Relative quantification of signal on T2-weighted images in the basal ganglia: limited value in differential diagnosis of patients with parkinsonism

Abstract

A reduction in signal in the basal ganglia on T2-weighted images is said to correlate with a poor response to L-DOPA and may help to identify patients with nonidiopathic parkinsonism. Our aim in this prospective study was to use the contrast-to-noise ratio of the MRI signal on T2-weighted images in various parts of the basal ganglia in 43 patients with de novo parkinsonism. Signal intensity measurements were compared to the response to the dopamine agonist apomorphine and dopamine-D2 receptor binding obtained by 3-iodo-6-methoxybenzamine single-photon emission computed tomography (IBZM-SPECT). A reduced contrast-to-noise ratio in the putamen correlated significantly with a negative response to apomorphine and reduced striatal IBZM binding. No additional signal intensity measurement correlated with response to apomorphine or specific IBZM binding. However, there was a considerable overlap of contrast-to-noise ratios between patients with a positive or negative response to apomorphine or normal and reduced IBZM binding. We suggest that semiquantitative assessment of signal intensity in the putamen shows a significant reduction in patients with probably nonidiopathic parkinsonism compared with patients with probably idiopathic parkinsonism. However, this method does not exclude idiopathic parkinsonism in a given patient.