Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Oct 28, 2017; 9(10): 371-388
Published online Oct 28, 2017. doi: 10.4329/wjr.v9.i10.371
Cerebellum and neurodegenerative diseases: Beyond conventional magnetic resonance imaging
Enricomaria Mormina, Maria Petracca, Giulia Bommarito, Niccolò Piaggio, Sirio Cocozza, Matilde Inglese
Enricomaria Mormina, Maria Petracca, Giulia Bommarito, Sirio Cocozza, Matilde Inglese, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Enricomaria Mormina, Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, 98100 Messina, Italy
Maria Petracca, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy
Giulia Bommarito, Niccolò Piaggio, Matilde Inglese, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
Niccolò Piaggio, Department of Neuroradiology, San Martino Hospital, 16132 Genoa, Italy
Sirio Cocozza, Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
Author contributions: Inglese M takes responsibility for the integrity and accuracy of the review; Study concept and design: Mormina E, Petracca M and Inglese M; Literature review: All authors; Drafting and critical revision of the manuscript for important intellectual content: All authors; Study supervision: Inglese M.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Matilde Inglese, MD, PhD, Associate Professor, Director of Neurology Imaging Laboratory, Department of Neurology, Icahn School of Medicine at Mount Sinai, Annenberg 14, Box 1137, One Gustave L. Levy Place, New York, NY 10029, United States.
Telephone: +1-212-8249310 Fax: +1-212-3481310
Received: January 27, 2017
Peer-review started: February 12, 2017
First decision: April 17, 2017
Revised: July 18, 2017
Accepted: August 2, 2017
Article in press: August 2, 2017
Published online: October 28, 2017

The cerebellum plays a key role in movement control and in cognition and cerebellar involvement is described in several neurodegenerative diseases. While conventional magnetic resonance imaging (MRI) is widely used for brain and cerebellar morphologic evaluation, advanced MRI techniques allow the investigation of cerebellar microstructural and functional characteristics. Volumetry, voxel-based morphometry, diffusion MRI based fiber tractography, resting state and task related functional MRI, perfusion, and proton MR spectroscopy are among the most common techniques applied to the study of cerebellum. In the present review, after providing a brief description of each technique’s advantages and limitations, we focus on their application to the study of cerebellar injury in major neurodegenerative diseases, such as multiple sclerosis, Parkinson’s and Alzheimer’s disease and hereditary ataxia. A brief introduction to the pathological substrate of cerebellar involvement is provided for each disease, followed by the review of MRI studies exploring structural and functional cerebellar abnormalities and by a discussion of the clinical relevance of MRI measures of cerebellar damage in terms of both clinical status and cognitive performance.

Keywords: Cerebellum, Neurodegenerative disease, Ataxia, Multiple sclerosis, Parkinson’s disease, Diffusion magnetic resonance imaging, Tractography, Volumetry, Functional magnetic resonance imaging, Alzheimer’s disease

Core tip: The cerebellum is involved in movement control and cognition. Conventional and advanced magnetic resonance imaging (MRI) techniques are widely used for the morphologic evaluation and the microstructural and functional investigation of the cerebellum. In this review we show the state of the art of advanced MRI techniques in the investigation of cerebellum alterations, especially in patients affected by neurodegenerative diseases. In particular, we evaluated advantages, limitations and future perspective of these techniques in multiple sclerosis, Parkinson’s disease and Parkinsonisms, Alzheimer’s disease and hereditary ataxia, highlighting how the investigation of cerebellum may play a key role in the assessment of motor performance and clinical status of these diseases.