run in France.

Among these patients, 46 were diagnosed with Parkinson’s, 18 with progressive supranuclear palsy (PSP), 10 with multiple system atrophy cerebellar subtype (MSAc), and seven with multiple system atrophy parkinsonian subtype (MSAp).

Small changes in brain’s white matter could distinguish among diseases

Researchers looked specifically at radial diffusivity as a biomarker related to myelin, which coats nerve cell fibers to aid communication, in the two brain regions: the middle cerebellar peduncle and brainstem. They also looked at fractional anisotropy as a biomarker of changes in white matter above the cerebellum, a brain region involved in movement and balance.

Certain differences were noted when comparing scans of individuals with MSAc, PSP, and Parkinson’s. One such difference was significantly decreased communication patterns in nerve fibers, represented by the anisotropy fraction, in both MSAc and PSP patients relative to Parkinson’s patients. Another difference was greater radial diffusivity, which reflects how freely water molecules move in the brain, in the MSAc group compared with the Parkinson’s group. No significant differences were found between MSAp and the other patient groups.

Findings suggest that there are distinct variations in how nerve fibers are organized in the brain and how water molecules move in different neurodegenerative conditions.

“This study shows that white-matter alterations related to different neuropathological mechanisms involved in Parkinsonian syndromes can be captured by brainTale-care platform,” the researchers wrote. “It paves the way for further exploration based on the differential diagnosis potential.”

The company recently secured €4.5 million (about $5 million) in funding to speed further development of its software, which is offered as software as service. This means that users pay a subscription to gain access to the platform over the internet.

A recently updated version of Braintale-care is available for medical center use in diagnosing Parkinson’s. “The entire BrainTale team is highly committed to providing our solutions to all stakeholders,” said Vincent Perlbarg, PhD, the company’s co-founder, president, and chief scientific officer.