Free water imaging in white matter of early-stage tremor-dominant Parkinson<sup><sup>,</sup></sup>s disease

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• Clinical Article •

Free water imaging in white matter of early-stage tremor-dominant Parkinson's disease

DING Kaiyue SHEN Yu BAI Yan WEI Wei WANG Xinhui ZHOU Yihang LIU Shuo WANG Meiyun

Cite this article as: DING K Y, SHEN Y, BAI Y, et al. Free water imaging in white matter of early-stage tremor-dominant Parkinson's disease[J]. Chin J Magn Reson Imaging, 2025, 16(1): 81-88. DOI:10.12015/issn.1674-8034.2025.01.013.

Abstract

[Abstract] Objective Tremor-dominant Parkinson's disease (TDPD) is considered a benign subtype of Parkinson's disease. Early identification of microstructural alterations in TDPD is critical for advancing our understanding of its disease trajectory and for optimizing early therapeutic interventions. This study aims to explore microstructural alterations in the white matter tracts of the brain in early-stage TDPD using free water imaging (FWI). Furthermore, the study investigates the relationship between these alterations and clinical symptoms, thereby uncovering the pathophysiological mechanisms of early-stage TDPD.Materials and Methods FWI data from 39 early-stage TDPD patients (H-Y stage 1 or 2) and 38 healthy controls (HC) were analyzed in this study to identify white matter tract abnormalities. Free water (FW), fractional anisotropy (FA), and mean diffusivity (MD) values were extracted from white matter regions showing significant differences between groups. These values were subsequently correlated with clinical measures, including the MDS-UPDRS Ⅲ score and tremor sub-scores, using multiple linear regression analysis. Furthermore, logistic regression as employed to assess the relationship between FW values and H-Y stage, providing insights into the pathophysiological mechanisms underlying early-stage TDPD.Results In early TDPD patients, white matter fiber tracts exhibited significantly increased FW values (P < 0.05), notably in the genu of corpus callosum (t = 1.909, P = 0.049) and the bilateral anterior limb of the internal capsule (left t = 2.194, P = 0.049; right t = 2.064, P = 0.048). No significant differences were found in MD values of these tracts between groups. However, the FA values, prior to TFCE correction (P < 0.05), were significantly reduced in the genu of corpus callosum (t = -1.832, P = 0.029) and the bilateral superior corona radiata (left t = -2.012, P = 0.034; right t = -1.881, P = 0.021). These findings suggest that the white matter tracts may be indicative of neurodegenerative processes. The FW value in the left anterior limb of internal capsule was significantly positively correlated with the MDS-UPDRS tremor score (β = 32.798, P < 0.001) and the MDS-UPDRS Ⅲ score (β = 98.496, P = 0.012). Additionally, binary logistic regression analysis revealed that the FW value of the right superior longitudinal fasciculus served as a significant predictor of H-Y staging (β = 0.97, P = 0.04).Conclusions FWI can sensitively detect microstructural alterations in the white matter tracts of early-stage TDPD patients. The study indicates extensive neuroinflammatory changes in the white matter microstructure of TDPD patients, providing new insights for the diagnosis and evaluation of clinical symptoms of the disease.

[Keywords] tremor-dominant Parkinson's disease；early-stage Parkinson's disease；diffusion tensor imaging；free water imaging；magnetic resonance imaging

Contributor Information

DING Kaiyue^{1,
2} SHEN Yu² BAI Yan² WEI Wei² WANG Xinhui² ZHOU Yihang² LIU Shuo² WANG Meiyun^{1,
2,
3*}

¹ Department of Medical Imaging, People's Hospital of Henan University, Zhengzhou 450003, China

² Department of Medical Imaging, Henan Provincial People's Hospital, Zhengzhou 450003, China

³ Institute of Biomedical Research, Henan Academy of Sciences, Zhengzhou 450003, China

Corresponding author: WANG M Y, E-mail: mywang@zzu.edu.cn

Conflicts of interest None.

Publication Information

Received 2024-05-20

Accepted 2024-12-16

DOI: 10.12015/issn.1674-8034.2025.01.013

Text

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