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Evaluation of White Matter and Cerebellum Structures of Essential Tremor and Parkinson's Patients by Diffusion Tensor Imaging and Volbrain Method

Year 2023, Volume: 12 Issue: 4, 1887 - 1895, 26.12.2023
https://doi.org/10.37989/gumussagbil.1329521

Abstract

Essential tremor (ET) and Parkinson's disease (PD) are the two most commonly encountered tremor disorders in movement disorders. Diffusion tensor imaging (DTI) is one of the best in vivo ways of mapping white matter pathways in the human brain. The aim of our study was to investigate diffusion variables and cerebellum volume in ET and PD using parcellation methods. Our study included 20 ET, 20 PD and 20 healthy controls. Fraction Anisotropy (FA) and Mean Diffusivity (MD) values were obtained with DTI, while the volume of each lobe of the cerebellum was obtained with T1 images. One-way ANOVA was used for intergroup analysis and Scheffe test was used for post-hoc analysis. Significant differences were found in the diffusion values of the pedunculus cerebellaris, fornix stria, superior longitudinal fasciculus, sagittal stratum, cerebral pedunculus, tapatum and thalamus of ET and PD. Lobule V, Lobule IX, Lobule X volumes of the cerebellum showed significant differences between the groups. Stria thermialis shows involvement of mesolimbic dopaminergic system in PD and it is thought that disruption of strial networks leads to changes in the activity of cerebellar networks and reveals the role of the cerebellum in tremor. It is obvious that cerebellar thalamocortical pathways are affected in Parkinson's disease. In Parkinson's disease, patients should be evaluated for visual processing, conceptualisation, postural instability and gait disturbance to clarify the diagnosis or to differentiate from essential tremor.

References

  • 1. Sellbach, A.N, Boyle, R.S, Silburn, P.A. and Mellick, G.D. (2006). “Parkinson's Disease and Family History”. Parkinsonism & Related Disorders, 12, 399-409.
  • 2. Hallett, M. (2014). “Tremor: Pathophysiology”. Parkinsonism & Related Disorders, 20, 118-122.
  • 3. Muthuraman, M, Raethjen, J, Koirala, N, Anwar, A.R, Mideksa, K.G, Elble, R, Sergiu, G. and Günter, D. (2018). “Cerebello-Cortical Network Fingerprints Differ Between Essential, Parkinson’s Aand Mimicked Tremors”. Brain, 141, 1770-1781.
  • 4. Minen, M.T. and Louis, E.D. (2008). “Emergence of Parkinson's Disease in Essential Tremor: A Study of The Clinical Correlates in 53 Patients. Movement Disorders”. Official Journal of The Movement Disorder Society, 23, 1602-1605.
  • 5. Chaudhuri, K.R, Buxton,Thomas, M, Dhawan, V, Peng, R, Meilak, C. and Brooks, D. (2005). “Long Duration Asymmetrical Postural Tremor is Likely to Predict Development of Parkinson’s Disease and Not Essential Tremor: Clinical Follow Up Study of 13 Cases”. Journal of Neurology, Neurosurgery & Psychiatry, 76, 115-117.
  • 6. Jankovic, J. (2008). “Parkinson’s Disease: Clinical Features and Diagnosis”. Journal of Neurology, Neurosurgery & Psychiatry, 79, 368-376.
  • 7. Kurtoğlu, E, Payas, A, Düz, S, Arık, M, Ucar, I, Tokmak, T.T, Erbay, M.F, Acer, N. and Unur, E. (2023). “Analysis of Changes in Brain Morphological Structure of Taekwondo Athletes by Diffusion Tensor Imaging”. Journal of Chemical Neuroanatomy, 129, 102250.
  • 8. Acer, N, Bastepe, S, Sagiroglu, A, Gumus, K.Z, Degirmencioglu, L, Zararsiz, G. and Ozıc, M.U. (2018). “Diffusion Tensor and Volumetric Magnetic Resonance Imaging Findings in The Brains of Professional Musicians”. Journal of Chemical Neuroanatomy, 88, 33-40.
  • 9. Sykova, E. (2004). “Extrasynaptic Volume Transmission and Diffusion Parameters of The Extracellular Space”. Neuroscience, 129, 861-876.
  • 10. Li, Y, Shea, S.M, Lorenz, C.H, Jiang, H, Chou, M.C. and Mori, S. (2013). “Image Corruption Detection in Diffusion Tensor Imaging for Post-Processing and Real-Time Monitoring”. PloS One, 8, e49764.
  • 11. Manjón, J.V. and Coupé, P. (2016). “VolBrain: An Online MRI Brain Volumetry System”. Frontiers in Neuroinformatics, 10, 30.
  • 12. Luo, C, Song, W, Chen, Q, Yang, J, Gong, Q. and Shang, H.F. (2017). “White Matter Microstructure Damage in Tremor-Dominant Parkinson’s Disease Patients”. Neuroradiology, 59, 691-698.
  • 13. Chiang, P.L, Chen, H.L, Lu, C.H, Chen, P.C, Chen, M.H, Yang, I., Tsai, N.W. and Lin, WC. (2017). “White Matter Damage and Systemic Inflammation in Parkinson’s Disease” BMC Neuroscience, 18, 1-11.
  • 14. Zheng, Z, Shemmassian, S, Wijekoon, C, Kim, W, Bookheimer, S.Y. and Pouratian, N. (2014). “DTI Correlates of Distinct Cognitive Impairments in Parkinson's Disease”. Human Brain Mapping, 35, 1325-1333.
  • 15. Jiang, M-f, Shi, F, Niu, G-m, Xie, S-h. and Yu, S-y. (2015). ‘‘A Novel Method for Evaluating Brain Function and Microstructural Changes in Parkinson's Disease’’. Neural Regeneration Research, 10, 2025.
  • 16. Youn, J, Lee, J-M, Kwon, H, Kim, J.S, Son. T.O. and Cho, J.W. (2015). “Alterations of Mean Diffusivity of Pedunculopontine Nucleus Pathway in Parkinson's Disease Patients with Freezing of Gait”. Parkinsonism & Related Disorders, 21, 12-17.
  • 17. Liu, Z, Zhang, Y, Wang, H, Xu, D, You, H, Zuo, Z. and Feng, F. (2022). “Altered Cerebral Perfusion and Microstructure in Advanced Parkinson’s Disease and Their Associations with Clinical Features”. Neurological Research, 44, 47-56.
  • 18. Wang, M, Jiang, S, Yuan, Y, Zhang, L, Ding, J, Wang, J, Zhang, J, Zhang, K. and Wang, J. (2016). “Alterations of Functional and Structural Connectivity of Freezing of Gait in Parkinson’s Disease”. Journal of Neurology, 263, 1583-1592.
  • 19. Pozorski, V, Oh, J.M, Adluru, N, Merluzzi, A.P. Theisen, F. and Okonkwo, O. (2018). “Longitudinal White Matter Microstructural Change in Parkinson's Disease”. Human Brain Mapping, 39, 4150-4161.
  • 20. Chen, B, Fan, G, Sun, W, Shang, X, Shi, S, Wang, S, Lv, G. and Wu, C. (2017). “Usefulness of Diffusion-Tensor MRI in The Diagnosis of Parkinson Variant of Multiple System Atrophy and Parkinson's Disease: A Valuable Tool to Differentiate Between Them?”. Clinical Radiology, 72, 610. e9-e15.
  • 21. Juttukonda, M.R, Franco, G, Englot, D.J, Lin, Y-C, Petersen, K.J. and Trujillo, P. (2019). “White Matter Differences Between Essential Tremor and Parkinson Disease”. Neurology, 92, e30-e39.
  • 22. Guimarães, R.P, Campos, B.M, de Rezende, T.J, Piovesana, L, Azevedo, P.C, Amato-Filho, A.C, Cendes, F. and D'Abreu, A. (2018). “Is Diffusion Tensor Imaging a Good Biomarker for Early Parkinson's Disease”. Frontiers in Neurology, 9, 626.
  • 23. Klein, J.C, Lorenz, B, Kang, J.S, Baudrexel, S, Seifried, C, van de Loo, S., Steinmetz, H., Deichmann, R. and Hilker, R. (2011). “Diffusion Tensor Imaging of White Matter Involvement in Essential Tremor”. Human Brain Mapping, 32, 896-904.Barbagallo, G. Caligiuri, ME. Arabia, G. Cherubini, A. Lupo, A. Nistico, R. et al. (2017). “Structural Connectivity Differences in Motor Network Between Tremor‐Dominant and Nontremor Parkinson's Disease”. Human Brain Mapping, 38, 4716-4729.
  • 24. Nigro, S, Riccelli, R, Passamonti, L, Arabia, G, Morelli, M, Nisticò, R, Novellino, M, Salsone, G, Barbagallo, G. and Quattrone, A. (2016). “Characterizing structural Neural Networks in De Novo Parkinson Disease Patients Using Diffusion Tensor Imaging”. Human Brain Mapping, 37, 4500-4510.
  • 25. Haghshomar, M, Dolatshahi, M, Ghazi Sherbaf, F, Sanjari Moghaddam, H, Shirin Shandiz, M. and Aarabi, MH. (2018). “Disruption of Inferior Longitudinal Fasciculus Microstructure in Parkinson's Disease: A Systematic Review of Diffusion Tensor Imaging Studies”. Frontiers in Neurology, 9, 598.
  • 26. Haghshomar, M, Shobeiri, P, Seyedi, S.A, Abbasi-Feijani, F, Poopak, A, Sotoudeh, H, Kamalı, A. and Aarabi M.H. (2022). “Cerebellar Microstructural Abnormalities in Parkinson’s Disease: A Systematic Review of Diffusion Tensor Imaging Studies”. The Cerebellum, 1-27.
  • 27. Choi, S-M, Kim, B.C, Chang, J, Choi, K-H, Nam, T-S, Kim, J-T, Lee, S.H, Parkı, M.S, Yoon, W. and Leon, M.J. (2015). “Comparison of The Brain Volume in Essential Tremor and Parkinson's Disease Tremor Using An Automated Segmentation Method”. European Neurology, 73, 303-309.
  • 28. Piccinin, C.C, Campos, L.S, Guimarães, R.P, Piovesana, L.G, Dos Santos, M.C.A, Azevedo, P.C, Campos B.M, Junqueira, T., Rezende, R, Amato-Filho, A, Cendes, F. and D'Abreu, A. (2017). “Differential Pattern of Cerebellar Atrophy in Tremor-Predominant and Akinetic/Rigidity-Predominant Parkinson’s Disease”. The Cerebellum, 16, 623-628.
  • 29. Hett, K, Lyu, I, Trujillo, P, Lopez, A.M, Aumann, M, Larson, K.E, Hedera, P, Dawant, B, A.Landman, B, O Claassen, D. and Oguz, İ. (2021). “Anatomical Texture Patterns Identify Cerebellar Distinctions Between Essential Tremor and Parkinson's Disease”. Human Brain Mapping, 42, 2322-2331.
  • 30. Benninger, D.H, Thees, S, Kollias, S.S, Bassetti, C.L. and Waldvogel, D. (2009). “Morphological Differences in Parkinson’s Disease with and Without Rest Tremor”. Journal of Neurology, 256, 256-263.
  • 31. Sadeghi, F, Pötter-Nerger, M, Grimm, K, Gerloff, C, Schulz, R. and Zittel, S. (2023). “Smaller Cerebellar Lobule VIIb is Associated with Tremor Severity in Parkinson’s Disease”. The Cerebellum, 1-8.
  • 32. Lopez, A.M, Trujillo, P, Hernandez, A.B, Lin, Y.C, Kang, H, Landman, B.A, Englot, D.J, Dawant, B.M, Konrad, P.E. and Claassen, D.O. (2020). “Structural Correlates of The Sensorimotor Cerebellum in Parkinson's Disease and Essential Tremor”. Movement Disorders, 35, 1181-1188.

Esansiyel Tremor ve Parkinson Hastalarında Beyaz Cevher ve Serebellum Yapılarının Difüzyon Tensör Görüntüleme ve Volbrain Yöntemi ile Değerlendirilmesi

Year 2023, Volume: 12 Issue: 4, 1887 - 1895, 26.12.2023
https://doi.org/10.37989/gumussagbil.1329521

Abstract

Esansiyel tremor (ET) ve Parkinson hastalığı (PH) hareket bozuklukları içinde en sık karşılaşılan iki tremor bozukluğudur. Difüzyon tensör görüntüleme (DTI), insan beynindeki beyaz madde yollarını haritalamanın en iyi in vivo yollarından biridir. Çalışmamızın amacı ET ve PH'da parselasyon yöntemlerini kullanarak difüzyon değişkenlerini ve serebellum hacmini araştırmaktır. Çalışmamıza 20 ET, 20 PH ve 20 sağlıklı kontrol dahil edildi. Fraksiyon Anizotropi (FA) ve Ortalama Difüzivite (MD) değerleri DTI ile elde edilirken, serebellumun her bir lobunun hacmi T1 görüntüleri ile elde edildi. Gruplar arası analiz için tek yönlü ANOVA ve post-hoc analiz için Scheffe testi kullanıldı. ET ve PD'de pedunculus cerebellaris, fornix stria, superior longitudinal fasciculus, sagittal stratum, serebral pedunculus, tapatum ve talamusun difüzyon değerlerinde anlamlı farklılıklar bulundu. Serebellumun Lobül V, Lobül IX, Lobül X hacimleri gruplar arasında anlamlı farklılıklar gösterdi. Stria thermialis, PH'da mezolimbik dopaminerjik sistemin tutulumunu gösterir ve strial ağların bozulmasının serebellar ağların aktivitesinde değişikliklere yol açtığı ve serebellumun tremordaki rolünü ortaya koyduğu düşünülmektedir. Parkinson hastalığında serebellar talamokortikal yolakların etkilendiği aşikardır. Parkinson hastalığında, tanıyı netleştirmek veya esansiyel tremordan ayırmak için hastalar görsel işleme, kavramsallaştırma, postüral instabilite ve yürüme bozukluğu açısından değerlendirilmelidir.

References

  • 1. Sellbach, A.N, Boyle, R.S, Silburn, P.A. and Mellick, G.D. (2006). “Parkinson's Disease and Family History”. Parkinsonism & Related Disorders, 12, 399-409.
  • 2. Hallett, M. (2014). “Tremor: Pathophysiology”. Parkinsonism & Related Disorders, 20, 118-122.
  • 3. Muthuraman, M, Raethjen, J, Koirala, N, Anwar, A.R, Mideksa, K.G, Elble, R, Sergiu, G. and Günter, D. (2018). “Cerebello-Cortical Network Fingerprints Differ Between Essential, Parkinson’s Aand Mimicked Tremors”. Brain, 141, 1770-1781.
  • 4. Minen, M.T. and Louis, E.D. (2008). “Emergence of Parkinson's Disease in Essential Tremor: A Study of The Clinical Correlates in 53 Patients. Movement Disorders”. Official Journal of The Movement Disorder Society, 23, 1602-1605.
  • 5. Chaudhuri, K.R, Buxton,Thomas, M, Dhawan, V, Peng, R, Meilak, C. and Brooks, D. (2005). “Long Duration Asymmetrical Postural Tremor is Likely to Predict Development of Parkinson’s Disease and Not Essential Tremor: Clinical Follow Up Study of 13 Cases”. Journal of Neurology, Neurosurgery & Psychiatry, 76, 115-117.
  • 6. Jankovic, J. (2008). “Parkinson’s Disease: Clinical Features and Diagnosis”. Journal of Neurology, Neurosurgery & Psychiatry, 79, 368-376.
  • 7. Kurtoğlu, E, Payas, A, Düz, S, Arık, M, Ucar, I, Tokmak, T.T, Erbay, M.F, Acer, N. and Unur, E. (2023). “Analysis of Changes in Brain Morphological Structure of Taekwondo Athletes by Diffusion Tensor Imaging”. Journal of Chemical Neuroanatomy, 129, 102250.
  • 8. Acer, N, Bastepe, S, Sagiroglu, A, Gumus, K.Z, Degirmencioglu, L, Zararsiz, G. and Ozıc, M.U. (2018). “Diffusion Tensor and Volumetric Magnetic Resonance Imaging Findings in The Brains of Professional Musicians”. Journal of Chemical Neuroanatomy, 88, 33-40.
  • 9. Sykova, E. (2004). “Extrasynaptic Volume Transmission and Diffusion Parameters of The Extracellular Space”. Neuroscience, 129, 861-876.
  • 10. Li, Y, Shea, S.M, Lorenz, C.H, Jiang, H, Chou, M.C. and Mori, S. (2013). “Image Corruption Detection in Diffusion Tensor Imaging for Post-Processing and Real-Time Monitoring”. PloS One, 8, e49764.
  • 11. Manjón, J.V. and Coupé, P. (2016). “VolBrain: An Online MRI Brain Volumetry System”. Frontiers in Neuroinformatics, 10, 30.
  • 12. Luo, C, Song, W, Chen, Q, Yang, J, Gong, Q. and Shang, H.F. (2017). “White Matter Microstructure Damage in Tremor-Dominant Parkinson’s Disease Patients”. Neuroradiology, 59, 691-698.
  • 13. Chiang, P.L, Chen, H.L, Lu, C.H, Chen, P.C, Chen, M.H, Yang, I., Tsai, N.W. and Lin, WC. (2017). “White Matter Damage and Systemic Inflammation in Parkinson’s Disease” BMC Neuroscience, 18, 1-11.
  • 14. Zheng, Z, Shemmassian, S, Wijekoon, C, Kim, W, Bookheimer, S.Y. and Pouratian, N. (2014). “DTI Correlates of Distinct Cognitive Impairments in Parkinson's Disease”. Human Brain Mapping, 35, 1325-1333.
  • 15. Jiang, M-f, Shi, F, Niu, G-m, Xie, S-h. and Yu, S-y. (2015). ‘‘A Novel Method for Evaluating Brain Function and Microstructural Changes in Parkinson's Disease’’. Neural Regeneration Research, 10, 2025.
  • 16. Youn, J, Lee, J-M, Kwon, H, Kim, J.S, Son. T.O. and Cho, J.W. (2015). “Alterations of Mean Diffusivity of Pedunculopontine Nucleus Pathway in Parkinson's Disease Patients with Freezing of Gait”. Parkinsonism & Related Disorders, 21, 12-17.
  • 17. Liu, Z, Zhang, Y, Wang, H, Xu, D, You, H, Zuo, Z. and Feng, F. (2022). “Altered Cerebral Perfusion and Microstructure in Advanced Parkinson’s Disease and Their Associations with Clinical Features”. Neurological Research, 44, 47-56.
  • 18. Wang, M, Jiang, S, Yuan, Y, Zhang, L, Ding, J, Wang, J, Zhang, J, Zhang, K. and Wang, J. (2016). “Alterations of Functional and Structural Connectivity of Freezing of Gait in Parkinson’s Disease”. Journal of Neurology, 263, 1583-1592.
  • 19. Pozorski, V, Oh, J.M, Adluru, N, Merluzzi, A.P. Theisen, F. and Okonkwo, O. (2018). “Longitudinal White Matter Microstructural Change in Parkinson's Disease”. Human Brain Mapping, 39, 4150-4161.
  • 20. Chen, B, Fan, G, Sun, W, Shang, X, Shi, S, Wang, S, Lv, G. and Wu, C. (2017). “Usefulness of Diffusion-Tensor MRI in The Diagnosis of Parkinson Variant of Multiple System Atrophy and Parkinson's Disease: A Valuable Tool to Differentiate Between Them?”. Clinical Radiology, 72, 610. e9-e15.
  • 21. Juttukonda, M.R, Franco, G, Englot, D.J, Lin, Y-C, Petersen, K.J. and Trujillo, P. (2019). “White Matter Differences Between Essential Tremor and Parkinson Disease”. Neurology, 92, e30-e39.
  • 22. Guimarães, R.P, Campos, B.M, de Rezende, T.J, Piovesana, L, Azevedo, P.C, Amato-Filho, A.C, Cendes, F. and D'Abreu, A. (2018). “Is Diffusion Tensor Imaging a Good Biomarker for Early Parkinson's Disease”. Frontiers in Neurology, 9, 626.
  • 23. Klein, J.C, Lorenz, B, Kang, J.S, Baudrexel, S, Seifried, C, van de Loo, S., Steinmetz, H., Deichmann, R. and Hilker, R. (2011). “Diffusion Tensor Imaging of White Matter Involvement in Essential Tremor”. Human Brain Mapping, 32, 896-904.Barbagallo, G. Caligiuri, ME. Arabia, G. Cherubini, A. Lupo, A. Nistico, R. et al. (2017). “Structural Connectivity Differences in Motor Network Between Tremor‐Dominant and Nontremor Parkinson's Disease”. Human Brain Mapping, 38, 4716-4729.
  • 24. Nigro, S, Riccelli, R, Passamonti, L, Arabia, G, Morelli, M, Nisticò, R, Novellino, M, Salsone, G, Barbagallo, G. and Quattrone, A. (2016). “Characterizing structural Neural Networks in De Novo Parkinson Disease Patients Using Diffusion Tensor Imaging”. Human Brain Mapping, 37, 4500-4510.
  • 25. Haghshomar, M, Dolatshahi, M, Ghazi Sherbaf, F, Sanjari Moghaddam, H, Shirin Shandiz, M. and Aarabi, MH. (2018). “Disruption of Inferior Longitudinal Fasciculus Microstructure in Parkinson's Disease: A Systematic Review of Diffusion Tensor Imaging Studies”. Frontiers in Neurology, 9, 598.
  • 26. Haghshomar, M, Shobeiri, P, Seyedi, S.A, Abbasi-Feijani, F, Poopak, A, Sotoudeh, H, Kamalı, A. and Aarabi M.H. (2022). “Cerebellar Microstructural Abnormalities in Parkinson’s Disease: A Systematic Review of Diffusion Tensor Imaging Studies”. The Cerebellum, 1-27.
  • 27. Choi, S-M, Kim, B.C, Chang, J, Choi, K-H, Nam, T-S, Kim, J-T, Lee, S.H, Parkı, M.S, Yoon, W. and Leon, M.J. (2015). “Comparison of The Brain Volume in Essential Tremor and Parkinson's Disease Tremor Using An Automated Segmentation Method”. European Neurology, 73, 303-309.
  • 28. Piccinin, C.C, Campos, L.S, Guimarães, R.P, Piovesana, L.G, Dos Santos, M.C.A, Azevedo, P.C, Campos B.M, Junqueira, T., Rezende, R, Amato-Filho, A, Cendes, F. and D'Abreu, A. (2017). “Differential Pattern of Cerebellar Atrophy in Tremor-Predominant and Akinetic/Rigidity-Predominant Parkinson’s Disease”. The Cerebellum, 16, 623-628.
  • 29. Hett, K, Lyu, I, Trujillo, P, Lopez, A.M, Aumann, M, Larson, K.E, Hedera, P, Dawant, B, A.Landman, B, O Claassen, D. and Oguz, İ. (2021). “Anatomical Texture Patterns Identify Cerebellar Distinctions Between Essential Tremor and Parkinson's Disease”. Human Brain Mapping, 42, 2322-2331.
  • 30. Benninger, D.H, Thees, S, Kollias, S.S, Bassetti, C.L. and Waldvogel, D. (2009). “Morphological Differences in Parkinson’s Disease with and Without Rest Tremor”. Journal of Neurology, 256, 256-263.
  • 31. Sadeghi, F, Pötter-Nerger, M, Grimm, K, Gerloff, C, Schulz, R. and Zittel, S. (2023). “Smaller Cerebellar Lobule VIIb is Associated with Tremor Severity in Parkinson’s Disease”. The Cerebellum, 1-8.
  • 32. Lopez, A.M, Trujillo, P, Hernandez, A.B, Lin, Y.C, Kang, H, Landman, B.A, Englot, D.J, Dawant, B.M, Konrad, P.E. and Claassen, D.O. (2020). “Structural Correlates of The Sensorimotor Cerebellum in Parkinson's Disease and Essential Tremor”. Movement Disorders, 35, 1181-1188.
There are 32 citations in total.

Details

Primary Language English
Subjects Health Services and Systems (Other)
Journal Section Original Article
Authors

Özgür Palancı 0000-0003-0396-7455

Zekeriya Alioğlu 0000-0003-0092-779X

Ali Faruk Özyaşar 0000-0002-5396-9486

İlker Eyüboğlu 0000-0002-7732-1289

Elif Gökçen Köktürk This is me 0000-0002-7764-7625

Vildan Altunayoglu Cakmak 0000-0003-2828-2583

Publication Date December 26, 2023
Published in Issue Year 2023 Volume: 12 Issue: 4

Cite

APA Palancı, Ö., Alioğlu, Z., Özyaşar, A. F., Eyüboğlu, İ., et al. (2023). Evaluation of White Matter and Cerebellum Structures of Essential Tremor and Parkinson’s Patients by Diffusion Tensor Imaging and Volbrain Method. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 12(4), 1887-1895. https://doi.org/10.37989/gumussagbil.1329521
AMA Palancı Ö, Alioğlu Z, Özyaşar AF, Eyüboğlu İ, Köktürk EG, Altunayoglu Cakmak V. Evaluation of White Matter and Cerebellum Structures of Essential Tremor and Parkinson’s Patients by Diffusion Tensor Imaging and Volbrain Method. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. December 2023;12(4):1887-1895. doi:10.37989/gumussagbil.1329521
Chicago Palancı, Özgür, Zekeriya Alioğlu, Ali Faruk Özyaşar, İlker Eyüboğlu, Elif Gökçen Köktürk, and Vildan Altunayoglu Cakmak. “Evaluation of White Matter and Cerebellum Structures of Essential Tremor and Parkinson’s Patients by Diffusion Tensor Imaging and Volbrain Method”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12, no. 4 (December 2023): 1887-95. https://doi.org/10.37989/gumussagbil.1329521.
EndNote Palancı Ö, Alioğlu Z, Özyaşar AF, Eyüboğlu İ, Köktürk EG, Altunayoglu Cakmak V (December 1, 2023) Evaluation of White Matter and Cerebellum Structures of Essential Tremor and Parkinson’s Patients by Diffusion Tensor Imaging and Volbrain Method. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12 4 1887–1895.
IEEE Ö. Palancı, Z. Alioğlu, A. F. Özyaşar, İ. Eyüboğlu, E. G. Köktürk, and V. Altunayoglu Cakmak, “Evaluation of White Matter and Cerebellum Structures of Essential Tremor and Parkinson’s Patients by Diffusion Tensor Imaging and Volbrain Method”, Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, vol. 12, no. 4, pp. 1887–1895, 2023, doi: 10.37989/gumussagbil.1329521.
ISNAD Palancı, Özgür et al. “Evaluation of White Matter and Cerebellum Structures of Essential Tremor and Parkinson’s Patients by Diffusion Tensor Imaging and Volbrain Method”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12/4 (December 2023), 1887-1895. https://doi.org/10.37989/gumussagbil.1329521.
JAMA Palancı Ö, Alioğlu Z, Özyaşar AF, Eyüboğlu İ, Köktürk EG, Altunayoglu Cakmak V. Evaluation of White Matter and Cerebellum Structures of Essential Tremor and Parkinson’s Patients by Diffusion Tensor Imaging and Volbrain Method. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2023;12:1887–1895.
MLA Palancı, Özgür et al. “Evaluation of White Matter and Cerebellum Structures of Essential Tremor and Parkinson’s Patients by Diffusion Tensor Imaging and Volbrain Method”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, vol. 12, no. 4, 2023, pp. 1887-95, doi:10.37989/gumussagbil.1329521.
Vancouver Palancı Ö, Alioğlu Z, Özyaşar AF, Eyüboğlu İ, Köktürk EG, Altunayoglu Cakmak V. Evaluation of White Matter and Cerebellum Structures of Essential Tremor and Parkinson’s Patients by Diffusion Tensor Imaging and Volbrain Method. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2023;12(4):1887-95.