From the Guidelines
For resting tremor, an MRI of the brain without contrast is typically sufficient as the initial imaging study. According to the American College of Radiology Appropriateness Criteria for movement disorders and neurodegenerative diseases 1, MRI head without IV contrast is usually appropriate for the initial imaging of patients with Parkinsonian syndromes, which includes resting tremor. The primary goal of neuroimaging in resting tremor is to rule out structural lesions that might explain the symptoms, particularly in the basal ganglia, substantia nigra, or cerebellar pathways.
Some key points to consider when evaluating resting tremor include:
- The clinical presentation and history of the patient
- The presence of associated neurological symptoms
- The response to dopaminergic therapy
- The age of onset and symptom duration
Adding contrast is not routinely necessary unless there are specific concerns for inflammatory, infectious, or neoplastic processes. MRI without contrast can adequately visualize the relevant structures and detect abnormalities such as vascular lesions, atrophy patterns, or iron deposition that might suggest conditions like Parkinson's disease, multiple system atrophy, or vascular parkinsonism. If the clinical presentation includes atypical features, then contrast-enhanced imaging might be warranted to look for inflammatory lesions or tumors. The decision should ultimately be guided by the clinical context, including the patient's age, symptom duration, associated neurological findings, and whether the tremor fits a typical pattern for a neurodegenerative disorder.
From the Research
Resting Tremor and MRI of the Brain
- The provided studies do not directly address the question of whether to order an MRI of the brain with and without contrast for resting tremor.
- However, study 2 investigates the morphological and functional changes associated with essential tremor (ET) and the presence or absence of resting tremor, using a 3T-MRI protocol including Spoiled Gradient T1-weighted sequence for Voxel-Based Morphometry (VBM) analysis.
- The study 2 found no gray and white matter atrophy comparing ET patients to healthy controls and ET patients with resting tremor to those without, suggesting that MRI may not be necessary for diagnosing resting tremor in ET patients.
- Studies 3, 4, 5, and 6 focus on the treatment of Parkinson's disease, including the use of dopamine agonists, monoamine oxidase B inhibitors, and levodopa, but do not provide information on the use of MRI for diagnosing resting tremor.
- There is no clear evidence to support the routine use of MRI with and without contrast for resting tremor, and the decision to order an MRI should be based on individual clinical judgment and other diagnostic criteria 2.