Parkinsonism & related disorders · 2026
Neuromelanin-sensitive MRI as a biomarker for individualized deep brain stimulation in Parkinson's disease: Associations between substantia nigra imaging and therapeutic outcomes.
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Zhou Yinling, Zhang Yindi, Li Guo, Zhang Wei
Аннотация
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.
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.