Locus coeruleus and substantia nigra neuromelanin magnetic resonance imaging differentiates Parkinson's disease and essential tremor

Background: Differential diagnosis of essential tremor (ET) and Parkinson's disease (PD) can still be a challenge in clinical practice. These two tremor disorders may have different pathogenesis related to the substantia nigra (SN) and locus coeruleus (LC). Characterizing neuromelanin (NM) in these structures may help improve the differential diagnosis.Methods: Forty-three subjects with tremor-dominant PD (PDTD), 31 subjects with ET, and 30 age- and sex-matched healthy controls were included. All subjects were scanned with NM magnetic resonance imaging (NM-MRI). NM volume and contrast measures for the SN and contrast for the LC were evaluated. Logistic regression was used to calculate predicted probabilities by using the combination of SN and LC NM measures. The discriminative power of the NM measures in detecting subjects with PDTD from ET was assessed with a receiver operative characteristic curve, and the area under the curve (AUC) was calculated.Results: The NM contrast-to-noise ratio (CNR) of the LC, the NM volume, and CNR of the SN on the right and left sides were significantly lower in PD(TD )subjects than in ET subjects or healthy controls (all P < 0.05). Furthermore, when combining the best model constructed from the NM measures, the AUC reached 0.92 in differentiating PDTD from ET.Conclusion: The NM volume and contrast measures of the SN and contrast for the LC provided a new perspective on the differential diagnosis of PDTD and ET, and the investigation of the underlying pathophysiology.