• Manuel A Schmidt, Tobias Engelhorn, Franz Marxreiter, Juergen Winkler, Stefan Lang, Stephan Kloska, Philipp Goelitz, and Arnd Doerfler.
• Department of Neuroradiology, University Hospital Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany. manuel.schmidt@uk-erlangen.de.
• Bmc Neurol. 2017 Oct 26; 17 (1): 194.

BackgroundThe loss of the swallow-tail sign of the substantia nigra has been proposed for diagnosis of Parkinson's disease. Aim was to evaluate, if the sign occurs consistently in healthy subjects and if it can be reliably detected with high-resolution 7T susceptibility weighted imaging (SWI).MethodsThirteen healthy adults received SWI at 7T. 3 neuroradiologists, who were blinded to patients' diagnosis, independently classified subjects regarding the swallow-tail sign to be present or absent. Accuracy, positive and negative predictive values (PPV and NPV) as well as inter- and intra-rater reliability and internal consistency were analyzed.ResultsThe sign could be detected in 81% of the cases in consensus reading. Accuracy to detect the sign compared to the consensus was 100, 77 and 96% for the three readers with PPV reader 1/2/3 = 1/0.45/0.83 and NPV = 1/1/1. Inter-rater reliability was excellent (inter-class correlation coefficient = 0.844, alpha = 0.871). Intra-rater reliability was good to excellent (reader 1 R/L = 0.625/0.786; reader 2 = 0.7/0.64; reader 3 = 0.9/1).ConclusionThe swallow-tail sign can be reliably detected. However, our data suggest its occurrence is not consistent in healthy subjects. It may be possible that one reason is an individually variable molecular organization of nigrosome 1 so that it does not return a uniform signal in SWI.

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