Morphological features of deep cervical lymph nodes: potential novel markers for assessing Parkinson’s disease severity

Abstract Background Evidence indicates that deep cervical lymph nodes (DCLNs) act as the terminal site of cerebral lymphatic drainage, while diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) reflects the intermediate functional status of this system. Aims It remains unclear whether morphological changes of DCLNs are correlated with DTI-ALPS and clinical characteristics of Parkinson's disease (PD). Methods In this study, we enrolled 40 subjects, including 20 healthy controls (HC) and 20 PD patients. The Movement Disorder Society Sponsored Revision Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was adopted to evaluate progression of PD. Scales for Outcomes in Parkinson's Disease - Autonomic Dysfunction (SCOPA-AUT) was used to evaluate autonomic function. The size of DCLNs were measured by ultrasound. The manual approaches to the region of interest (ROI) selection used in ALPS-index calculation. Results The Volume and diameters of DCLN showed significantly decreased PD compared to HC (P < 0.05) and correlated with MDS-UPDRSIII in PD. The ROI selection showed significantly lower ALPS indices in PD compared to HC (P < 0.05). And DTI-ALPS indices were correlated to mean DCLN longitudinal diameter (R 2 = -0.502, P = 0.024) in HC group. Conclusion These findings underscore that abnormal clearance of central metabolic waste is associated with morphological alterations of peripheral DCLNs. Morphological indicators of DCLNs are promising novel non-invasive methods for evaluating the severity of Parkinson's disease.