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The Swallow Tail Sign of Substantia Nigra: A Case–Control Study to Establish Its Role in Diagnosis of Parkinson Disease on 3T MRIFunding None.
Background and Objectives The loss of swallow tail sign (STS) has been studied for the diagnosis of Parkinson's disease (PD). The study aims to establish the role of STS on high-resolution 3D susceptibility-weighted images (SWI) on 3T MRI in clinically diagnosed cases of PD and compare with control population.
Methods and Materials Forty-five patients with clinically diagnosed PD and Parkinson plus syndrome (PPS) formed the study group and were compared with 45 controls without any neurological disease and normal brain magnetic resonance imaging (MRI). Presence or absence of STS was studied on 1-mm thick axial 3D SWI images in bilateral substantia nigra by two radiologists independently, followed by consensus reading. Bilateral absent, unilateral absent, and faintly present STS were considered as absent STS and predicted PD or PPS, and bilateral presence was considered as a positive STS, and was assessed keeping the clinical diagnosis as the gold standard.
Results The sensitivity of the absent STS was 75.55%, specificity 97.77%, positive predictive value 97.14%, negative predictive value 80% and accuracy 86.66%, in the diagnosis of PD or PPS, with odd ratio of 132 (confidence interval 15.97–1098.75). Kappa coefficient was 0.80 (p < 0.001) for both inter- and intrarater agreement, suggesting high reproducibility for the detection of STS.
Conclusions Absence of the STS is a good predictor of degeneration of the nigrosome 1 in the substantia nigra in the PD or PPS patients; hence, it can act as a useful marker of these diseases.
KeywordsSWI - susceptibility - 3T - nigrosome - swallow tail sign - parkinson disease - parkinson plus syndrome
Article published online:
09 February 2022
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- 1 Broski SM, Hunt CH, Johnson GB, Morreale RF, Lowe VJ, Peller PJ. Structural and functional imaging in parkinsonian syndromes. Radiographics 2014; 34 (05) 1273-1292
- 2 Schwarz ST, Afzal M, Morgan PS, Bajaj N, Gowland PA, Auer DP. The 'swallow tail' appearance of the healthy nigrosome - a new accurate test of Parkinson's disease: a case-control and retrospective cross-sectional MRI study at 3T. PLoS One 2014; 9 (04) e93814
- 3 Brooks DJ. Diagnosis and management of atypical parkinsonian syndromes. J Neurol Neurosurg Psychiatry 2002; 72 (Suppl. 01) I10-I16
- 4 Mitra K. P. K. Gangopadhaya SK Das. Parkinsonism plus syndrome – A review. Neurol India 2009; 51: 183-188
- 5 Halefoglu AM, Yousem DM. Susceptibility weighted imaging: clinical applications and future directions. World J Radiol 2018; 10 (04) 30-45
- 6 Wang Z, Luo XG, Gao C. Utility of susceptibility-weighted imaging in Parkinson's disease and atypical Parkinsonian disorders. Transl Neurodegener 2016; 5: 17
- 7 Schwarz ST, Mougin O, Xing Y. et al. Parkinson's disease related signal change in the nigrosomes 1-5 and the substantia nigra using T2* weighted 7T MRI. Neuroimage Clin 2018; 19: 683-689
- 8 Blazejewska AI, Schwarz ST, Pitiot A. et al. Visualization of nigrosome 1 and its loss in PD: pathoanatomical correlation and in vivo 7 T MRI. Neurology 2013; 81 (06) 534-540
- 9 Cosottini M, Frosini D, Pesaresi I. et al. Comparison of 3T and 7T susceptibility-weighted angiography of the substantia nigra in diagnosing Parkinson disease. AJNR Am J Neuroradiol 2015; 36 (03) 461-466
- 10 Gao P, Zhou PY, Wang PQ. et al. Universality analysis of the existence of substantia nigra “swallow tail” appearance of non-Parkinson patients in 3T SWI. Eur Rev Med Pharmacol Sci 2016; 20 (07) 1307-1314
- 11 Schmidt MA, Engelhorn T, Marxreiter F. et al. Ultra high-field SWI of the substantia nigra at 7T: reliability and consistency of the swallow-tail sign. BMC Neurol 2017; 17 (01) 194
- 12 Oustwani CS, Korutz AW, Lester MS, Kianirad Y, Simuni T, Hijaz TA. Can loss of the swallow tail sign help distinguish between Parkinson Disease and the Parkinson-Plus syndromes?. Clin Imaging 2017; 44: 66-69
- 13 Noh Y, Sung YH, Lee J, Kim EY. Nigrosome 1 detection at 3T MRI for the diagnosis of early-stage idiopathic Parkinson disease: assessment of diagnostic accuracy and agreement on imaging asymmetry and clinical laterality. AJNR Am J Neuroradiol 2015; 36 (11) 2010-2016
- 14 Shams S, Fällmar D, Schwarz S. et al. MRI of the swallow tail sign: a useful marker in the diagnosis of lewy body dementia?. AJNR Am J Neuroradiol 2017; 38 (09) 1737-1741
- 15 Kim EY, Sung YH, Shin HG, Noh Y, Nam Y, Lee J. Diagnosis of early-stage idiopathic parkinson's disease using high-resolution quantitative susceptibility mapping combined with histogram analysis in the substantia nigra at 3 T. J Clin Neurol 2018; 14 (01) 90-97