The Swallow Tail Sign of Substantia Nigra: A Case-Control Study to Establish Its Role in Diagnosis of Parkinson Disease on 3T MRI

Ruchi Gupta, Gunjan Kumar, Subhash Kumar, Bhaskar Thakur, Richa Tiwari, Amit Kumar Verma

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Objectives  The loss of swallow tail sign (STS) has been studied for the diagnosis of Parkinson's disease (PD). The study aims to establish the role of STS on high-resolution 3D susceptibility-weighted images (SWI) on 3T MRI in clinically diagnosed cases of PD and compare with control population. Methods and Materials  Forty-five patients with clinically diagnosed PD and Parkinson plus syndrome (PPS) formed the study group and were compared with 45 controls without any neurological disease and normal brain magnetic resonance imaging (MRI). Presence or absence of STS was studied on 1-mm thick axial 3D SWI images in bilateral substantia nigra by two radiologists independently, followed by consensus reading. Bilateral absent, unilateral absent, and faintly present STS were considered as absent STS and predicted PD or PPS, and bilateral presence was considered as a positive STS, and was assessed keeping the clinical diagnosis as the gold standard. Results  The sensitivity of the absent STS was 75.55%, specificity 97.77%, positive predictive value 97.14%, negative predictive value 80% and accuracy 86.66%, in the diagnosis of PD or PPS, with odd ratio of 132 (confidence interval 15.97-1098.75). Kappa coefficient was 0.80 (p < 0.001) for both inter- and intrarater agreement, suggesting high reproducibility for the detection of STS. Conclusions  Absence of the STS is a good predictor of degeneration of the nigrosome 1 in the substantia nigra in the PD or PPS patients; hence, it can act as a useful marker of these diseases.

Original languageEnglish (US)
JournalJournal of Neurosciences in Rural Practice
DOIs
StateAccepted/In press - 2021
Externally publishedYes

Keywords

  • 3T
  • nigrosome
  • parkinson disease
  • parkinson plus syndrome
  • susceptibility
  • swallow tail sign
  • SWI

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology

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