Role of MRI on distinguishing between progressive supranuclear palsy and Parkinson's disease
Main Article Content
Abstract
SUMMARY
Background: The parkinsonian syndromes include idiopathic Parkinson disease (PD), progressive supranuclear palsy (PSP), multiple
system atrophy (MSA), corticobasal degeneration (CBD) and other rarer causes. Differentiating between them plays a crucial role in treatment and prognosis.
Aims: To evaluate the role of MRI in differentiating PSP from PD, MSA-P and controls.
Subjects and methods: 22 PSP patients, 24 PD patients, 10 MSA-P patients, and 25 controls underwent MRI. For each patient, midbrain area (M), pons area (P), M/P ratio, MCP width, SCP width, MRPI (= P/M x MCP/SCP),
and the lateral midbrain diameter were calculated. The morning glory sign and
the flat or concave of the midbrain were also included.
Results: Mean MRPI in PSP patients (27.02 ± 10.77) was significantly higher than that in PD patients (11.41 ± 1.38), MSA-P patients (10.01 ± 2.64) and controls (10.14 ± 1.68). In this study, MRPI was 100% sensitive, specific, and accurate in differentiating PSP from other groups. Mean M/P ratio were smaller in patients with PSP than in patients in other groups. The mean lateral
midbrain width in PSP patients (10,53 ± 0,88) was smaller than that in PD (12,32 ± 0,52) and controls (12,45 ± 0,44), not statistically different from
MSA-P. The morning glory sign has a high specificity but low sensitivity in differentiating PSP from other groups. Inversely, the sensitivity of flat or concave of the midbrain sign is high but low the specificity.
Conclusions: MRI plays an important role in supporting the diagnosis of PSP based on some signs and indices. MRPI is the most sensitive, specific, and accurate index in differentiating PSP from PD and MSA-P on an individual basis.
Article Details
Keywords
Parkinson disease, progressive supranuclear palsy, multiple system atrophy, MRI, Parkinsonism Index.
References
1. E. Aydin, et al. The morphometric parameters in MRI for differentiation progressive supranuclear Palsy from Parkinson’s disease, multiple system atrophy and controls. 2017; Available from: https://posterng.netkey.at/ esr/viewing/index.php?module=viewing_poster&task=&pi=139777.
2. E. Camuera, et al. Parkinson disease and Parkinsonian syndromes: What the radiologist should know? 2016; Available from: https://posterng.netkey.at/esr/viewing/index.php module=vie wing_poster&task=viewsection& pi=131800&ti=446164&si=1550&searchkey=.
3. Graber J. J., Staudinger R. (2009), “Teaching NeuroImages: “Penguin” or “hummingbird” sign and midbrain atrophy in progressive supranuclear palsy”. Neurology, 72 (17), pp. e81.
4. Groschel K., Kastrup A., Litvan I., Schulz J. B. (2006), “Penguins and hummingbirds: midbrain atrophy in progressive supranuclear palsy”. Neurology, 66 (6), pp. 949-50.
5. Josephs K. A. (2007), “Frontotemporal lobar degeneration”. Neurol Clin, 25 (3), pp. 683-96, vi.
6. Kato N., Arai K., Hattori T. (2003), “Study of the rostral midbrain atrophy in progressive supranuclear palsy”. J Neurol Sci, 210 (1-2), pp. 57-60.
7. Ling Helen (2016), “Clinical Approach to Progressive Supranuclear Palsy”. Journal of movement disorders, 9 (1), pp. 3-13.
8. Massey L. A., Micallef C., Paviour D. C., O’Sullivan S. S., Ling H., et al. (2012), “Conventional magnetic resonance imaging in confirmed progressive supranuclear palsy and multiple system atrophy”. Mov Disord, 27 (14), pp. 1754-62.
9. Mori H., Aoki S., Ohtomo K. (2004), “Morning glory sign is not prevalent in progressive supranuclear palsy”. Magn Reson Med Sci, 3 (4), pp. 215; author reply 216-7.
10. Nizamani Waseem Mehmood, Mubarak Fatima, Barakzai Muhammad Danish, Ahmed Muhammad Saad (2017), “Role of magnetic resonance planimetry and magnetic resonance parkinsonism index in discriminating Parkinson’s disease and progressive supranuclear palsy: a retrospective study based on 1.5 and 3 T MRI”. International journal of general medicine, 10, pp. 375-384.
11. Oba H., Yagishita A., Terada H., Barkovich A. J., Kutomi K., et al. (2005), “New and reliable MRI diagnosis for progressive supranuclear palsy”. Neurology, 64 (12), pp. 2050-5.
12. Paviour D. C., Price S. L., Jahanshahi M., Lees A. J., Fox N. C. (2006), “Longitudinal MRI in progressive supranuclear palsy and multiple system atrophy: rates and regions of atrophy”. Brain, 129 (Pt 4), pp. 1040-9.
13. Sankhla C. S., Patil K. B., Sawant N., Gupta S. (2016), “Diagnostic accuracy of Magnetic Resonance
Parkinsonism Index in differentiating progressive supranuclear palsy from Parkinson’s disease and controls in Indian patients”. Neurol India, 64 (2), pp. 239-45.
14. Tsuboi Y., Slowinski J., Josephs K. A., Honer W. G., Wszolek Z. K., et al. (2003), “Atrophy of superior cerebellar peduncle in progressive supranuclear palsy”. Neurology, 60 (11), pp. 1766-9.
15. Zanigni Stefano, Calandra-Buonaura Giovanna, Manners David Neil, Testa Claudia, Gibertoni Dino, et al. (2016), “Accuracy of MR markers for differentiating Progressive Supranuclear Palsy from Parkinson’s disease”. NeuroImage. Clinical, 11, pp. 736-742.