Neuromelanin-sensitive MRI as a biomarker for individualized deep brain stimulation in Parkinson's disease: Associations between substantia nigra imaging and therapeutic outcomes

IF 4.3 3区医学 Q2 CLINICAL NEUROLOGY

Parkinsonism & related disorders Pub Date : 2026-03-01 Epub Date: 2026-01-28 DOI:10.1016/j.parkreldis.2026.108205

Yinling Zhou , Yindi Zhang , Guo Li , Wei Zhang

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Abstract

Background

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) effectively treats advanced Parkinson's disease (PD), yet motor and non-motor outcomes vary considerably. Neuromelanin-sensitive MRI (NM-MRI) visualizes dopaminergic neuron loss in the substantia nigra pars compacta (SNc) and may serve as a predictive biomarker.

Objectives

To explore quantitative associations between preoperative NM-MRI SNc characteristics and postoperative clinical improvement in PD patients undergoing STN-DBS.

Methods

In this prospective cohort study, 33 PD patients scheduled for bilateral STN-DBS and 16 age-matched healthy controls were enrolled. Clinical outcomes at 3 months post-surgery included percentage improvement in Unified PD Rating Scale Part III (UPDRS-III), PD Questionnaire-39 (PDQ-39), and levodopa equivalent daily dose (LEDD). High-resolution T1-weighted and NM-sensitive sequences were acquired at 3.0 T; SNc volume and signal-to-noise ratio (SNR) were calculated after manual region-of-interest delineation.

Results

Contralesional SNc volume and SNR were significantly reduced versus ipsilesional sides (both P < 0.001) and controls (P = 0.043 and P = 0.031). Contralesional SNc volume correlated moderately with UPDRS-III improvement (r = 0.508, P = 0.003), whereas SNR correlated strongly with PDQ-39 improvement (r = 0.599, P < 0.001). Multivariable regression confirmed contralesional volume as an independent predictor of motor response and SNR of quality-of-life response. ROC analysis yielded AUCs of 0.785 for volume predicting good motor outcome and 0.724 for SNR predicting good quality-of-life outcome, increasing to 0.800 and 0.786 when combined with Hoehn-Yahr stage.

Conclusion

Preoperative NM-MRI-derived SNc volume and SNR are robust, non-invasive biomarkers for predicting motor and quality-of-life responses to STN-DBS, supporting personalized patient selection and precision neuromodulation in Parkinson's disease. Larger longitudinal studies are warranted.

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神经黑色素敏感MRI作为帕金森病个体化深部脑刺激的生物标志物：黑质成像与治疗结果之间的关系

脑深部电刺激（DBS）丘脑下核（STN）有效治疗晚期帕金森病（PD），但运动和非运动结果差异很大。神经黑色素敏感MRI （NM-MRI）可显示黑质致密部（SNc）多巴胺能神经元的损失，并可作为预测性生物标志物。目的探讨行STN-DBS的PD患者术前NM-MRI SNc特征与术后临床改善的定量关系。方法在这项前瞻性队列研究中，纳入了33名计划进行双侧STN-DBS的PD患者和16名年龄匹配的健康对照者。术后3个月的临床结果包括统一PD评定量表第三部分（UPDRS-III）、PD问卷-39 （PDQ-39）和左旋多巴当量日剂量（LEDD）的百分比改善。3.0 T时获得高分辨率t1加权和纳米敏感序列；人工绘制感兴趣区域后计算SNc体积和信噪比（SNR）。结果对比同侧SNc体积和SNR显著降低（P < 0.001）和对照（P = 0.043和P = 0.031）。对照SNc体积与UPDRS-III改善中度相关（r = 0.508, P = 0.003），而信噪比与PDQ-39改善强烈相关（r = 0.599, P < 0.001）。多变量回归证实对照体积是运动反应和生活质量反应信噪比的独立预测因子。ROC分析显示，体积预测良好运动预后的auc为0.785，信噪比预测良好生活质量预后的auc为0.724，与Hoehn-Yahr分期相结合时，auc增加到0.800和0.786。结论术前nm - mri衍生的SNc体积和SNR是预测STN-DBS运动和生活质量反应的稳健、非侵入性生物标志物，支持帕金森病的个性化患者选择和精确神经调节。更大规模的纵向研究是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Parkinsonism & related disorders 医学-临床神经学

CiteScore

6.20

自引率

4.90%

发文量

292

审稿时长

39 days

期刊介绍： Parkinsonism & Related Disorders publishes the results of basic and clinical research contributing to the understanding, diagnosis and treatment of all neurodegenerative syndromes in which Parkinsonism, Essential Tremor or related movement disorders may be a feature. Regular features will include: Review Articles, Point of View articles, Full-length Articles, Short Communications, Case Reports and Letter to the Editor.