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The clinical significance of the swallow tail sign in distinguishing Parkinson’s disease patients from healthy individuals

J. Prasuhn, A. Neumann, R. Strautz, S. Dreischmeier, F. Lemmer, H. Hanßen, M. Heldmann, N. Brüggemann (Lübeck, Germany)

Meeting: MDS Virtual Congress 2020

Abstract Number: 617

Keywords: Magnetic resonance imaging(MRI), Parkinsonism, Substantia nigra

Category: Parkinson's Disease: Neuroimaging

Objective: To investigate whether the absence of the swallow tail sign can be applied for distinguishing PD patients from healthy individuals.

Background: With conventional MRI, no Parkinson’s disease (PD)-specific abnormalities can be detected. However, there is a critical need for accompanying neuroimaging markers to guide diagnosis.
With high-resolution susceptibility-weighted MRI sequences, the imaging of nigrosome-1 is possible. In healthy individuals, the hyperintense nigrosome-1 is located in the posterior third of the substantia nigra corresponds to a linear shape and is surrounded by hypointense areas at frontal and lateral portions. This configuration is reminiscent of a swallow-tail, which is why it is also referred to as the swallow-tail sign.

Method: Thirty-seven PD patients (female/male: .54; mean age: 70 ± 7.2 years) and 35 age- and gender-matched healthy controls (female/male: .46; mean age: 70 ± 6.6 years) were investigated using a 3T MRI scanner (Siemens Skyra, 64 channel head coil). MR images were acquired with a magnetization transfer prepared dual-echo gradient-echo sequence. A trained neuroradiologist blind-rated the images and evaluated whether the swallow tail sign was absent on (i) both or at least (ii) one side of the participant’s midbrain.

Results: Contingency tables and chi-square tests were calculated as implemented in SPSS 26. Neither for condition (i) (X2 (1, n=72) = .326, p=.568) nor for condition (ii) X2 (1, n=72) = 1.595, p=.154) any relevant group difference between PD patients and healthy controls were present. Sensitivity for condition (i) is 37.8% and for condition (ii) 45.9%. Specificity for condition (i) is 68.6% and for condition (ii) 68.6%. In summary, the area under the receiver operating characteristics curve for condition (i) is .532, and for condition (ii) .573.

Conclusion: Even though previously stated by other research groups, our study does not provide evidence for the potential use of the swallow-tail sign as a supportive neuroimaging marker for the diagnosis of Parkinson’s disease. In conclusion, there is a critical need for improvements of substantia nigra targeted MRI sequences and the development of advanced segmentation algorithms.

To cite this abstract in AMA style:

J. Prasuhn, A. Neumann, R. Strautz, S. Dreischmeier, F. Lemmer, H. Hanßen, M. Heldmann, N. Brüggemann. The clinical significance of the swallow tail sign in distinguishing Parkinson’s disease patients from healthy individuals [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/the-clinical-significance-of-the-swallow-tail-sign-in-distinguishing-parkinsons-disease-patients-from-healthy-individuals/. Accessed June 15, 2025.
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