Apart from proton MRS, none of the MRI approaches described in this chapter have yet been used to study the pathophysiology of atypical parkinsonian disorders. Therefore, the potential of these techniques for the diagnosis and research of atypical parkinsonian disorders remains to be defined. Based on the MRI experience gathered with other neuropsychiatry disorders, we anticipate that fMRI, MRS, and water diffusion MRI will significantly contribute to early diagnosis and advance our understanding of pathophysiological evolution of the different atypical parkinsonian disorders. Future advances in MR technology and new MR techniques (e.g., magnetization transfer technique) will further increase the diagnostic and research potential of MRI in parkinsonian disorders (39).
It is important to bear in mind that these MRI techniques can readily be combined with each other and with high-resolution structural MRI. Indeed, multimodal MRI studies that combine structural and functional MR techniques represent the most promising approach to exploit MRI as a research tool. Since VBM of structural MRI images maps the pattern of structural abnormalities, VBM provides complementary anatomic information for the interpretation of altered neuronal activity as revealed by fMRI. The same applies for DT-MRI which, in combination with fMRI, might provide important clues to altered functional connectivity in patients with atypical parkinsonism. On an individual basis, interfacing fMRI with structural MRI and DT-MRI may considerably enhance diagnostic accuracy of MRI in the differential diagnosis of the atypical parkinsonian disorders.
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