Susceptibility Magnetic Resonance Imaging Correlates with Glial Density and Tau in the Substantia Nigra Pars Compacta

ABSTRACT Background Susceptibility magnetic resonance imaging (MRI) is sensitive to iron‐related changes in the substantia nigra pars compacta (SNc), the key pathologic locus of parkinsonisms. It is unclear, however, if iron deposition in the SNc is associated with its neurodegeneration. Objective The objective of this study was to test whether susceptibility MRI metrics in parkinsonisms are associated with SNc neuropathologic features of dopaminergic neuron loss, gliosis, and α‐synuclein and tau burden. Methods This retrospective study included 27 subjects with both in vivo MRI and postmortem data. Multigradient echo imaging was used to derive the apparent transverse relaxation rate (R2*) and quantitative susceptibility mapping (QSM) in the SNc. Archived midbrain slides that were stained with hematoxylin and eosin, anti‐α‐synuclein, and anti‐tau were digitized to quantify neuromelanin‐positive neuron density, glial density, and the percentages of area occupied by positive α‐synuclein and tau staining. MRI‐histology associations were examined using Pearson correlations and regression. Results Twenty‐four subjects had postmortem parkinsonism diagnoses (Lewy body disorder, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration), two had only Alzheimer's neuropathology, and one exhibited only mild atrophy. Among all subjects, both R2* and QSM were associated with glial density ( r ≥ 0.67; P < 0.001) and log‐transformed tau burden ( r ≥ 0.53; P ≤ 0.007). Multiple linear regression identified glial density and log‐transformed tau as determinants for both MRI metrics ( R 2 ≥ 0.580; P < 0.0001). Neither MRI metric was associated with neuron density or α‐synuclein burden. Conclusions R2* and QSM are associated with both glial density and tau burden, key neuropathologic features in the parkinsonism SNc. © 2023 International Parkinson and Movement Disorder Society.