Use of Magnetic Resonance Tractography in Detecting Specific Features of the Impairment of Conduction Pathways and Their Prognostic Value in Parkinson’s Disease Complicated by Freezing of Gait
The aim of the study was to determine the localization of conductive pathways in patients with Parkinson’s disease (PD) complicated with freezing of gait, by using data from magnetic resonance tractography, and to identify the prognostic value of these pathways in predicting the course of the disease.
Materials and Methods. 78 patients with idiopathic PD were examined and divided into two groups: patients with freezing of gait (n=31) and without freezing of gait (n=47). The protocol of the investigation consisted of clinical evaluation of the condition of the patients to determine the stage of the disease, and the use of a Siemens MRI Device (magnetic induction field, 1.5 T) to obtain standard images of the coronary, axial and sagittal planes, as well as MRI-protocols of the T1 gradient echo, plus diffusion-tensor tractography with further analysis of the findings with FreeSurfer software.
Results. The groups of patients showed statistically significant differences in the levels of the tract length, diffusivity and fractional anisotropy in the anterior thalamic radiations of both sides, the temporal area of the superior longitudinal fascicle on the left, the parietal area of the superior longitudinal fascicle on the right, and the corticospinal tract on the right. Analysis of the correlative tractographic values with the total scores on the walk-and-balance scale revealed that the highest prognostic value in the development of freezing of gait pertained to damage to the thalamo-frontal tract. A reduction in the value of the maximum voxel length to 80.0 or below, increased the risk of development of freezing of gait in 10 times.
Conclusion. The results demonstrate the involvement of conduction pathways in the mechanisms leading to freezing of gait in PD. Early diagnosis and prediction of the development of this complication using magnetic resonance tractography can indicate the need to adjust the medical treatment and to develop an appropriate special system of rehabilitation.
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