{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:51:40Z","timestamp":1781639500288,"version":"3.54.5"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS-2023-00252618"],"award-info":[{"award-number":["RS-2023-00252618"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This qualitative, exploratory case report presents comprehensive diffusion tensor tractography (DTT) analysis of all three major dopaminergic pathways in advanced Parkinson\u2019s disease (PD), which is rarely reported. We present a case demonstrating structural alterations across mesocortical, mesolimbic, and nigrostriatal pathways in a patient with severe motor and non-motor symptoms, highlighting DTT\u2019s educational and clinical visualization value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 77-year-old female with advanced PD presented with a complex symptom profile including severe cognitive impairment (MMSE not assessable), major depression (predating motor symptoms by 7 years), severe dysphagia with silent aspiration (PAS 8), bilateral motor weakness (MMT P- to P+), and wheelchair dependence. DTT analysis revealed marked architectural differences compared to an age-matched control subject. The mesocortical tract showed notably reduced fiber density and thinning, particularly in prefrontal cortex projections. The mesolimbic tract demonstrated diminished volume with altered trajectory patterns, especially affecting ventral tegmental area connections. The nigrostriatal tract exhibited the most pronounced degeneration with markedly reduced fiber density and widespread disruption of tract integrity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While qualitative in nature and limited by single-case design and comparison with a single age-matched control subject acquired on a different MRI system, this case illustrates comprehensive structural deterioration across three dopaminergic pathways in advanced PD, with pathway-specific structural features observed alongside the patient\u2019s complex clinical presentation. This detailed visualization demonstrates DTT\u2019s potential utility as a clinical tool for understanding both motor and non-motor manifestations in advanced PD. The findings highlight the educational value of comprehensive dopaminergic pathway assessment and suggest directions for future controlled studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12883-026-04757-0","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:54:15Z","timestamp":1772067255000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive diffusion tensor tractography of three dopaminergic pathways in advanced Parkinson\u2019s disease: a case report"],"prefix":"10.1186","volume":"26","author":[{"given":"Heun Jae","family":"Ryu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong Pyo","family":"Seo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seo Yoon","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"issue":"9996","key":"4757_CR1","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/S0140-6736(14)61393-3","volume":"386","author":"LV Kalia","year":"2015","unstructured":"Kalia LV, Lang AE. Parkinson\u2019s disease. Lancet. 2015;386(9996):896\u2013912.","journal-title":"Lancet"},{"issue":"1","key":"4757_CR2","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1001\/archneur.64.1.20","volume":"64","author":"MR DeLong","year":"2007","unstructured":"DeLong MR, Wichmann T. Circuits and circuit disorders of the basal ganglia. Arch Neurol. 2007;64(1):20\u20134.","journal-title":"Arch Neurol"},{"issue":"2 Suppl 2","key":"4757_CR3","first-page":"S2","volume":"51","author":"O Hornykiewicz","year":"1998","unstructured":"Hornykiewicz O. Biochemical aspects of Parkinson\u2019s disease. Neurology. 1998;51(2 Suppl 2):S2\u20139.","journal-title":"Neurology"},{"issue":"6","key":"4757_CR4","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1038\/nrn1406","volume":"5","author":"RA Wise","year":"2004","unstructured":"Wise RA. Dopamine, learning and motivation. Nat Rev Neurosci. 2004;5(6):483\u201394.","journal-title":"Nat Rev Neurosci"},{"issue":"3","key":"4757_CR5","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/S1474-4422(06)70373-8","volume":"5","author":"KR Chaudhuri","year":"2006","unstructured":"Chaudhuri KR, Healy DG, Schapira AH. Non-motor symptoms of Parkinson\u2019s disease: diagnosis and management. Lancet Neurol. 2006;5(3):235\u201345.","journal-title":"Lancet Neurol"},{"issue":"8","key":"4757_CR6","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1016\/S1474-4422(13)70118-2","volume":"12","author":"P Calabresi","year":"2013","unstructured":"Calabresi P, Castrioto A, Di Filippo M, Picconi B. New experimental and clinical links between the hippocampus and the dopaminergic system in Parkinson\u2019s disease. Lancet Neurol. 2013;12(8):811\u201321.","journal-title":"Lancet Neurol"},{"issue":"4","key":"4757_CR7","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1002\/1522-2594(200010)44:4<625::AID-MRM17>3.0.CO;2-O","volume":"44","author":"PJ Basser","year":"2000","unstructured":"Basser PJ, Pajevic S, Pierpaoli C, Duda J, Aldroubi A. vivo fiber tractography using DT-MRI data. Magn Reson Med. 2000;44(4):625\u201332.","journal-title":"Magn Reson Med"},{"issue":"9","key":"4757_CR8","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1212\/WNL.0b013e318284070c","volume":"80","author":"CJ Cochrane","year":"2013","unstructured":"Cochrane CJ, Ebmeier KP. Diffusion tensor imaging in parkinsonian syndromes: a systematic review and meta-analysis. Neurology. 2013;80(9):857\u201364.","journal-title":"Neurology"},{"issue":"2","key":"4757_CR9","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.ejrad.2009.07.032","volume":"77","author":"K Zhang","year":"2011","unstructured":"Zhang K, Yu C, Zhang Y, Wu X, Zhu C, Chan P, et al. Voxel-based analysis of diffusion tensor indices in the brain in patients with Parkinson\u2019s disease. Eur J Radiol. 2011;77(2):269\u201373.","journal-title":"Eur J Radiol"},{"key":"4757_CR10","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1016\/j.neuroimage.2014.06.033","volume":"99","author":"E Ziegler","year":"2014","unstructured":"Ziegler E, Rouillard M, Andr\u00e9 E, Coolen T, Stender J, Balteau E, et al. Mapping track density changes in nigrostriatal and extranigral pathways in Parkinson\u2019s disease. NeuroImage. 2014;99:498\u2013508.","journal-title":"NeuroImage"},{"key":"4757_CR11","doi-asserted-by":"publisher","first-page":"531993","DOI":"10.3389\/fneur.2020.531993","volume":"11","author":"Y Zhang","year":"2020","unstructured":"Zhang Y, Burock MA. Diffusion tensor imaging in Parkinson\u2019s disease and parkinsonian syndrome: a systematic review. Front Neurol. 2020;11:531993.","journal-title":"Front Neurol"},{"issue":"3","key":"4757_CR12","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1002\/hbm.21245","volume":"33","author":"T Hattori","year":"2012","unstructured":"Hattori T, Orimo S, Aoki S, Ito K, Abe O, Amano A, et al. Cognitive status correlates with white matter alteration in Parkinson\u2019s disease. Hum Brain Mapp. 2012;33(3):727\u201339.","journal-title":"Hum Brain Mapp"},{"issue":"10","key":"4757_CR13","doi-asserted-by":"publisher","first-page":"e0165540","DOI":"10.1371\/journal.pone.0165540","volume":"11","author":"Y Zhang","year":"2016","unstructured":"Zhang Y, Wu IW, Tosun D, Foster E, Schuff N. Parkinson\u2019s Progression Markers Initiative. Progression of regional microstructural degeneration in Parkinson\u2019s disease: a multicenter diffusion tensor imaging study. PLoS ONE. 2016;11(10):e0165540.","journal-title":"PLoS ONE"},{"key":"4757_CR14","doi-asserted-by":"publisher","first-page":"175628641984344","DOI":"10.1177\/1756286419843447","volume":"12","author":"M Gorges","year":"2019","unstructured":"Gorges M, M\u00fcller HP, Liepelt-Scarfone I, Storch A, Dodel R, LANDSCAPE Consortium, Hilker-Roggendorf R, Berg D, Kunz MS, Kalbe E, Baudrexel S, Kassubek J. Structural brain signature of cognitive decline in Parkinson\u2019s disease: DTI-based evidence from the LANDSCAPE study. Ther Adv Neurol Disord. 2019;12:1756286419843447.","journal-title":"Ther Adv Neurol Disord"},{"issue":"20","key":"4757_CR15","doi-asserted-by":"publisher","first-page":"1841","DOI":"10.1212\/WNL.0b013e3182929f62","volume":"80","author":"TR Melzer","year":"2013","unstructured":"Melzer TR, Watts R, MacAskill MR, Pitcher TL, Livingston L, Keenan RJ, et al. White matter microstructure deteriorates across cognitive stages in Parkinson disease. Neurology. 2013;80(20):1841\u20139.","journal-title":"Neurology"},{"issue":"9","key":"4757_CR16","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1007\/s00415-006-0236-6","volume":"254","author":"H Matsui","year":"2007","unstructured":"Matsui H, Nishinaka K, Oda M, Niikawa H, Kubori T, Udaka F. Depression in Parkinson\u2019s disease: diffusion tensor imaging study. J Neurol. 2007;254(9):1170\u20133.","journal-title":"J Neurol"},{"key":"4757_CR17","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.jad.2015.06.041","volume":"187","author":"T Bracht","year":"2015","unstructured":"Bracht T, Linden D, Keedwell P. A review of white matter microstructure alterations of pathways of the reward circuit in depression. J Affect Disord. 2015;187:45\u201353.","journal-title":"J Affect Disord"},{"issue":"5","key":"4757_CR18","doi-asserted-by":"publisher","first-page":"857","DOI":"10.3174\/ajnr.A2400","volume":"32","author":"J Puig","year":"2011","unstructured":"Puig J, Pedraza S, Blasco G, Daunis-I-Estadella J, Prados F, Remollo S, et al. Acute damage to the posterior limb of the internal capsule on diffusion tensor tractography as an early imaging predictor of motor outcome after stroke. AJNR Am J Neuroradiol. 2011;32(5):857\u201363.","journal-title":"AJNR Am J Neuroradiol"},{"issue":"Suppl 1","key":"4757_CR19","doi-asserted-by":"publisher","first-page":"S208","DOI":"10.1016\/j.neuroimage.2004.07.051","volume":"23","author":"SM Smith","year":"2004","unstructured":"Smith SM, Jenkinson M, Woolrich MW, Beckmann CF, Behrens TE, Johansen-Berg H, et al. Advances in functional and structural MR image analysis and implementation as FSL. NeuroImage. 2004;23(Suppl 1):S208\u201319.","journal-title":"NeuroImage"},{"issue":"1","key":"4757_CR20","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.neuroimage.2006.09.018","volume":"34","author":"TE Behrens","year":"2007","unstructured":"Behrens TE, Berg HJ, Jbabdi S, Rushworth MF, Woolrich MW. Probabilistic diffusion tractography with multiple fibre orientations: What can we gain? NeuroImage. 2007;34(1):144\u201355.","journal-title":"NeuroImage"},{"issue":"7","key":"4757_CR21","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1038\/nn1075","volume":"6","author":"TE Behrens","year":"2003","unstructured":"Behrens TE, Johansen-Berg H, Woolrich MW, Smith SM, Wheeler-Kingshott CA, Boulby PA, et al. Non-invasive mapping of connections between human thalamus and cortex using diffusion imaging. Nat Neurosci. 2003;6(7):750\u20137.","journal-title":"Nat Neurosci"},{"issue":"1","key":"4757_CR22","doi-asserted-by":"publisher","first-page":"11","DOI":"10.2463\/mrms.3.11","volume":"3","author":"A Kunimatsu","year":"2004","unstructured":"Kunimatsu A, Aoki S, Masutani Y, Abe O, Hayashi N, Mori H, et al. The optimal trackability threshold of fractional anisotropy for diffusion tensor tractography of the corticospinal tract. Magn Reson Med Sci. 2004;3(1):11\u20137.","journal-title":"Magn Reson Med Sci"},{"issue":"10","key":"4757_CR23","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1007\/s00702-016-1559-9","volume":"123","author":"EM Nakamura-Palacios","year":"2016","unstructured":"Nakamura-Palacios EM, Lopes IBC, Souza RA, Klauss J, Batista EK, Conti CL, et al. Ventral medial prefrontal cortex (vmPFC) as a target of the dorsolateral prefrontal modulation by transcranial direct current stimulation (tDCS) in drug addiction. J Neural Transm. 2016;123(10):1179\u201394.","journal-title":"J Neural Transm"},{"issue":"9","key":"4757_CR24","doi-asserted-by":"publisher","first-page":"994","DOI":"10.3390\/medicina57090994","volume":"57","author":"J-P Seo","year":"2021","unstructured":"Seo J-P, Koo D-K. Aging of the nigrostriatal tract in the human brain: a diffusion tensor imaging study. Medicina. 2021;57(9):994.","journal-title":"Medicina"},{"issue":"1","key":"4757_CR25","doi-asserted-by":"publisher","first-page":"e84825","DOI":"10.1371\/journal.pone.0084825","volume":"9","author":"YJC Song","year":"2014","unstructured":"Song YJC, Korgaonkar MS, Armstrong LV, Eagles S, Williams LM, Grieve SM. Tractography of the brainstem in major depressive disorder using diffusion tensor imaging. PLoS ONE. 2014;9(1):e84825.","journal-title":"PLoS ONE"},{"issue":"8","key":"4757_CR26","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1016\/j.biopsych.2008.10.039","volume":"65","author":"A Pfefferbaum","year":"2009","unstructured":"Pfefferbaum A, Rosenbloom M, Rohlfing T, Sullivan EV. Degradation of association and projection white matter systems in alcoholism detected with quantitative fiber tracking. Biol Psychiatry. 2009;65(8):680\u201390.","journal-title":"Biol Psychiatry"},{"issue":"1","key":"4757_CR27","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.pscychresns.2008.09.002","volume":"173","author":"TF Chen","year":"2009","unstructured":"Chen TF, Lin CC, Chen YF, Liu HM, Hua MS, Huang YC, et al. Diffusion tensor changes in patients with amnesic mild cognitive impairment and various dementias. Psychiatry Res. 2009;173(1):15\u201321.","journal-title":"Psychiatry Res"},{"issue":"1","key":"4757_CR28","doi-asserted-by":"publisher","first-page":"8422","DOI":"10.1038\/s41598-018-26316-5","volume":"8","author":"LJ Zuo","year":"2018","unstructured":"Zuo LJ, Li ZX, Zhu RY, Chen YJ, Dong Y, Wang YL, et al. The relationship between cerebral white matter integrity and cognitive function in mild stroke with basal ganglia region infarcts. Sci Rep. 2018;8(1):8422.","journal-title":"Sci Rep"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-026-04757-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-026-04757-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-026-04757-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T18:53:43Z","timestamp":1781636023000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12883-026-04757-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4757"],"URL":"https:\/\/doi.org\/10.1186\/s12883-026-04757-0","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]},"assertion":[{"value":"10 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Institutional Review Board of Yeungnam University Medical Center(IRB No: YUMC 2019-06-032). Written informed consent for participation was obtained from the patient\u2019s legal guardian prior to the study. All neuroimaging data were anonymized, and personal identifiers were removed prior to analysis and publication to protect patient privacy.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication of this case report and accompanying images was obtained from the patient\u2019s legal guardian. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"214"}}