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Badihian N, Gatto RG, Satoh R, Ali F, Clark HM, Pham NTT, Whitwell JL, Josephs KA. Clinical and neuroimaging characteristics of primary lateral sclerosis with overlapping features of progressive supranuclear palsy. Eur J Neurol 2024; 31:e16320. [PMID: 38686979 PMCID: PMC11227385 DOI: 10.1111/ene.16320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND AND PURPOSE Primary lateral sclerosis (PLS) is a neurodegenerative disorder that primarily affects the central motor system. In rare cases, clinical features of PLS may overlap with those of progressive supranuclear palsy (PSP). We investigate neuroimaging features that can help distinguish PLS with overlapping features of PSP (PLS-PSP) from PSP. METHODS Six patients with PLS-PSP were enrolled between 2019 and 2023. We compared their clinical and neuroimaging characteristics with 18 PSP-Richardson syndrome (PSP-RS) patients and 20 healthy controls. Magnetic resonance imaging, 18F-flortaucipir positron emission tomography (PET), quantitative susceptibility mapping, and diffusion tensor imaging tractography (DTI) were performed to evaluate eight brain regions of interest. Area under the receiver operating characteristic curve (AUROC) was calculated. RESULTS Five of the six PLS-PSP patients (83.3%) were male. Median age at symptom onset was 61.5 (52.5-63) years, and all had mixed features of PLS and PSP. Volumes of the pallidum, caudate, midbrain, and cerebellar dentate were smaller in PSP-RS than PLS-PSP, providing good discrimination (AUROC = 0.75 for all). The susceptibilities in pallidum, midbrain, and cerebellar dentate were greater in PSP-RS compared to PLS-PSP, providing excellent discrimination (AUROC ≥ 0.90 for all). On DTI, fractional anisotropy (FA) in the posterior limb of the internal capsule from the corticospinal tract was lower in PLS-PSP compared to PSP-RS (AUROC = 0.86), but FA in the superior cerebellar peduncle was lower in PSP-RS (AUROC = 0.95). Pallidum flortaucipir PET uptake was greater in PSP-RS compared to PLS-PSP (AUROC = 0.74). CONCLUSIONS Regional brain volume, tractography, and magnetic susceptibility, but not tau-PET, are useful in distinguishing PLS-PSP from PSP.
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Affiliation(s)
| | | | - Ryota Satoh
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Farwa Ali
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
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Brinia ME, Kapsali I, Giagkou N, Constantinides VC. Planimetric and Volumetric Brainstem MRI Markers in Progressive Supranuclear Palsy, Multiple System Atrophy, and Corticobasal Syndrome. A Systematic Review and Meta-Analysis. Neurol Int 2023; 16:1-19. [PMID: 38392951 PMCID: PMC10892270 DOI: 10.3390/neurolint16010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Various MRI markers-including midbrain and pons areas (Marea, Parea) and volumes (Mvol, Pvol), ratios (M/Parea, M/Pvol), and composite markers (magnetic resonance imaging Parkinsonism Indices 1,2; MRPI 1,2)-have been proposed as imaging markers of Richardson's syndrome (RS) and multiple system atrophy-Parkinsonism (MSA-P). A systematic review/meta-analysis of relevant studies aiming to compare the diagnostic accuracy of these imaging markers is lacking. METHODS Pubmed and Scopus were searched for studies with >10 patients (RS, MSA-P or CBS) and >10 controls with data on Marea, Parea, Mvol, Pvol, M/Parea, M/Pvol, MRPI 1, and MRPI 2. Cohen's d, as a measure of effect size, was calculated for all markers in RS, MSA-P, and CBS. RESULTS Twenty-five studies on RS, five studies on MSA-P, and four studies on CBS were included. Midbrain area provided the greatest effect size for differentiating RS from controls (Cohen's d = -3.10; p < 0.001), followed by M/Parea and MRPI 1. MSA-P had decreased midbrain and pontine areas. Included studies exhibited high heterogeneity, whereas publication bias was low. CONCLUSIONS Midbrain area is the optimal MRI marker for RS, and pons area is optimal for MSA-P. M/Parea and MRPIs produce smaller effect sizes for differentiating RS from controls.
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Affiliation(s)
| | | | | | - Vasilios C. Constantinides
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (M.-E.B.); (I.K.)
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3
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Painous C, Pascual-Diaz S, Muñoz-Moreno E, Sánchez V, Pariente JC, Prats-Galino A, Soto M, Fernández M, Pérez-Soriano A, Camara A, Muñoz E, Valldeoriola F, Caballol N, Pont-Sunyer C, Martin N, Basora M, Tio M, Rios J, Martí MJ, Bargalló N, Compta Y. Midbrain and pons MRI shape analysis and its clinical and CSF correlates in degenerative parkinsonisms: a pilot study. Eur Radiol 2023; 33:4540-4551. [PMID: 36773046 PMCID: PMC10290009 DOI: 10.1007/s00330-023-09435-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/19/2022] [Accepted: 01/08/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES To conduct brainstem MRI shape analysis across neurodegenerative parkinsonisms and control subjects (CS), along with its association with clinical and cerebrospinal fluid (CSF) correlates. METHODOLOGY We collected demographic and clinical variables, performed planimetric and shape MRI analyses, and determined CSF neurofilament-light chain (NfL) levels in 84 participants: 11 CS, 12 with Parkinson's disease (PD), 26 with multiple system atrophy (MSA), 21 with progressive supranuclear palsy (PSP), and 14 with corticobasal degeneration (CBD). RESULTS MSA featured the most extensive and significant brainstem shape narrowing (that is, atrophy), mostly in the pons. CBD presented local atrophy in several small areas in the pons and midbrain compared to PD and CS. PSP presented local atrophy in small areas in the posterior and upper midbrain as well as the rostral pons compared to MSA. Our findings of planimetric MRI measurements and CSF NfL levels replicated those from previous literature. Brainstem shape atrophy correlated with worse motor state in all parkinsonisms and with higher NfL levels in MSA, PSP, and PD. CONCLUSION Atypical parkinsonisms present different brainstem shape patterns which correlate with clinical severity and neuronal degeneration. In MSA, shape analysis could be further explored as a potential diagnostic biomarker. By contrast, shape analysis appears to have a rather limited discriminant value in PSP. KEY POINTS • Atypical parkinsonisms present different brainstem shape patterns. • Shape patterns correlate with clinical severity and neuronal degeneration. • In MSA, shape analysis could be further explored as a potential diagnostic biomarker.
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Affiliation(s)
- C Painous
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - S Pascual-Diaz
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Laboratory of Surgical Neuroanatomy (LSNA), Universitat de Barcelona, Barcelona, Spain
| | - E Muñoz-Moreno
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - V Sánchez
- Centre de Diagnostic Per La Imatge (CDIC), Hospital Clinic, Barcelona, Spain
| | - J C Pariente
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Prats-Galino
- Centre de Diagnostic Per La Imatge (CDIC), Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - M Soto
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - M Fernández
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - A Pérez-Soriano
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - A Camara
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - E Muñoz
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - F Valldeoriola
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - N Caballol
- UParkinson Centro Médico Teknon, Grupo Hospitalario Quirón Salud, Barcelona, Spain
- Department of Neurology, Hospital Sant Joan Despí Moisès Broggi and Hospital General de L'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - C Pont-Sunyer
- Neurology Unit, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain
| | - N Martin
- Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
| | - M Basora
- Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
| | - M Tio
- Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
| | - J Rios
- Medical Statistics Core Facility, IDIBAPS & Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - M J Martí
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain
| | - N Bargalló
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- Laboratory of Surgical Neuroanatomy (LSNA), Universitat de Barcelona, Barcelona, Spain.
- Neuroradiology Service, Hospital Clínic de Barcelona, 170 Villarroel Street, 08036, Barcelona, Spain.
| | - Y Compta
- Parkinson's Disease & Movement Disorders Unit, Parkinson's Disease and Other Degenerative Movement Disorders Team, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED (CB06/05/0018-ISCIII), ERN-RND, Institut Clínic de Neurociències (UBNeuro), Department of Medicine, School of Medicine, Universitat de Barcelona, Catalonia, Barcelona, Spain.
- Lab of Parkinson Disease and Other Neurodegenerative Movement Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Institut de Neurociències, Hospital Clínic de Barcelona, Institut de Neurociències (UBNeuro), Universitat de Barcelona, Catalonia, Barcelona, Spain.
- Neuroradiology Service, Hospital Clínic de Barcelona, 170 Villarroel Street, 08036, Barcelona, Spain.
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Carlos AF, Josephs KA. The Role of Clinical Assessment in the Era of Biomarkers. Neurotherapeutics 2023; 20:1001-1018. [PMID: 37594658 PMCID: PMC10457273 DOI: 10.1007/s13311-023-01410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
Hippocratic Medicine revolved around the three main principles of patient, disease, and physician and promoted the systematic observation of patients, rational reasoning, and interpretation of collected information. Although these remain the cardinal features of clinical assessment today, Medicine has evolved from a more physician-centered to a more patient-centered approach. Clinical assessment allows physicians to encounter, observe, evaluate, and connect with patients. This establishes the patient-physician relationship and facilitates a better understanding of the patient-disease relationship, as the ultimate goal is to diagnose, prognosticate, and treat. Biomarkers are at the core of the more disease-centered approach that is currently revolutionizing Medicine as they provide insight into the underlying disease pathomechanisms and biological changes. Genetic, biochemical, radiographic, and clinical biomarkers are currently used. Here, we define a seven-level theoretical construct for the utility of biomarkers in neurodegenerative diseases. Level 1-3 biomarkers are considered supportive of clinical assessment, capable of detecting susceptibility or risk factors, non-specific neurodegeneration or dysfunction, and/or changes at the individual level which help increase clinical diagnostic accuracy and confidence. Level 4-7 biomarkers have the potential to surpass the utility of clinical assessment through detection of early disease stages and prediction of underlying pathology. In neurodegenerative diseases, biomarkers can potentiate, but cannot substitute, clinical assessment. In this current era, aside from adding to the discovery, evaluation/validation, and implementation of more biomarkers, clinical assessment remains crucial to maintaining the personal, humanistic, and sociocultural aspects of patient care. We would argue that clinical assessment is a custom that should never go obsolete.
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Affiliation(s)
- Arenn F Carlos
- Department of Neurology, Mayo Clinic, 200 1st St. S.W., Rochester, MN, 55905, USA.
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, 200 1st St. S.W., Rochester, MN, 55905, USA
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5
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Miyata M, Kakeda S, Yoneda T, Ide S, Okada K, Adachi H, Korogi Y. Superior cerebellar peduncle atrophy of progressive supranuclear palsy on phase difference enhanced imaging: a comparison with Parkinson's disease. Neuroradiology 2023; 65:719-727. [PMID: 36670276 DOI: 10.1007/s00234-023-03119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE Phase difference enhanced (PADRE) imaging can enhance myelin density and delineate the superior cerebellar peduncle (SCP). We aimed to determine if SCP atrophy was distinguishable on PADRE imaging and evaluate its diagnostic performance compared with previous MRI progressive supranuclear palsy (PSP) findings. METHODS Two reviewers measured the SCP widths on PADRE in 20 PSP and 31 Parkinson's disease (PD) patients. The SCP and middle cerebellar peduncle (MCP) widths and the pons and midbrain areas were measured on 3D-T1WI, and the ratio of the area of the pons to the area of the midbrain, the MCP/SCP ratio, and the magnetic resonance parkinsonism index (MRPI) were calculated. We used the Steel-Dwass test to compare PSP, PD, and HS, and receiver operating characteristic curve (ROC) analyses to assess the sensitivity and specificity for diagnosing PSP from PD. A comparison of ROC curves was performed between the SCP on PADRE and these 3D-T1WI parameters. RESULTS In radiologist 1, the SCP on PADRE in PSP (1.1 ± 0.3 mm) was significantly smaller than those in PD (2.4 ± 0.4 mm) (P < 0.001); the area under the curve (AUC) was 0.97. At a 1.75-mm cutoff value, the diagnostic sensitivity and specificity for differentiating PSP from PD were 93.5% and 100%, respectively. The AUC of the SCP on PADRE was significantly higher than the 3D-T1WI parameters (the SCP, MCP, pons area, MCP/SCP ratio, and MRPI). CONCLUSION Assessing SCP with PADRE imaging may yield high diagnostic accuracy for discriminating PSP from PD.
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Affiliation(s)
- Mari Miyata
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu, Fukuoka, 807-8555, Japan.
| | - Shingo Kakeda
- Department of Radiology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Tetsuya Yoneda
- Department of Medical Physics in Advanced Biomedical Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoru Ide
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu, Fukuoka, 807-8555, Japan
| | - Kazumasa Okada
- Department of Neurology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Hiroaki Adachi
- Department of Neurology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu, Fukuoka, 807-8555, Japan
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Mazzucchi S, Del Prete E, Costagli M, Frosini D, Paoli D, Migaleddu G, Cecchi P, Donatelli G, Morganti R, Siciliano G, Cosottini M, Ceravolo R. Morphometric imaging and quantitative susceptibility mapping as complementary tools in the diagnosis of parkinsonisms. Eur J Neurol 2022; 29:2944-2955. [PMID: 35700041 PMCID: PMC9545010 DOI: 10.1111/ene.15447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/26/2022]
Abstract
Background and purpose In the quest for in vivo diagnostic biomarkers to discriminate Parkinson's disease (PD) from progressive supranuclear palsy (PSP) and multiple system atrophy (MSA, mainly p phenotype), many advanced magnetic resonance imaging (MRI) techniques have been studied. Morphometric indices, such as the Magnetic Resonance Parkinsonism Index (MRPI), demonstrated high diagnostic value in the comparison between PD and PSP. The potential of quantitative susceptibility mapping (QSM) was hypothesized, as increased magnetic susceptibility (Δχ) was reported in the red nucleus (RN) and medial part of the substantia nigra (SNImed) of PSP patients and in the putamen of MSA patients. However, disease‐specific susceptibility values for relevant regions of interest are yet to be identified. The aims of the study were to evaluate the diagnostic potential of a multimodal MRI protocol combining morphometric and QSM imaging in patients with determined parkinsonisms and to explore its value in a population of undetermined cases. Method Patients with suspected degenerative parkinsonism underwent clinical evaluation, 3 T brain MRI and clinical follow‐up. The MRPI was manually calculated on T1‐weighted images. QSM maps were generated from 3D multi‐echo T2*‐weighted sequences. Results In determined cases the morphometric evaluation confirmed optimal diagnostic accuracy in the comparison between PD and PSP but failed to discriminate PD from MSA‐p. Significant nigral and extranigral differences were found with QSM. RN Δχ showed excellent diagnostic accuracy in the comparison between PD and PSP and good accuracy in the comparison of PD and MSA‐p. Optimal susceptibility cut‐off values of RN and SNImed were tested in undetermined cases in addition to MRPI. Conclusions A combined use of morphometric imaging and QSM could improve the diagnostic phase of degenerative parkinsonisms.
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Affiliation(s)
- Sonia Mazzucchi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eleonora Del Prete
- Neurology Unit, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mauro Costagli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy.,Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Daniela Frosini
- Neurology Unit, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Davide Paoli
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Paolo Cecchi
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Graziella Donatelli
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Imago7 Research Foundation, Pisa, Italy
| | | | - Gabriele Siciliano
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mirco Cosottini
- Imago7 Research Foundation, Pisa, Italy.,Neuroradiology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Centre for Neurodegenerative Diseases, Parkinson's Disease and Movement Disorders, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Combined CSF α-SYN RT-QuIC, CSF NFL and midbrain-pons planimetry in degenerative parkinsonisms: From bedside to bench, and back again. Parkinsonism Relat Disord 2022; 99:33-41. [PMID: 35594661 DOI: 10.1016/j.parkreldis.2022.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Differential diagnosis between Parkinson's disease (PD) and atypical parkinsonisms (APs: multiple system atrophy[MSA], progressive supranuclear palsy[PSP], corticobasal degeneration[CBD]) remains challenging. Lately, cerebrospinal fluid (CSF) studies of neurofilament light-chain (NFL) and RT-QuIC of alpha-synuclein (α-SYN) have shown promise, but data on their combination with MRI measures is lacking. OBJECTIVE (1) to assess the combined diagnostic ability of CSF RT-QuIC α-SYN, CSF NFL and midbrain/pons MRI planimetry in degenerative parkinsonisms; (2) to evaluate if biomarker-signatures relate to clinical diagnoses and whether or not unexpected findings can guide diagnostic revision. METHODS We collected demographic and clinical data and set up α-SYN RT-QuIC at our lab in a cross-sectional cohort of 112 participants: 19 control subjects (CSs), 20PD, 37MSA, 23PSP, and 13CBD cases. We also determined CSF NFL by ELISA and, in 74 participants (10CSs, 9PD, 26MSA, 19PSP, 10CBD), automatized planimetric midbrain/pons areas from 3T-MRI. RESULTS Sensitivity of α-SYN RT-QuIC for PD was 75% increasing to 81% after revisiting clinical diagnoses with aid of biomarkers. Sensitivity for MSA was 12% but decreased to 9% with diagnostic revision. Specificities were 100% against CSs, and 89% against tauopathies raising to 91% with diagnostic revision. CSF NFL was significantly higher in APs. The combination of biomarkers yielded high diagnostic accuracy (PD vs. non-PD AUC = 0.983; MSA vs. non-MSA AUC = 0.933; tauopathies vs. non-tauopathies AUC = 0.924). Biomarkers-signatures fitted in most cases with clinical classification. CONCLUSIONS The combination of CSF NFL, CSF RT-QuIC α-SYN and midbrain/pons MRI measures showed high discriminant ability across all groups. Results opposite to expected can assist diagnostic reclassification.
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Parmera JB, de Oliveira MCB, Rodrigues RD, Coutinho AM. Progressive supranuclear palsy and corticobasal degeneration: novel clinical concepts and advances in biomarkers. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:126-136. [PMID: 35976324 PMCID: PMC9491415 DOI: 10.1590/0004-282x-anp-2022-s134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are sporadic adult-onset primary tauopathies clinically classified among the atypical parkinsonian syndromes. They are intrinsically related with regard to their clinical features, pathology, biochemistry, and genetic risk factors. OBJECTIVES This review highlights the current knowledge on PSP and CBD, focusing on evolving clinical concepts, new diagnostic criteria, and advances in biomarkers. METHODS We performed a non-systematic literature review through the PubMed database. The search was restricted to articles written in English, published from 1964 to date. RESULTS Clinicopathologic and in vivo biomarkers studies have broadened PSP and CBD clinical phenotypes. They are now recognized as a range of motor and behavioral syndromes associated with underlying 4R-tauopathy neuropathology. The Movement Disorders Society PSP diagnostic criteria included clinical variants apart from the classical description, increasing diagnostic sensitivity. Meanwhile, imaging biomarkers have explored the complexity of symptoms and pathological processes related to corticobasal syndrome and CBD. CONCLUSIONS In recent years, several prospective or clinicopathologic studies have assessed clinical, radiological, and fluid biomarkers that have helped us gain a better understanding of the complexity of the 4R-tauopathies, mainly PSP and CBD.
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Affiliation(s)
- Jacy Bezerra Parmera
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo, SP, Brazil
| | | | - Roberta Diehl Rodrigues
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo, SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia, Laboratório de Medicina Nuclear (LIM 44), São Paulo, SP, Brazil
| | - Artur Martins Coutinho
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, Centro de Medicina Nuclear, Laboratório de Medicina Nuclear (LIM 43), São Paulo, SP, Brazil
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Ruiz ST, Bakklund RV, Håberg AK, Berntsen EM. Normative Data for Brainstem Structures, the Midbrain-to-Pons Ratio, and the Magnetic Resonance Parkinsonism Index. AJNR Am J Neuroradiol 2022; 43:707-714. [PMID: 35393362 PMCID: PMC9089261 DOI: 10.3174/ajnr.a7485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/11/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Imaging biomarkers derived from different brainstem structures are suggested to differentiate among parkinsonian disorders, but clinical implementation requires normative data. The main objective was to establish high-quality, sex-specific data for relevant brainstem structures derived from MR imaging in healthy subjects from the general population in their sixth and seventh decades of life. MATERIALS AND METHODS 3D T1WI acquired on the same 1.5T scanner of 996 individuals (527 women) between 50 and 66 years of age from a prospective population study was used. The area of the midbrain and pons and the widths of the middle cerebellar peduncles and superior cerebellar peduncles were measured, from which the midbrain-to-pons ratio and Magnetic Resonance Parkinsonism Index [MRPI = (Pons Area / Midbrain Area) × (Middle Cerebellar Peduncles / Superior Cerebellar Peduncles)] were calculated. Sex differences in brainstem measures and correlations to age, height, weight, and body mass index were investigated. RESULTS Inter- and intrareliability for measuring the different brainstem structures showed good-to-excellent reliability (intraclass correlation coefficient = 0.785-0.988). There were significant sex differences for the pons area, width of the middle cerebellar peduncles and superior cerebellar peduncles, midbrain-to-pons ratio, and MRPI (all, P < .001; Cohen D = 0.44-0.98), but not for the midbrain area (P = .985). There were significant very weak-to-weak correlations between several of the brainstem measures and age, height, weight, and body mass index in both sexes. However, no systematic difference in distribution caused by these variables was found, and because age had the highest and most consistent correlations, age-/sex-specific percentiles for the brainstem measures were created. CONCLUSIONS We present high-quality, sex-specific data and age-/sex-specific percentiles for the mentioned brainstem measures. These normative data can be implemented in the neuroradiologic work-up of patients with suspected brainstem atrophy to avoid the risk of misdiagnosis.
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Affiliation(s)
- S T Ruiz
- From the Department of Circulation and Medical Imaging (S.T.R., R.V.B., E.M.B.)
| | - R V Bakklund
- From the Department of Circulation and Medical Imaging (S.T.R., R.V.B., E.M.B.)
| | - A K Håberg
- Faculty of Medicine and Health Sciences, and Neuromedicine and Movement Sciences (A.K.H.), Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine (A.K.H., E.M.B.), St. Olavs University Hospital, Trondheim, Norway
| | - E M Berntsen
- From the Department of Circulation and Medical Imaging (S.T.R., R.V.B., E.M.B.) .,Department of Radiology and Nuclear Medicine (A.K.H., E.M.B.), St. Olavs University Hospital, Trondheim, Norway
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10
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Scotton WJ, Bocchetta M, Todd E, Cash DM, Oxtoby N, VandeVrede L, Heuer H, Alexander DC, Rowe JB, Morris HR, Boxer A, Rohrer JD, Wijeratne PA. A data-driven model of brain volume changes in progressive supranuclear palsy. Brain Commun 2022; 4:fcac098. [PMID: 35602649 PMCID: PMC9118104 DOI: 10.1093/braincomms/fcac098] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/08/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
The most common clinical phenotype of progressive supranuclear palsy is Richardson syndrome, characterized by levodopa unresponsive symmetric parkinsonism, with a vertical supranuclear gaze palsy, early falls and cognitive impairment. There is currently no detailed understanding of the full sequence of disease pathophysiology in progressive supranuclear palsy. Determining the sequence of brain atrophy in progressive supranuclear palsy could provide important insights into the mechanisms of disease progression, as well as guide patient stratification and monitoring for clinical trials. We used a probabilistic event-based model applied to cross-sectional structural MRI scans in a large international cohort, to determine the sequence of brain atrophy in clinically diagnosed progressive supranuclear palsy Richardson syndrome. A total of 341 people with Richardson syndrome (of whom 255 had 12-month follow-up imaging) and 260 controls were included in the study. We used a combination of 12-month follow-up MRI scans, and a validated clinical rating score (progressive supranuclear palsy rating scale) to demonstrate the longitudinal consistency and utility of the event-based model's staging system. The event-based model estimated that the earliest atrophy occurs in the brainstem and subcortical regions followed by progression caudally into the superior cerebellar peduncle and deep cerebellar nuclei, and rostrally to the cortex. The sequence of cortical atrophy progresses in an anterior to posterior direction, beginning in the insula and then the frontal lobe before spreading to the temporal, parietal and finally the occipital lobe. This in vivo ordering accords with the post-mortem neuropathological staging of progressive supranuclear palsy and was robust under cross-validation. Using longitudinal information from 12-month follow-up scans, we demonstrate that subjects consistently move to later stages over this time interval, supporting the validity of the model. In addition, both clinical severity (progressive supranuclear palsy rating scale) and disease duration were significantly correlated with the predicted subject event-based model stage (P < 0.01). Our results provide new insights into the sequence of atrophy progression in progressive supranuclear palsy and offer potential utility to stratify people with this disease on entry into clinical trials based on disease stage, as well as track disease progression.
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Affiliation(s)
- W. J. Scotton
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen
Square Institute of Neurology, University College London, London, UK
- Correspondence to: William J. Scotton UCL Institute of Neurology
Department of Neurodegeneration Dementia Research Centre First Floor, 8-11 Queen Square,
WC1N 3AR London, UK E-mail:
| | - M. Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen
Square Institute of Neurology, University College London, London, UK
| | - E. Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen
Square Institute of Neurology, University College London, London, UK
| | - D. M. Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen
Square Institute of Neurology, University College London, London, UK
| | - N. Oxtoby
- Centre for Medical Image Computing, Department of Computer Science, University
College London, London, UK
| | - L. VandeVrede
- Department of Neurology, Memory and Aging Center, University of
California, San Francisco, CA, USA
| | - H. Heuer
- Department of Neurology, Memory and Aging Center, University of
California, San Francisco, CA, USA
| | | | - D. C. Alexander
- Centre for Medical Image Computing, Department of Computer Science, University
College London, London, UK
| | - J. B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge
University Hospitals NHS Trust, Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge
University, Cambridge, UK
| | - H. R. Morris
- Department of Clinical and Movement Neurosciences, University College London
Queen Square Institute of Neurology, London, UK
- Movement Disorders Centre, University College London Queen Square Institute of
Neurology, London, UK
| | - A. Boxer
- Department of Neurology, Memory and Aging Center, University of
California, San Francisco, CA, USA
| | - J. D. Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen
Square Institute of Neurology, University College London, London, UK
| | - P. A. Wijeratne
- Centre for Medical Image Computing, Department of Computer Science, University
College London, London, UK
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11
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Grijalva RM, Pham NTT, Huang Q, Martin PR, Ali F, Clark HM, Duffy JR, Utianski RL, Botha H, Machulda MM, Weigand SD, Ahlskog JE, Dickson DW, Josephs KA, Whitwell JL. Brainstem Biomarkers of Clinical Variant and Pathology in Progressive Supranuclear Palsy. Mov Disord 2021; 37:702-712. [PMID: 34970796 DOI: 10.1002/mds.28901] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Magnetic resonance brainstem measurements are useful structural biomarkers in the Richardson's syndrome variant of progressive supranuclear palsy (PSP). However, it is unclear how these biomarkers differ across the phenotypic spectrum of PSP and how they relate to underlying pathology. OBJECTIVE The aim of this study was to compare brainstem imaging measures across clinical variants of PSP and determine sensitivity and specificity based on pathologically diagnosed cases. METHODS A total of 153 patients with PSP who represented eight clinical variants were recruited at Mayo Clinic (Rochester, MN, USA) and underwent structural magnetic resonance imaging (MRI). Midbrain and pons area and superior and middle cerebellar peduncle width measurements were performed, and midbrain/pons ratio and Magnetic Resonance Parkinsonism Index (MRPI) were calculated. Among the 43 patients who later died, PSP pathology was confirmed in 29, whereas 14 had other pathology. RESULTS Brainstem measurements varied across PSP clinical variants and were most abnormal in PSP-Richardson's syndrome and frontal variants, followed by PSP-corticobasal, PSP-speech/language, and PSP-parkinsonism variants. All these variants showed abnormalities compared with controls. The PSP-gait freezing variant and patients with prominent corticospinal tract signs showed normal brainstem measures. Among cases with confirmed PSP pathology, the midbrain area, midbrain/pons ratio, and MRPI were all more abnormal compared to those with other pathologies, with best differentiation obtained with the MRPI (sensitivity = 83%; specificity = 85%). CONCLUSIONS MRI brainstem measures show utility as diagnostic biomarkers across PSP clinical variants and have the potential to be useful in predicting underlying pathology. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | | | - Qiao Huang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter R Martin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen D Weigand
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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12
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"Parkinson's disease" on the way to progressive supranuclear palsy: a review on PSP-parkinsonism. Neurol Sci 2021; 42:4927-4936. [PMID: 34532773 DOI: 10.1007/s10072-021-05601-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022]
Abstract
Progressive supranuclear palsy (PSP) is a progressive atypical parkinsonian syndrome characterised by postural instability, supranuclear ophthalmoplegia, dysarthria, dysphagia, executive dysfunction and other features. This clinical presentation represents the classic PSP-Richardson syndrome (PSP-RS). However, several other clinical subtypes have been recognised, including PSP-parkinsonism (PSP-P), probably the second most common PSP variant. Unlike PSP-RS, PSP-P often presents with an asymmetric onset, tremor and a moderate initial response to levodopa, especially during the first years of the disease, thus resembling Parkinson's disease (PD). It runs a more favourable course, but over time, PSP-P may evolve clinically into PSP-RS. Therefore, it may seem that PSP-P stands clinically between PD and PSP. There are several peculiarities that can distinguish PSP-P from these entities. As there is lack of systematic reviews on PSP-P in the literature, we decided to summarise all the necessary data about the epidemiology, clinical picture, neuroimaging, genetics and other aspects of this PSP variant in order to provide complete information for the reader.
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13
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Sander L, Horvath A, Pezold S, Andermatt S, Amann M, Sinnecker T, Wendebourg MJ, Kesenheimer E, Yaldizli Ö, Kappos L, Granziera C, Wuerfel J, Cattin P, Schlaeger R. Improving Accuracy of Brainstem MRI Volumetry: Effects of Age and Sex, and Normalization Strategies. Front Neurosci 2021; 14:609422. [PMID: 33424541 PMCID: PMC7785816 DOI: 10.3389/fnins.2020.609422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/30/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Brainstem-mediated functions are impaired in neurodegenerative diseases and aging. Atrophy can be visualized by MRI. This study investigates extrinsic sources of brainstem volume variability, intrinsic sources of anatomical variability, and the influence of age and sex on the brainstem volumes in healthy subjects. We aimed to develop efficient normalization strategies to reduce the effects of intrinsic anatomic variability on brainstem volumetry. Methods: Brainstem segmentation was performed from MPRAGE data using our deep-learning-based brainstem segmentation algorithm MD-GRU. The extrinsic variability of brainstem volume assessments across scanners and protocols was investigated in two groups comprising 11 (median age 33.3 years, 7 women) and 22 healthy subjects (median age 27.6 years, 50% women) scanned twice and compared using Dice scores. Intrinsic anatomical inter-individual variability and age and sex effects on brainstem volumes were assessed in segmentations of 110 healthy subjects (median age 30.9 years, range 18–72 years, 53.6% women) acquired on 1.5T (45%) and 3T (55%) scanners. The association between brainstem volumes and predefined anatomical covariates was studied using Pearson correlations. Anatomical variables with associations of |r| > 0.30 as well as the variables age and sex were used to construct normalization models using backward selection. The effect of the resulting normalization models was assessed by % relative standard deviation reduction and by comparing the inter-individual variability of the normalized brainstem volumes to the non-normalized values using paired t- tests with Bonferroni correction. Results: The extrinsic variability of brainstem volumetry across different field strengths and imaging protocols was low (Dice scores > 0.94). Mean inter-individual variability/SD of total brainstem volumes was 9.8%/7.36. A normalization based on either total intracranial volume (TICV), TICV and age, or v-scale significantly reduced the inter-individual variability of total brainstem volumes compared to non-normalized volumes and similarly reduced the relative standard deviation by about 35%. Conclusion: The extrinsic variability of the novel brainstem segmentation method MD-GRU across different scanners and imaging protocols is very low. Anatomic inter-individual variability of brainstem volumes is substantial. This study presents efficient normalization models for variability reduction in brainstem volumetry in healthy subjects.
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Affiliation(s)
- Laura Sander
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Antal Horvath
- Department of Biomedical Engineering, Center for Medical Image Analysis & Navigation (CIAN), University of Basel, Allschwil, Switzerland
| | - Simon Pezold
- Department of Biomedical Engineering, Center for Medical Image Analysis & Navigation (CIAN), University of Basel, Allschwil, Switzerland
| | - Simon Andermatt
- Department of Biomedical Engineering, Center for Medical Image Analysis & Navigation (CIAN), University of Basel, Allschwil, Switzerland
| | - Michael Amann
- Department of Biomedical Engineering, Medical Image Analysis Center (MIAC AG) and qbig, University of Basel, Basel, Switzerland
| | - Tim Sinnecker
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Medical Image Analysis Center (MIAC AG) and qbig, University of Basel, Basel, Switzerland
| | - Maria J Wendebourg
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Eva Kesenheimer
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Özgür Yaldizli
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Department of Biomedical Engineering, Medical Image Analysis Center (MIAC AG) and qbig, University of Basel, Basel, Switzerland
| | - Philippe Cattin
- Department of Biomedical Engineering, Center for Medical Image Analysis & Navigation (CIAN), University of Basel, Allschwil, Switzerland
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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14
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Constantinides VC, Paraskevas GP, Velonakis G, Toulas P, Stefanis L, Kapaki E. Midbrain morphology in idiopathic normal pressure hydrocephalus: A progressive supranuclear palsy mimic. Acta Neurol Scand 2020; 141:328-334. [PMID: 31856297 DOI: 10.1111/ane.13205] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/29/2019] [Accepted: 12/14/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Various MRI markers have been applied to support the diagnosis of progressive supranuclear palsy (PSP), such as midbrain diameter and surface, superior cerebellar peduncle (SCP) width, midbrain to pons (m/p) diameter and surface ratio and the Magnetic Resonance Parkinsonism Index (MRPI). These markers provide excellent diagnostic accuracy in discriminating Richardson's syndrome from other causes of Parkinsonism. Idiopathic normal pressure hydrocephalus (iNPH) may mimic Richardson's syndrome, particularly in cases of subtle opthalmokinetic abnormalities. The aim of this study was to compare these MRI markers in PSP and iNPH and examine their diagnostic accuracy. MATERIALS AND METHODS Forty-three patients with probable PSP, 17 patients with iNPH, and 29 controls were included. Midbrain diameter and surface, SCP width, m/p diameter and surface ratio and the MRPI were recorded. The "hummingbird sign," "morning glory sign" and "mickey mouse sign" were also evaluated. Analysis of covariance, chi-squared test, and ROC curve analysis were used as appropriate. RESULTS All MRI measurements differed significantly among the three study groups. Comparison of PSP and iNPH patients produced the following significant differences: midbrain diameter (P < .0001), m/p diameter ratio (P < .0001), SCP width (P = .050), and MRPI (P = .049). None of these markers produced combined high (>80%) specificity and sensitivity. Qualitative MRI signs were specific, but lacked sensitivity. DISCUSSION Midbrain morphology in iNPH may resemble that of PSP. Established MRI markers of midbrain and SCP atrophy cannot confidently differentiate PSP from iNPH. MRI markers do not provide combined high sensitivity and specificity for the differential diagnosis of PSP from iNPH.
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Affiliation(s)
- Vasilios C. Constantinides
- 1st Department of Neurology School of Medicine National and Kapodistrian University of Athens Eginition Hospital Athens Greece
| | - George P. Paraskevas
- 1st Department of Neurology School of Medicine National and Kapodistrian University of Athens Eginition Hospital Athens Greece
| | - Georgios Velonakis
- 2nd Department of Radiology Research Unit of Radiology Medical School National and Kapodistrian University of Athens Athens Greece
| | - Panagiotis Toulas
- 2nd Department of Radiology Research Unit of Radiology Medical School National and Kapodistrian University of Athens Athens Greece
| | - Leonidas Stefanis
- 1st Department of Neurology School of Medicine National and Kapodistrian University of Athens Eginition Hospital Athens Greece
| | - Elisabeth Kapaki
- 1st Department of Neurology School of Medicine National and Kapodistrian University of Athens Eginition Hospital Athens Greece
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15
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Methods and utility of quantitative brainstem measurements in progressive supranuclear palsy versus Parkinson's disease in a routine clinical setting. Clin Park Relat Disord 2020; 3:100033. [PMID: 34316619 PMCID: PMC8298805 DOI: 10.1016/j.prdoa.2020.100033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/26/2019] [Accepted: 12/17/2019] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose The clinical diagnosis of progressive supranuclear palsy can be challenging, as the clinical presentation overlaps with that of Parkinson's disease and multiple system atrophy. We sought to examine the practical utility of radiologic markers of progressive supranuclear palsy by investigating whether these markers could distinguish between patients with progressive supranuclear palsy-Richardson syndrome (PSP-RS) and those with Parkinson's disease based on imaging obtained in a typical clinical setting, not in a prospective research environment. Materials and methods This retrospective study included 13 patients with PSP-RS and 13 patients with Parkinson's disease who were followed for either condition at our institution at the time of the study and who had MRI records available. Patients were selected without regard to type of imaging obtained. All diagnoses were confirmed by a trained movement disorders specialist using validated diagnostic criteria. Groups were matched for age and disease duration at the time of scanning. MRI records were retrospectively obtained, and image analysis was performed by investigators blinded to disease classification. Midbrain area, midbrain to pons area ratio, midbrain anterior-posterior diameter, and MR parkinsonism index were calculated for each patient. Results All established measures of identifying progressive supranuclear palsy (midbrain area, midbrain to pons area ratio, midbrain anterior-posterior diameter, and MR parkinsonism index) were significantly different between patients with PSP-RS and those with Parkinson's disease. Conclusion Previously established radiographic markers distinguishing between PSP-RS and Parkinson's disease have practical utility in the clinical setting and not just in well-designed prospective analyses.
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16
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Picillo M, Tepedino MF, Abate F, Erro R, Ponticorvo S, Tartaglione S, Volpe G, Frosini D, Cecchi P, Cosottini M, Ceravolo R, Esposito F, Pellecchia MT, Barone P, Manara R. Midbrain MRI assessments in progressive supranuclear palsy subtypes. J Neurol Neurosurg Psychiatry 2020; 91:98-103. [PMID: 31527182 DOI: 10.1136/jnnp-2019-321354] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To explore the role of the available midbrain-based MRI morphometric assessments in (1) differentiating among progressive supranuclear palsy (PSP) subtypes (PSP Richardson's syndrome (PSP-RS), PSP with predominant parkinsonism (PSP-P) and the other variant syndromes of PSP (vPSP)), and (2) supporting the diagnosis of PSP subtypes compared with Parkinson's disease (PD) and healthy controls (HC). METHODS Seventy-eight patients with PSP (38 PSP-RS, 21 PSP-P and 19 vPSP), 35 PD and 38 HC were included in the present analysis. Available midbrain-based MRI morphometric assessments were calculated for all participants. RESULTS Current MRI midbrain-based assessments do not display an adequate sensitivity and specificity profile in differentiating PSP subtypes. On the other hand, we confirmed MR Parkinsonism Index (MRPI) and pons area to midbrain area ratio (P/M) have adequate diagnostic value to support PSP-RS clinical diagnosis compared with both PD and HC, but low sensitivity and specificity profile in differentiating PSP-P from PD as well as from HC. The same measures show acceptable sensitivity and specificity profile in supporting clinical diagnosis of vPSP versus HC but not versus PD. Similar findings were detected for the newer MRPI and P/M versions. CONCLUSIONS Further studies are warranted to identify neuroimaging biomarkers supporting the clinical phenotypic categorisation of patients with PSP. MRPI and P/M have diagnostic value in supporting the clinical diagnosis of PSP-RS. CLASSIFICATION OF EVIDENCE This study provides class III evidence that available MRI midbrain-based assessments do not have diagnostic value in differentiating the Movement Disorder Society PSP subtypes.
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Affiliation(s)
- Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Maria Francesca Tepedino
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Filomena Abate
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Sara Ponticorvo
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi (SA), Italy
| | - Salvatore Tartaglione
- Department of Diagnostic Imaging, University Hospital A.O.U. OO.RR. San Giovanni di Dio e Ruggi D'Aragona, Scuola Medica Salernitana, Salerno, Italy
| | - Giampiero Volpe
- Neurology, University Hospital A.O.U. OO.RR. San Giovanni di Dio e Ruggi D'Aragona, Scuola Medica Salernitana, Salerno, Italy
| | - Daniela Frosini
- Dipartimento di Medicina Clinica e Sperimentale Università di Pisa, Italy, Università di Pisa, Pisa, Italy
| | - Paolo Cecchi
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
| | - Mirco Cosottini
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
| | - Roberto Ceravolo
- Dipartimento di Medicina Clinica e Sperimentale Università di Pisa, Italy, Università di Pisa, Pisa, Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi (SA), Italy.,Department of Diagnostic Imaging, University Hospital A.O.U. OO.RR. San Giovanni di Dio e Ruggi D'Aragona, Scuola Medica Salernitana, Salerno, Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Renzo Manara
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi (SA), Italy
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17
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Schönecker S, Brendel M, Palleis C, Beyer L, Höglinger GU, Schuh E, Rauchmann BS, Sauerbeck J, Rohrer G, Sonnenfeld S, Furukawa K, Ishiki A, Okamura N, Bartenstein P, Dieterich M, Bötzel K, Danek A, Rominger A, Levin J. PET Imaging of Astrogliosis and Tau Facilitates Diagnosis of Parkinsonian Syndromes. Front Aging Neurosci 2019; 11:249. [PMID: 31572166 PMCID: PMC6749151 DOI: 10.3389/fnagi.2019.00249] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/22/2019] [Indexed: 11/13/2022] Open
Abstract
Neurodegenerative parkinsonian syndromes comprise a number of disorders that are characterized by similar clinical features but are separated on the basis of different pathologies, i.e., aggregates of α-synuclein or tau protein. Due to the overlap of signs and symptoms a precise differentiation is often difficult, especially early in the disease course. Enormous efforts have been taken to develop tau-selective PET imaging agents, but strong off-target binding to monoamine oxidase B (MAO-B) has been observed across first generation ligands. Nonetheless, astrogliosis-related MAO-B elevation is a common histopathological known feature of all parkinsonian syndromes and might be itself an interesting imaging target. Therefore, this study aimed to investigate the performance of [18F]-THK5351, a combined MAO-B and tau tracer for differential diagnosis of parkinsonian syndromes. [18F]-THK5351 PET was performed in 34 patients: six with Parkinson's disease (PD), nine with multiple system atrophy with predominant parkinsonism (MSA-P), six with MSA with predominant cerebellar ataxia (MSA-C), and 13 with progressive supranuclear palsy (PSP) Richardson's syndrome. Volume-of-interest-based quantification of standardized-uptake-values was conducted in different parkinsonian syndrome-related target regions. PET results were subjected to multinomial logistic regression to create a prediction model discriminating among groups. Furthermore, we correlated tracer uptake with clinical findings. Elevated [18F]-THK5351 uptake in midbrain and diencephalon differentiated PSP patients from PD and MSA-C. MSA-C patients were distinguishable by high tracer uptake in the pons and cerebellar deep white matter when compared to PSP and PD patients, whereas MSA-P patients tended to show higher tracer uptake in the lentiform nucleus. A multinomial logistic regression classified 33/34 patients into the correct clinical diagnosis group. Tracer uptake in the pons, cerebellar deep white matter, and striatum was closely associated with the presence of cerebellar and parkinsonian symptoms of MSA patients. The current study demonstrates that combined MAO-B and tau binding of THK5351 facilitates differential diagnosis of parkinsonian syndromes. Furthermore, our data indicate a correlation of MSA phenotype with [18F]-THK5351 uptake in certain brain regions, illustrating their relevance for the emergence of clinical symptoms and underlining the potential of THK5351 PET as a biomarker that correlates with pathological changes as well as with disease stage.
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Affiliation(s)
- Sonja Schönecker
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital LMU Munich, Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital LMU Munich, Munich, Germany
| | - Günter U Höglinger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Technical University of Munich, Munich, Germany
| | - Elisabeth Schuh
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Julia Sauerbeck
- Department of Nuclear Medicine, University Hospital LMU Munich, Munich, Germany
| | - Guido Rohrer
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stefan Sonnenfeld
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Katsutoshi Furukawa
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Aiko Ishiki
- Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Nobuyuki Okamura
- Division of Pharmacology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital LMU Munich, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, University Hospital LMU Munich, Munich, Germany.,Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
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18
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Sako W, Abe T, Haji S, Murakami N, Osaki Y, Izumi Y, Harada M, Kaji R. "One line": A method for differential diagnosis of parkinsonian syndromes. Acta Neurol Scand 2019; 140:229-235. [PMID: 31225648 DOI: 10.1111/ane.13136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/30/2019] [Accepted: 06/01/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Neurological findings are important for the differential diagnosis of Parkinson's disease (PD), multiple system atrophy with predominant parkinsonian features (MSA-P), and progressive supranuclear palsy (PSP). There is currently no fast and reliable method to distinguish these patients. OBJECTIVES To address this, we propose a novel approach to measure midbrain and pons size using a longitudinal "one line" method from the mid-sagittal view. METHODS Structural images were acquired from 101 subjects who underwent 3.0 T MRI (20 controls, 44 PD, 20 MSA, 12 PSP, and 5 corticobasal syndrome). We measured the middle cerebellar peduncle (MCP), superior cerebellar peduncle (SCP), midbrain, and pons. Brainstem size was measured by area or length of the longitudinal axis, which we named the "one line" method. We conducted intraclass correlation coefficients to assess the extent of agreement and consistency among raters, and receiver operating characteristic curves were used to determine diagnostic accuracy. RESULTS Intraclass correlation coefficients (ICC) of MCP width were excellent in sagittal and axial sections while those of SCP width were moderate. There were also excellent ICCs between raters for "one line" method of the midbrain and pons, while areas showed good ICCs. "One line" method and area of the midbrain were better than SCP width for the differential diagnosis of PSP from MSA-P and PD. In contrast, there was no clearly superior measurement for differentially diagnosing MSA-P. CONCLUSIONS The "one line" method was comparable with area for inter-rater agreement and diagnostic accuracy even though this was a simple and fast way.
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Affiliation(s)
- Wataru Sako
- Department of Clinical Neuroscience, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Takashi Abe
- Department of Radiology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Shotaro Haji
- Department of Clinical Neuroscience, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Nagahisa Murakami
- Department of Clinical Neuroscience, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Yusuke Osaki
- Department of Clinical Neuroscience, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Yuishin Izumi
- Department of Clinical Neuroscience, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Masafumi Harada
- Department of Radiology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Ryuji Kaji
- Department of Clinical Neuroscience, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
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19
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Quantitative susceptibility mapping in atypical Parkinsonisms. NEUROIMAGE-CLINICAL 2019; 24:101999. [PMID: 31539801 PMCID: PMC6812245 DOI: 10.1016/j.nicl.2019.101999] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/18/2019] [Accepted: 08/30/2019] [Indexed: 12/13/2022]
Abstract
Background and purpose Differential diagnosis between Parkinson's disease (PD) and Atypical Parkinsonisms, mainly Progressive Supranuclear Palsy (PSP) and Multiple System Atrophy (MSA), remains challenging. The low sensitivity of macroscopic findings at imaging might limit early diagnosis. The availability of iron-sensitive MR techniques and high magnetic field MR scanners provides new insights in evaluating brain structures in degenerative parkinsonisms. Quantitative Susceptibility Mapping (QSM) allows quantifying tissue iron content and could be sensitive to microstructural abnormalities which precede the appearence of regional atrophy. We measured the magnetic susceptibility (χ) of nigral and extranigral regions in patients with PD, PSP and MSA to evaluate the potential utility of the QSM technique for differential diagnosis. Materials and methods 65 patients (36 PD, 14 MSA, 15 PSP) underwent clinical and radiological evaluation with 3 T MRI. QSM maps were obtained from GRE sequences. ROI were drawn on substantia nigra (SN), red nucleus (RN), subthalamic nucleus (STN), putamen, globus pallidus and caudate. χ values were compared to detect inter-group differences. Results The highest diagnostic accuracy for PSP (area under the ROC curve, AUC, range 0.9–0.7) was observed for increased χ values in RN, STN and medial part of SN whereas in MSA (AUC range 0.8–0.7) iron deposition was significantly higher in the putamen, according to the patterns of pathological involvement that characterize the different diseases. Conclusion QSM could be used for iron quantification of nigral and extranigral structures in all degenerative parkinsonisms and should be tested longitudinally in order to identify early microscopical changes. The qualitative evaluation of the SN failed to discriminate PD and atypical parkinsonisms. QSM showed increased susceptibility values within nigral and extranigral regions in AP. In MSA susceptibility values of putamen, STN and RN were higher than in PD. In PSP susceptibility values of medial SN, STN, RN and putamen were higher than in PD. QSM seems to be a promising tool in distinguishing PD from AP and MSA from PSP.
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20
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Midbrain area for differentiating Parkinson’s disease from progressive supranuclear palsy. Clin Neurol Neurosurg 2019; 183:105383. [DOI: 10.1016/j.clineuro.2019.105383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/18/2019] [Accepted: 06/04/2019] [Indexed: 11/17/2022]
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21
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Ahn JH, Kim M, Kim JS, Youn J, Jang W, Oh E, Lee PH, Koh SB, Ahn TB, Cho JW. Midbrain atrophy in patients with presymptomatic progressive supranuclear palsy-Richardson's syndrome. Parkinsonism Relat Disord 2019; 66:80-86. [PMID: 31307918 DOI: 10.1016/j.parkreldis.2019.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/27/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION In the present study, midbrain atrophy and the pons-to-midbrain area ratio (P/M ratio) were investigated as diagnostic markers for presymptomatic progressive supranuclear palsy-Richardson's syndrome (Pre-PSP-RS). METHODS The present study included 27 patients with probable PSP-RS who underwent brain MRI at least twice before and after the development of clinical symptoms, age- and sex-matched participants with Parkinson's disease (PD, n = 27), and healthy controls (n = 27). The midbrain area, pons area, and P/M ratio of the Pre-PSP-RS, PD, and control subjects were measured using midsagittal images from brain MRI, and the parameters were compared among the groups. RESULTS The midbrain area decreased and the P/M ratio increased significantly in the Pre-PSP-RS patients compared with both the PD and control subjects (midbrain, Pre-PSP-RS vs. PD = 1.01 cm2vs. 1.29 cm2, p < 0.001, Pre-PSP-RS vs. controls = 1.01 cm2vs. 1.29 cm2, p < 0.001; P/M ratio, Pre-PSP-RS vs. PD = 5.27 vs. 4.03, p < 0.001, Pre-PSP-RS vs. controls = 5.27 cm2vs. 4.06 cm2, p < 0.001). The P/M ratio had high sensitivity (vs. PD, 96.3%, vs. control, 88.9%) and specificity (vs. PD, 81.5%, vs. control, 96.3%) in differentiating Pre-PSP-RS patients from PD and control subjects. CONCLUSION Midbrain atrophy precedes the clinical symptoms of PSP-RS and could be a useful diagnostic imaging biomarker for Pre-PSP-RS. Furthermore, this information could play an important role in the development of future treatment strategies.
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Affiliation(s)
- Jong Hyeon Ahn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Minkyeong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Wooyoung Jang
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon, Gangneung, 25440, Republic of Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, College of Medicine, 282 Munhwa-ro, Jung-Gu, Daejun, 35015, Republic of Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seong-Beom Koh
- Departments of Neurology, Korea University College of Medicine, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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22
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Deep learning to differentiate parkinsonian disorders separately using single midsagittal MR imaging: a proof of concept study. Eur Radiol 2019; 29:6891-6899. [DOI: 10.1007/s00330-019-06327-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 12/14/2022]
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23
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Constantinides VC, Paraskevas GP, Efthymiopoulou E, Stefanis L, Kapaki E. Clinical, neuropsychological and imaging characteristics of Alzheimer's disease patients presenting as corticobasal syndrome. J Neurol Sci 2019; 398:142-147. [DOI: 10.1016/j.jns.2019.01.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 12/12/2022]
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24
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Abstract
Qualitative and quantitative structural magnetic resonance imaging offer objective measures of the underlying neurodegeneration in atypical parkinsonism. Regional changes in tissue volume, signal changes and increased deposition of iron as assessed with different structural MRI techniques are surrogate markers of underlying neurodegeneration and may reflect cell loss, microglial proliferation and astroglial activation. Structural MRI has been explored as a tool to enhance diagnostic accuracy in differentiating atypical parkinsonian disorders (APDs). Moreover, the longitudinal assessment of serial structural MRI-derived parameters offers the opportunity for robust inferences regarding the progression of APDs. This review summarizes recent research findings as (1) a diagnostic tool for APDs as well as (2) as a tool to assess longitudinal changes of serial MRI-derived parameters in the different APDs.
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25
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Constantinides VC, Paraskevas GP, Velonakis G, Toulas P, Stamboulis E, Kapaki E. MRI Planimetry and Magnetic Resonance Parkinsonism Index in the Differential Diagnosis of Patients with Parkinsonism. AJNR Am J Neuroradiol 2018; 39:1047-1051. [PMID: 29622555 DOI: 10.3174/ajnr.a5618] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/07/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differential diagnosis of multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration from Parkinson disease on clinical grounds is often difficult. MR imaging biomarkers could assist in a more accurate diagnosis. We examined the utility of MR imaging surface measurements (MR imaging planimetry) in the differential diagnosis of patients with parkinsonism. MATERIALS AND METHODS Fifty-two patients with Parkinson-plus (progressive supranuclear palsy, n = 24; corticobasal degeneration, n = 9; multiple system atrophy, n = 19), 18 patients with Parkinson disease, and 15 healthy controls were included. Corpus callosum, midbrain, and pons surfaces; relevant indices; and the Magnetic Resonance Parkinsonism Index were calculated. Corpus callosum subsection analysis was performed, and the corpus callosum posteroanterior gradient was introduced. RESULTS A Magnetic Resonance Parkinsonism Index value of >12.6 discriminated progressive supranuclear palsy from other causes of parkinsonism with a 91% sensitivity and 95% specificity. No planimetry measurement could accurately discriminate those with multiple system atrophy with parkinsonism from patients with Parkinson disease. A corpus callosum posteroanterior gradient value of ≤191 was highly specific (97%) and moderately sensitive (75%) for the diagnosis of corticobasal degeneration versus all other groups. A midbrain-to-corpus callosum posteroanterior gradient ratio of ≤0.45 was highly indicative of progressive supranuclear palsy over corticobasal degeneration (sensitivity 86%, specificity 88%). CONCLUSIONS MR imaging planimetry measurements are potent imaging markers of progressive supranuclear palsy and promising markers of corticobasal degeneration but do not seem to assist in the diagnosis of multiple system atrophy with parkinsonism.
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Affiliation(s)
- V C Constantinides
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - G P Paraskevas
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - G Velonakis
- Research Unit of Radiology (G.V., P.T.), 2nd Department of Radiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Toulas
- Research Unit of Radiology (G.V., P.T.), 2nd Department of Radiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Stamboulis
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - E Kapaki
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
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26
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Brendel M, Schönecker S, Höglinger G, Lindner S, Havla J, Blautzik J, Sauerbeck J, Rohrer G, Zach C, Vettermann F, Lang AE, Golbe L, Nübling G, Bartenstein P, Furukawa K, Ishiki A, Bötzel K, Danek A, Okamura N, Levin J, Rominger A. [ 18F]-THK5351 PET Correlates with Topology and Symptom Severity in Progressive Supranuclear Palsy. Front Aging Neurosci 2018; 9:440. [PMID: 29387005 PMCID: PMC5776329 DOI: 10.3389/fnagi.2017.00440] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative movement disorder characterized by deposition of fibrillar aggregates of 4R tau-protein in neurons and glial cells of the brain. These deposits are a key neuropathological finding, allowing a diagnosis of “definite PSP,” which is usually established post mortem. To date criteria for clinical diagnosis of PSP in vivo do not include biomarkers of tau pathology. For intervention trials, it is increasingly important to (i) establish biomarkers for an early diagnosis and (ii) to develop biomarkers that correlate with disease progression of PSP. [18F]-THK5351 is a novel PET-ligand that may afford in vivo visualization and quantification of tau-related alterations. We investigated binding characteristics of [18F]-THK5351 in patients with clinically diagnosed PSP and correlate tracer uptake with clinical findings. Eleven patients (68.4 ± 7.4 year; N = 6 female) with probable PSP according to current clinical criteria and nine healthy controls (71.7 ± 7.2 year; N = 4 female) underwent [18F]-THK5351 PET scanning. Voxel-wise statistical parametric comparison and volume-of-interest based quantification of standardized-uptake-values (SUV) were conducted using the cerebellar cortex as reference region. We correlated disease severity as measured with the help of the PSP Rating Scale (PSPRS) as well as several other clinical parameters with the individual PET findings. By voxel-wise mapping of [18F]-THK5351 uptake in the patient group we delineated typical distribution patterns that fit to known tau topology for PSP post mortem. Quantitative analysis indicated the strongest discrimination between PSP patients and healthy controls based on tracer uptake in the midbrain (+35%; p = 3.01E-7; Cohen's d: 4.0), followed by the globus pallidus, frontal cortex, and medulla oblongata. Midbrain [18F]-THK5351 uptake correlated well with clinical severity as measured by PSPRS (R = 0.66; p = 0.026). OCT and MRI delineated PSP patients from healthy controls by use of established discrimination thresholds but only OCT did as well correlate with clinical severity (R = 0.79; p = 0.024). Regional [18F]-THK5351 binding patterns correlated well with the established post mortem distribution of lesions in PSP and with clinical severity. The contribution of possible MAO-B binding to the [18F]-THK5351 signal needs to be further evaluated, but nevertheless [18F]-THK5351 PET may still serve as valuable biomarker for diagnosis of PSP.
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Affiliation(s)
- Matthias Brendel
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sonja Schönecker
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Günter Höglinger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Technical University of Munich, Munich, Germany
| | - Simon Lindner
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Joachim Havla
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany.,Institute of Clinical Neuroimmunology, Biomedical Center and University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Janusch Blautzik
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julia Sauerbeck
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Guido Rohrer
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christian Zach
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Franziska Vettermann
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, and Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Lawrence Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Georg Nübling
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Katsutoshi Furukawa
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Aiko Ishiki
- Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Kai Bötzel
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nobuyuki Okamura
- Division of Pharmacology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
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27
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Constantinides VC, Paraskevas GP, Stamboulis E, Kapaki E. Simple linear brainstem MRI measurements in the differential diagnosis of progressive supranuclear palsy from the parkinsonian variant of multiple system atrophy. Neurol Sci 2017; 39:359-364. [DOI: 10.1007/s10072-017-3212-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
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28
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Nizamani WM, Mubarak F, Barakzai MD, Ahmed MS. 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. Int J Gen Med 2017; 10:375-384. [PMID: 29184432 PMCID: PMC5673040 DOI: 10.2147/ijgm.s134297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective The objective of the study was to assess magnetic resonance (MR) planimetric measurements and MR parkinsonism index (MRPI) in differentiating progressive supranuclear palsy (PSP) from Parkinson’s disease (PD) using 1.5 and 3 T MRI scanner. Subjects and methods After ethical approval was obtained, analysis of 34 consecutive patients with PSP, 34 patients with PD and 34 healthy controls (HCs) was performed. HCs were age-matched adults without any history of neurodegenerative disease or movement disorders. Retrospective data from the past 10 years (from January 2006 to December 2015) were obtained from the Hospital Information Management System, and informed consent was obtained from all participants. The measurements of pons area–midbrain area ratio (P/M) and MCP width–superior cerebellar peduncle (SCP) width ratio (MCP/SCP) were used, and MRPI was calculated by the formula ([P/M]×[MCP/SCP]). Results Midbrain area and SCP width in patients with PSP (19 males, 15 females; mean age =66.7 years) were significantly (P<0.001) smaller than in patients with PD (20 males, 14 females; mean age =66.7 years) and control participants (17 males, 17 females; mean age =66.1 years). P/M and MCP/SCP were significantly higher in patients with PSP than in patients with PD and control participants. All measurements showed some overlap of values between patients with PSP and patients from PD group and control participants. MRPI value was significantly higher in patients with PSP (mean 21.00) than in patients with PD (mean 9.50; P<0.001) and control participants (mean 9.6; P<0.001), without any overlap of values among groups. No correlation was found between the duration of disease, PSP rating scale, PSP staging system and MRPI in this study. No patient with PSP received a misdiagnosis when the index was used (sensitivity and specificity, 100%). Conclusion MRPI should be made an essential part of all MRI brain reporting whenever differentiation between PD and PSP is sought for.
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Affiliation(s)
| | - Fatima Mubarak
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
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Heim B, Krismer F, De Marzi R, Seppi K. Magnetic resonance imaging for the diagnosis of Parkinson's disease. J Neural Transm (Vienna) 2017; 124:915-964. [PMID: 28378231 PMCID: PMC5514207 DOI: 10.1007/s00702-017-1717-8] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/22/2017] [Indexed: 12/11/2022]
Abstract
The differential diagnosis of parkinsonian syndromes is considered one of the most challenging in neurology and error rates in the clinical diagnosis can be high even at specialized centres. Despite several limitations, magnetic resonance imaging (MRI) has undoubtedly enhanced the diagnostic accuracy in the differential diagnosis of neurodegenerative parkinsonism over the last three decades. This review aims to summarize research findings regarding the value of the different MRI techniques, including advanced sequences at high- and ultra-high-field MRI and modern image analysis algorithms, in the diagnostic work-up of Parkinson's disease. This includes not only the exclusion of alternative diagnoses for Parkinson's disease such as symptomatic parkinsonism and atypical parkinsonism, but also the diagnosis of early, new onset, and even prodromal Parkinson's disease.
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Affiliation(s)
- Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Roberto De Marzi
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria.
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30
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Whitwell JL, Höglinger GU, Antonini A, Bordelon Y, Boxer AL, Colosimo C, van Eimeren T, Golbe LI, Kassubek J, Kurz C, Litvan I, Pantelyat A, Rabinovici G, Respondek G, Rominger A, Rowe JB, Stamelou M, Josephs KA. Radiological biomarkers for diagnosis in PSP: Where are we and where do we need to be? Mov Disord 2017; 32:955-971. [PMID: 28500751 PMCID: PMC5511762 DOI: 10.1002/mds.27038] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/11/2022] Open
Abstract
PSP is a pathologically defined neurodegenerative tauopathy with a variety of clinical presentations including typical Richardson's syndrome and other variant PSP syndromes. A large body of neuroimaging research has been conducted over the past two decades, with many studies proposing different structural MRI and molecular PET/SPECT biomarkers for PSP. These include measures of brainstem, cortical and striatal atrophy, diffusion weighted and diffusion tensor imaging abnormalities, [18F] fluorodeoxyglucose PET hypometabolism, reductions in striatal dopamine imaging and, most recently, PET imaging with ligands that bind to tau. Our aim was to critically evaluate the degree to which structural and molecular neuroimaging metrics fulfill criteria for diagnostic biomarkers of PSP. We queried the PubMed, Cochrane, Medline, and PSYCInfo databases for original research articles published in English over the past 20 years using postmortem diagnosis or the NINDS-SPSP criteria as the diagnostic standard from 1996 to 2016. We define a five-level theoretical construct for the utility of neuroimaging biomarkers in PSP, with level 1 representing group-level findings, level 2 representing biomarkers with demonstrable individual-level diagnostic utility, level 3 representing biomarkers for early disease, level 4 representing surrogate biomarkers of PSP pathology, and level 5 representing definitive PSP biomarkers of PSP pathology. We discuss the degree to which each of the currently available biomarkers fit into this theoretical construct, consider the role of biomarkers in the diagnosis of Richardson's syndrome, variant PSP syndromes and autopsy confirmed PSP, and emphasize current shortfalls in the field. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Günter U. Höglinger
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, IRCCS Hospital San Camillo, Venice and Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
| | - Thilo van Eimeren
- German Center for Neurodegenerative Diseases (DZNE), Germany
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Lawrence I. Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Carolin Kurz
- Psychiatrische Klinik, Ludwigs-Maximilians-Universität, München, Germany
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, CA, USA
| | | | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Gesine Respondek
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Axel Rominger
- Deptartment of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - James B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Maria Stamelou
- Second Department of Neurology, Attikon University Hospital, University of Athens, Greece; Philipps University, Marburg, Germany; Movement Disorders Dept., HYGEIA Hospital, Athens, Greece
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Nigro S, Arabia G, Antonini A, Weis L, Marcante A, Tessitore A, Cirillo M, Tedeschi G, Zanigni S, Calandra-Buonaura G, Tonon C, Pezzoli G, Cilia R, Zappia M, Nicoletti A, Cicero CE, Tinazzi M, Tocco P, Cardobi N, Quattrone A. Magnetic Resonance Parkinsonism Index: diagnostic accuracy of a fully automated algorithm in comparison with the manual measurement in a large Italian multicentre study in patients with progressive supranuclear palsy. Eur Radiol 2017; 27:2665-2675. [PMID: 27761709 DOI: 10.1007/s00330-016-4622-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/26/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate the reliability of a new in-house automatic algorithm for calculating the Magnetic Resonance Parkinsonism Index (MRPI), in a large multicentre study population of patients affected by progressive supranuclear palsy (PSP) or Parkinson's disease (PD), and healthy controls (HC), and to compare the diagnostic accuracy of the automatic and manual MRPI values. METHODS The study included 88 PSP patients, 234 PD patients and 117 controls. MRI was performed using both 3T and 1.5T scanners. Automatic and manual MRPI values were evaluated, and accuracy of both methods in distinguishing PSP from PD and controls was calculated. RESULTS No statistical differences were found between automated and manual MRPI values in all groups. The automatic MRPI values differentiated PSP from PD with an accuracy of 95 % (manual MRPI accuracy 96 %) and 97 % (manual MRPI accuracy 100 %) for 1.5T and 3T scanners, respectively. CONCLUSION Our study showed that the new in-house automated method for MRPI calculation was highly accurate in distinguishing PSP from PD. Our automatic approach allows a widespread use of MRPI in clinical practice and in longitudinal research studies. KEY POINTS • A new automatic method for calculating the MRPI is presented. • Automatic MRPI values are in good agreement with manual values. • Automatic MRPI can distinguish patients with PSP from patients with PD. • The automatic method overcomes MRPI application limitations in routine practice. • The automatic method may allow a more widespread use of MRPI.
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Affiliation(s)
- Salvatore Nigro
- Institute of Bioimaging and Molecular Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Gennarina Arabia
- Institute of Neurology, Department of Medical and Surgical Sciences, University 'Magna Graecia', 88100, Catanzaro, Italy
| | - Angelo Antonini
- Parkinson's Disease and Movement Disorders Unit, 'Fondazione Ospedale San Camillo' - I.R.C.C.S, Venice-Lido, Italy
| | - Luca Weis
- Parkinson's Disease and Movement Disorders Unit, 'Fondazione Ospedale San Camillo' - I.R.C.C.S, Venice-Lido, Italy
| | - Andrea Marcante
- Parkinson's Disease and Movement Disorders Unit, 'Fondazione Ospedale San Camillo' - I.R.C.C.S, Venice-Lido, Italy
| | - Alessandro Tessitore
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, 80138, Italy
- MRI Research Center SUN-FISM, Second University of Naples, Naples, Italy
| | - Mario Cirillo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, 80138, Italy
- MRI Research Center SUN-FISM, Second University of Naples, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, 80138, Italy
- MRI Research Center SUN-FISM, Second University of Naples, Naples, Italy
| | - Stefano Zanigni
- Functional MR Unit, Policlinico S. Orsola - Malpighi, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Caterina Tonon
- Functional MR Unit, Policlinico S. Orsola - Malpighi, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gianni Pezzoli
- Parkinson Institute, ASST G.Pini - CTO, ex ICP, Milano, Italy
| | - Roberto Cilia
- Parkinson Institute, ASST G.Pini - CTO, ex ICP, Milano, Italy
| | - Mario Zappia
- Department 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Department 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Michele Tinazzi
- Department of Neurological and Movement Sciences, University Hospital of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Pierluigi Tocco
- Department of Neurological and Movement Sciences, University Hospital of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Nicolò Cardobi
- Institute of Radiology, University Hospital of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Aldo Quattrone
- Institute of Bioimaging and Molecular Physiology, National Research Council, 88100, Catanzaro, Italy.
- Institute of Neurology, Department of Medical and Surgical Sciences, University 'Magna Graecia', 88100, Catanzaro, Italy.
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Silsby M, Tweedie-Cullen RY, Murray CR, Halliday GM, Hodges JR, Burrell JR. The midbrain-to-pons ratio distinguishes progressive supranuclear palsy from non-fluent primary progressive aphasias. Eur J Neurol 2017; 24:956-965. [PMID: 28510312 DOI: 10.1111/ene.13314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE To determine the clinical utility of the midbrain-to-pons (M/P) ratio as a clinical biomarker of progressive supranuclear palsy (PSP) in patients with non-fluent primary progressive aphasia syndromes. METHODS Patients with PSP, progressive non-fluent aphasia (PNFA) and logopenic progressive aphasia (LPA) were recruited. Patients were diagnosed clinically, but pathological confirmation was available in a proportion of patients. Midbrain and pons areas were measured using Osirix Lite, a free DICOM viewer. The M/P ratio and Magnetic Resonance Parkinsonism Index were calculated and their diagnostic utility compared. RESULTS A total of 72 participants were included (16 PSP, 18 PNFA, 16 LPA and 22 controls). Patients with PSP had motor features typical of the syndrome. Both the M/P ratio and Magnetic Resonance Parkinsonism Index differed significantly in PSP compared with controls. The M/P ratio was disproportionately reduced in PSP compared with PNFA and LPA (PSP, 0.182 ± 0.043; PNFA, 0.255 ± 0.034; LPA, 0.258 ± 0.033; controls, 0.292 ± 0.031; P < 0.001). An M/P ratio of ≤0.215 produced a positive predictive value of 77.8% for the diagnosis of PSP syndrome. Pathological examination revealed Alzheimer's disease in three cases (all LPA), pathological PSP in two cases (one clinical PSP and one PNFA) and corticobasal degeneration in one case (PNFA). The M/P ratio was ≤0.215 in both pathological cases of PSP. CONCLUSIONS The M/P ratio was disproportionately reduced in PSP, suggesting its potential as a clinical marker of the PSP syndrome. Larger studies of pathologically confirmed cases are needed to establish the M/P ratio as a biomarker of PSP pathology.
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Affiliation(s)
- M Silsby
- Concord Hospital, Sydney, NSW, Australia
| | | | - C R Murray
- Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia
| | - G M Halliday
- Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - J R Hodges
- Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - J R Burrell
- Concord Hospital, Sydney, NSW, Australia.,Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Nigro S, Morelli M, Arabia G, Nisticò R, Novellino F, Salsone M, Rocca F, Quattrone A. Magnetic Resonance Parkinsonism Index and midbrain to pons ratio: Which index better distinguishes Progressive Supranuclear Palsy patients with a low degree of diagnostic certainty from patients with Parkinson Disease? Parkinsonism Relat Disord 2017; 41:31-36. [PMID: 28487107 DOI: 10.1016/j.parkreldis.2017.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/13/2017] [Accepted: 05/02/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Several studies have compared the performances of midbrain to pons area ratio (M/P) and the Magnetic Resonance Parkinsonism Index (MRPI) in distinguishing patients with Progressive Supranuclear Palsy (PSP) from those with Parkinson's disease (PD) with conflicting results. The current study aimed to compare the performance of these indexes in a well-characterized sample of PSP patients using either a manual or a fully automated approach to measure the brainstem structures involved in M/P and MRPI calculation. METHODS This study involved 179 patients affected by idiopathic PD, 35 patients affected by PSP (15 probable and 20 possible) and 87 healthy controls. Sensitivity, specificity, positive predictive value (PPV) and area under the curve (AUC) of MRPI and M/P in distinguishing possible and probable PSP from PD and controls were calculated. RESULTS No significant difference was found between manual and automated values for both MRPI and M/P. MRPI and M/P differentiated probable PSP from PD with similar performance. By contrast, MRPI showed higher sensitivity and specificity than M/P when patients with possible PSP were compared with PD (MRPI, sensitivity 100%, specificity 98.88%; M/P, sensitivity 85%, specificity 93.85%). A significant difference was also observed in AUC between MRPI and M/P in distinguishing possible PSP from PD. CONCLUSION Our study demonstrates that MRPI was more accurate than M/P, in differentiating patients with possible PSP from those with PD. In patients suspected of having PSP with a low level of clinic diagnostic accuracy, MRPI should be preferred to M/P for distinguishing these patients from PD.
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Affiliation(s)
- Salvatore Nigro
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Maurizio Morelli
- Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Graecia", 88100, Catanzaro, Italy
| | - Gennarina Arabia
- Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Graecia", 88100, Catanzaro, Italy
| | - Rita Nisticò
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Fabiana Novellino
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Maria Salsone
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Federico Rocca
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Aldo Quattrone
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy; Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Graecia", 88100, Catanzaro, Italy.
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Bacchi S, Chim I, Patel S. Specificity and sensitivity of magnetic resonance imaging findings in the diagnosis of progressive supranuclear palsy. J Med Imaging Radiat Oncol 2017; 62:21-31. [DOI: 10.1111/1754-9485.12613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 03/11/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Stephen Bacchi
- University of Adelaide; Adelaide South Australia Australia
| | - Ivana Chim
- University of Adelaide; Adelaide South Australia Australia
| | - Sandy Patel
- Royal Adelaide Hospital; Adelaide South Australia Australia
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Advanced structural neuroimaging in progressive supranuclear palsy: Where do we stand? Parkinsonism Relat Disord 2017; 36:19-32. [DOI: 10.1016/j.parkreldis.2016.12.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/01/2016] [Accepted: 12/23/2016] [Indexed: 12/11/2022]
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Möller L, Kassubek J, Südmeyer M, Hilker R, Hattingen E, Egger K, Amtage F, Pinkhardt EH, Respondek G, Stamelou M, Möller F, Schnitzler A, Oertel WH, Knake S, Huppertz HJ, Höglinger GU. Manual MRI morphometry in Parkinsonian syndromes. Mov Disord 2017; 32:778-782. [PMID: 28150443 DOI: 10.1002/mds.26921] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/01/2016] [Accepted: 12/20/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Several morphometric magnetic resonance imaging parameters may serve for differential diagnosis of parkinsonism. The objective of this study was to identify which performs best in clinical routine. METHODS We acquired multicentric magnetization-prepared rapid gradient echo sequences in patients with Parkinson's disease (n=204), progressive supranuclear palsy (n=106), multiple system atrophy-cerebellar, (n = 21); multiple system atrophy-parkinsonian (n = 60), and healthy controls (n = 73), performed manual planimetric measurements, and calculated receiver operator characteristics with leave-one-out cross-validation to propose cutoff values. RESULTS The midsagittal midbrain area was reduced in PSP versus all other groups (P < 0.001). The midsagittal pons area was reduced in MSA-cerebellar, MSA-parkinsonian, and PSP versus PD patients and healthy controls (P < 0.001). The midbrain/pons area ratio was lower in PSP (P < 0.001) and higher in MSA-cerebellar and MSA-parkinsonian versus PD and PSP (P < 0.001). CONCLUSIONS The midsagittal midbrain area most reliably identified PSP, the midsagittal pons area MSA-cerebellar. The midbrain/pons area ratio differentiated MSA-cerebellar and PSP better than the magnetic resonance-Parkinson index. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Leona Möller
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Martin Südmeyer
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Rüdiger Hilker
- Departement of Neurology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Karl Egger
- Department of Neuroradiology, Medical University Center Freiburg, Freiburg, Germany
| | - Florian Amtage
- Department of Neurology, Medical University Center Freiburg, Freiburg, Germany
| | | | - Gesine Respondek
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Department of Neurology, Technische Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Maria Stamelou
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Parkinson's Disease and Movement Disorders Department, HYGEIA Hospital, Athens, Greece and Second Dept. of Neurology, Attikon Hospital, University of Athens Greece
| | - Franz Möller
- Department of Children and Youth Medicine, Philipps University Marburg, Marburg, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang H Oertel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Susanne Knake
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | | | - Günter U Höglinger
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Department of Neurology, Medical University Center Freiburg, Freiburg, Germany.,Department of Neurology, Technische Universität München, Munich, Germany
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MRI measurements of brainstem structures in patients with vascular parkinsonism, progressive supranuclear palsy, and Parkinson's disease. Neurol Sci 2017; 38:627-633. [PMID: 28078564 DOI: 10.1007/s10072-017-2812-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
Magnetic resonance (MR) measurements of brainstem structures have been reported to be useful in differentiating patients with progressive supranuclear palsy (PSP) from those with Parkinson's disease (PD). The aim of this study was to determine whether quantitative measurements of brainstem structures on MR images can help differentiate vascular parkinsonism (VaP) from degenerative parkinsonism (PD and PSP). Areas of the midbrain and pons, and widths of the superior cerebellar peduncle (SCP) and middle cerebellar peduncle (MCP) were measured in 62 patients with PD, 25 patients with PSP (11 probable and 14 possible), and 24 patients with VaP on T 1-weighted MR images. The midbrain-to-pons area ratio (M/P ratio), MCP-to-SCP width ratio (MCP/SCP ratio), and MR parkinsonism index (MRPI; P/M × MCP/SCP) were calculated. The midbrain area and M/P ratio of patients with VaP (104 and 0.22 mm2, respectively) were smaller than those in patients with PD (121 and 0.24 mm2, respectively) and larger than those in patients with PSP (90 and 0.19 mm2, respectively). The MRPI was significantly larger in patients with PSP (13.6) in comparison with those with PD (10.1) and VaP (10.7). However, the MRPI of patients with VaP was not significantly different from patients with PD. Our study showed that MRPI was useful in differentiating PSP from VaP or PD. Thus, MR imaging measurements of brainstem structures may help differentiate patients with VaP from those with PD and PSP.
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Li C, Wu W, Zhu B, Liu X, Huang P, Wang Z, Tuo Y, Ren F. Multiple regression analysis of the craniofacial region of Chinese Han people using linear and angular measurements based on MRI. Forensic Sci Res 2017; 2:34-39. [PMID: 30483617 PMCID: PMC6197125 DOI: 10.1080/20961790.2016.1276120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/21/2016] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to measure the craniofacial region of Chinese Han people in the linear and angular dimensions, and to analyse the effects on sex, age and body parameters (height and weight). All 250 individuals (86 males, 164 females) underwent a three-dimensional magnetic resonance imaging (MRI) scan, and the MRI data were imported into VG Studio MAX 2.2 software. Each linear and angular measurement in the craniofacial region was processed directly. Using SPSS 20.0 software, nine multiple regression equations were constructed, and all the adjusted R2 values were statistically significant (0.031–0.311). Multiple regression analysis showed that most craniofacial measurements of Chinese people were significantly correlated with height, weight or age. The multiple regression equations constructed will be helpful in anthropometric analysis and forensic inference.
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Affiliation(s)
- Chengzhi Li
- Health Science Center, School of Forensic Science and Medicine, Xi'an Jiaotong University, Xi'an, China
- Department of Anatomy, Institute of Biological Anthropology, Liaoning Medical University, Jinzhou, China
- Shanghai Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Institute of Forensic Science, Ministry of Justice, PRC, Shanghai, China
| | - Wei Wu
- Department of Anatomy, Institute of Biological Anthropology, Liaoning Medical University, Jinzhou, China
| | - Bo Zhu
- Nuclear Medicine Department, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Xuefeng Liu
- Health Science Center, School of Forensic Science and Medicine, Xi'an Jiaotong University, Xi'an, China
- Department of Anatomy, Institute of Biological Anthropology, Liaoning Medical University, Jinzhou, China
| | - Ping Huang
- Shanghai Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Institute of Forensic Science, Ministry of Justice, PRC, Shanghai, China
| | - Zhenyuan Wang
- Health Science Center, School of Forensic Science and Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Ya Tuo
- Department of Biochemistry and Physiology, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Fu Ren
- Department of Anatomy, Institute of Biological Anthropology, Liaoning Medical University, Jinzhou, China
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Hwang M, Yang H, Kim Y, Youn J, Park J, Huh YE, Kim HT, Cho JW. Differential Progression of Midbrain Atrophy in Parkinsonism: Longitudinal MRI Study. NEURODEGENER DIS 2016; 17:31-37. [PMID: 27614955 DOI: 10.1159/000448174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/04/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS To elucidate different patterns of progression of midbrain atrophy in patients with Richardson's syndrome (RS), progressive supranuclear palsy-parkinsonism (PSP-P), and Parkinson's disease (PD) using magnetic resonance imaging (MRI)-based visual rating indexes. METHODS We recruited 12 patients with PSP-RS, 12 with PSP-P, and 23 with PD for whom MRIs had been followed up for at least 2 years (mean ± SD, 4.9 ± 1.6 years) after the initial MRI. MRI-based visual rating indexes were used to estimate midbrain atrophy, including the ratio of the pontine to midbrain tegmental areas (P/M ratio) on a midsagittal image, the length between the interpeduncular fossa and the center of the cerebral aqueduct at the midmammillary-body level (MTEGM) on axial images, and the morning glory sign. RESULTS Initially, there were no differences in MRI-based visual rating indexes between PSP-P and PD, while PSP-RS showed a higher P/M ratio and lower MTEGM compared with PSP-P and PD. In PD, the P/M ratio and MTEGM remained stable with disease progression. However, the extent of changes between initial and follow-up indexes was similarly greater for both PSP-RS and PSP-P than for PD. Finally, PSP-P showed a higher P/M ratio and lower MTEGM compared with PD in the follow-up, while PSP-RS still exhibited the most profound changes. CONCLUSIONS Midbrain atrophy progresses differentially in patients with PSP-RS, PSP-P, and PD. Longitudinal measurements of midbrain atrophy using MRI-based visual rating indexes can help distinguish patients with PSP-P from those with PSP-RS and PD.
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Affiliation(s)
- Minho Hwang
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Tipton PW, Konno T, Broderick DF, Dickson DW, Wszolek ZK. Cerebral peduncle angle: Unreliable in differentiating progressive supranuclear palsy from other neurodegenerative diseases. Parkinsonism Relat Disord 2016; 32:31-35. [PMID: 27553513 DOI: 10.1016/j.parkreldis.2016.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/01/2016] [Accepted: 08/09/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The significant symptom overlap between progressive supranuclear palsy (PSP) and other parkinsonian neurodegenerative diseases frequently results in misdiagnosis. However, neuroimaging can be used to quantify disease-related morphological changes and specific markers. The cerebral peduncle angle (CPA) has been shown to differentiate clinically diagnosed PSP from other parkinsonian diseases but this result has yet to be confirmed in autopsy-proven disease. METHODS Magnetic resonance imaging (MRI) scans were obtained for 168 patients representing 69 medical facilities. Following randomization, the images were divided into two groups (Type 1 and Type 2) based upon midbrain morphological differences. Two readers were blinded and independently measured the CPA of 146 patients with autopsy-proven progressive supranuclear palsy (PSP; n = 54), corticobasal degeneration (n = 16), multiple system atrophy (MSA; n = 11) and Lewy body disease (n = 65). RESULTS Applying two separate measurement techniques revealed no statistically significant differences in CPA measurements among any study groups regardless of classification measurement approach. The interobserver agreement showed significant differences in measurements using the Type 2 approach. CONCLUSION Measuring the CPA on MRI is not a reliable way of differentiating among patients with PSP, corticobasal degeneration, MSA, or Lewy body disease.
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Affiliation(s)
- Philip W Tipton
- Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Takuya Konno
- Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Daniel F Broderick
- Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Zbigniew K Wszolek
- Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Kim YE, Kang SY, Ma HI, Ju YS, Kim YJ. A Visual Rating Scale for the Hummingbird Sign with Adjustable Diagnostic Validity. JOURNAL OF PARKINSONS DISEASE 2016; 5:605-12. [PMID: 26406141 DOI: 10.3233/jpd-150537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although the hummingbird sign (HBS) is a distinctive feature of progressive supranuclear palsy (PSP) VS. idiopathic Parkinson's disease (IPD) and other parkinsonian disorders, there are no consensus criteria for its identification. OBJECTIVE To develop consensus criteria for the HBS to enable accurate communication between researchers and physicians, we developed a new radiologic rating scale for the HBS (the HBS-RS), and the inter-rater reliability (IRR) and diagnostic validity of the HBS-RS were evaluated. METHODS Two raters blinded to the clinical diagnoses reviewed T1 midsagittal magnetic resonance images of 133 patients with IPD (n = 93) or PSP (n = 40). The existence of the HBS was assessed in two steps that were separated by two weeks; the first was based on their own experience and the second was according to the HBS-RS. The HBS-RS comprises 4 items (contour of the third ventricle floor, shape of the beak, shape of the hummingbird head, and midbrain atrophy), with weighted scores from 0 to 2. RESULTS The IRR of individual items in the HBS-RS and of the composite scores showed moderate-to-good agreement (Cohen's kappa [κ], 0.479-0.766) and were observed to be highest for the contour of the third ventricle floor. The sensitivities and specificities varied depending on the cut-off for each item or for the composite scores. The sensitivities for each item were high (85.0-92.5) at a low cut-off (0 VS. 1 or 2). The specificities reached more than 80% when the composite scores of the HBS-RS were used. Receiver operating characteristic curves for the total HBS-RS scores showed fair diagnostic accuracy for PSP (AUC, 0.76 and 0.73). CONCLUSIONS The HBS-RS is a simple and measurable visual assessment tool to identify the HBS, with adjustable diagnostic validity for PSP. The results suggest that the HBS-RS may be used for objective measurements of the HBS in research and in the clinic.
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Affiliation(s)
- Young Eun Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Suk Yun Kang
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hallym
| | - Hyeo-Il Ma
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Young-Su Ju
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Yun Joong Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.,ILSONG Institute of Life Science, Hallym University, Anyang, Republic of Korea.,Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang, Republic of Korea
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Garrido A, Vilas D, Tolosa E. Update on the Diagnosis and Management of Progressive Supranuclear Palsy. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dąbrowska M, Schinwelski M, Sitek EJ, Muraszko-Klaudel A, Brockhuis B, Jamrozik Z, Sławek J. The role of neuroimaging in the diagnosis of the atypical parkinsonian syndromes in clinical practice. Neurol Neurochir Pol 2015; 49:421-31. [PMID: 26652877 DOI: 10.1016/j.pjnns.2015.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 11/18/2022]
Abstract
Atypical parkinsonian disorders (APD) are a heterogenous group of neurodegenerative diseases such as: progressive supranuclear palsy (PSP), multiple system atrophy (MSA), cortico-basal degeneration (CBD) and dementia with Lewy bodies (DLB). In all of them core symptoms of parkinsonian syndrome are accompanied by many additional clinical features not typical for idiopathic Parkinson's disease (PD) like rapid progression, gaze palsy, apraxia, ataxia, early cognitive decline, dysautonomia and usually poor response to levodopa therapy. In the absence of reliably validated biomarkers the diagnosis is still challenging and mainly based on clinical criteria. However, robust data emerging from routine magnetic resonance imaging (MRI) as well as from many advanced MRI techniques such as: diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), voxel-based morphometry (VBM), susceptibility-weighted imaging (SWI) may help in differential diagnosis. The main aim of this review is to summarize briefly the most important and acknowledged radiological findings of conventional MRI due to its availability in standard clinical settings. Nevertheless, we present shortly other methods of structural (like TCS - transcranial sonography) and functional imaging (like SPECT - single photon emission computed tomography or PET - positron emission tomography) as well as some selected advanced MRI techniques and their potential future applications in supportive role in distinguishing APD.
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Affiliation(s)
- Magda Dąbrowska
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdańsk, Poland.
| | - Michał Schinwelski
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdańsk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdańsk, Gdańsk, Poland
| | - Emilia J Sitek
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdańsk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Muraszko-Klaudel
- Radiology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdańsk, Poland
| | - Bogna Brockhuis
- Nuclear Medicine Department, Medical University of Gdańsk, Gdańsk, Poland
| | - Zygmunt Jamrozik
- Neurology Department, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Sławek
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdańsk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdańsk, Gdańsk, Poland
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Cerebral Peduncle Angle: An Objective Criterion for Assessing Progressive Supranuclear Palsy Richardson Syndrome. AJR Am J Roentgenol 2015. [DOI: 10.2214/ajr.14.12724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kim YH, Ma HI, Kim YJ. Utility of the Midbrain Tegmentum Diameter in the Differential Diagnosis of Progressive Supranuclear Palsy from Idiopathic Parkinson's Disease. J Clin Neurol 2015; 11:268-74. [PMID: 26174787 PMCID: PMC4507382 DOI: 10.3988/jcn.2015.11.3.268] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Various magnetic resonance (MR) measurements have been proposed to aid in differentiating between progressive supranuclear palsy (PSP) and idiopathic Parkinson's disease (IPD); however, these methods have not been compared directly. The aim of this study was to determine which measurement method exhibits the highest power to differentiate between PSP and IPD. Methods Brain MR images from 82 IPD and 29 PSP patients were analyzed retrospectively. T1-weighted 3D volumetric axial images, or sagittal images reconstructed from those axial images were examined. MR measurements included the length from the interpeduncular fossa to the center of the cerebral aqueduct at the mid-mammillary-body level, adjusted according to the anterior commissure-posterior commissure length (MBTegm), the ratio of the midbrain area to the pons area (M/P ratio) as measured by both Oba's method (Oba M/P) and Cosottini's method (Cosottini M/P), and a modified MR parkinsonism index (mMRPI). Results Receiver operating characteristic (ROC) analysis indicated that the areas under the ROC curves (AUCs) exceeded 0.70, with a high intrarater reliability for all MR measurement methods. ROC analyses of four MR measurements yielded AUCs of 0.69-0.76. At the cutoff value with the highest Youden index, mMRPI had the highest sensitivity, while Oba M/P offered the highest specificity. A comparison of the ROC analyses revealed that MBTegm was superior to mMRPI in differentiating PSP from IPD (p=0.049). There was no difference in discriminating power among Oba M/P, Cosottini M/P, and MBTegm. Conclusions Simple measurements of MBTegm on axial MR images at the mid-mammillary-body level are comparable to measurements of the M/P ratio with regard to their ability to discriminate PSP from IPD.
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Affiliation(s)
- Yool Hee Kim
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea
| | - Hyeo Il Ma
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea.
| | - Yun Joong Kim
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea.; ILSONG Institute of Life Science, Hallym University, Anyang, Korea.; Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang, Korea.
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Morelli M, Arabia G, Messina D, Vescio B, Salsone M, Chiriaco C, Perrotta P, Rocca F, Cascini GL, Barbagallo G, Nigro S, Quattrone A. Effect of aging on magnetic resonance measures differentiating progressive supranuclear palsy from Parkinson's disease. Mov Disord 2014; 29:488-95. [PMID: 24573655 DOI: 10.1002/mds.25821] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 11/18/2013] [Accepted: 12/30/2013] [Indexed: 11/08/2022] Open
Abstract
Imaging measurements, such as the ratio of the midsagittal areas of the midbrain and pons (midbrain/pons) and the Magnetic Resonance Parkinsonism Index (MRPI), have been proposed to differentiate progressive supranuclear palsy (PSP) from Parkinson's disease (PD). However, abnormal midbrain/pons values suggestive of PSP have also been reported in elderly individuals and in patients with PD. We investigated the effect of aging on single or combined imaging measurements of the brainstem. We calculated the midbrain/pons and the MRPI (the ratio of the midsagittal areas of the pons and the midbrain multiplied by the ratio of the middle cerebellar peduncle and superior cerebellar peduncle widths) in 152 patients affected by PD, 25 patients with PSP, and a group of 81 age-matched and sex-matched healthy controls using a 3-Tesla magnetic resonance imaging scanner. In healthy controls, aging was negatively correlated with midsagittal area of the midbrain and midbrain/pons values. In patients with PD, in addition to the effect of aging, the disease status further influenced the midbrain/pons values (R(2) = 0.23; P < 0.001). In both groups, MRPI values were not influenced either by aging or by disease status. No effect of aging on either midbrain/pons or MRPI values was shown in the patients with PSP. Our findings indicated that the MRPI was not significantly influenced by aging or disease-related changes occurring in PD; whereas, in contrast, the midbrain/pons was influenced. Therefore, the MRPI appears to be a more reliable imaging measurement compared with midbrain/pons values for differentiating PSP from PD and controls in an elderly population.
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Affiliation(s)
- Maurizio Morelli
- Institute of Neurology, University "Magna Graecia", Germaneto, Catanzaro, Italy
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Botha H, Whitwell JL, Madhaven A, Senjem ML, Lowe V, Josephs KA. The pimple sign of progressive supranuclear palsy syndrome. Parkinsonism Relat Disord 2013; 20:180-5. [PMID: 24252300 DOI: 10.1016/j.parkreldis.2013.10.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/12/2013] [Accepted: 10/25/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some patients with progressive supranuclear palsy syndrome (PSPS) demonstrate a focal area of midbrain hypometabolism on FDG-PET scans which we call the 'pimple sign'. We assessed its association with midbrain atrophy, its reliability and its ability to differentiate PSPS from corticobasal syndrome (CBS) and multiple system atrophy (MSA). METHODS We identified 67 patients with PSPS, CBS or MSA who had volumetric MRI as well as FDG-PET imaging. Midbrain volume was measured and expressed as a percentage of total intracranial volume. Two independent, blinded specialists rated the 'pimple sign' on FDG-PET as 'absent', 'possible' or 'definite'. Midbrain volumes were compared across these groups and reliability assessed with the kappa statistic. Sensitivity and specificity were calculated using CBS and MSA patients as controls. RESULTS Midbrain volume was decreased in the 'definite' group compared to the 'absent' and 'possible' groups (p = 0.0036). Inter-rater reliability for the pimple sign was high (κ = 0.90). A 'definite pimple sign' had a high specificity (100%) but low sensitivity (29%) for PSPS, whilst the presence of a possible or definite sign had a sensitivity of 79%. CONCLUSION The 'pimple sign' of PSPS is associated with midbrain atrophy, and may be helpful in differentiating PSPS from CBS and MSA.
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Affiliation(s)
- Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Ajay Madhaven
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Val Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Josephs KA, Duffy JR, Strand EA, Machulda MM, Senjem ML, Lowe VJ, Jack CR, Whitwell JL. Syndromes dominated by apraxia of speech show distinct characteristics from agrammatic PPA. Neurology 2013; 81:337-45. [PMID: 23803320 DOI: 10.1212/wnl.0b013e31829c5ed5] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We assessed whether clinical and imaging features of subjects with apraxia of speech (AOS) more severe than aphasia (dominant AOS) are more similar to agrammatic primary progressive aphasia (agPPA) or to primary progressive AOS (PPAOS). METHODS Sixty-seven subjects (PPAOS = 18, dominant AOS = 10, agPPA = 9, age-matched controls = 30) who all had volumetric MRI, diffusion tensor imaging, F18-fluorodeoxyglucose and C11-labeled Pittsburgh compound B (PiB)-PET scanning, as well as neurologic and speech and language assessments, were included in this case-control study. AOS was classified as either type 1, predominated by sound distortions and distorted sound substitutions, or type 2, predominated by syllabically segmented prosodic speech patterns. RESULTS The dominant AOS subjects most often had AOS type 2, similar to PPAOS. In contrast, agPPA subjects most often had type 1 (p = 0.01). Both dominant AOS and PPAOS showed focal imaging abnormalities in premotor cortex, whereas agPPA showed widespread involvement affecting premotor, prefrontal, temporal and parietal lobes, caudate, and insula. Only the dominant AOS and PPAOS groups showed midbrain atrophy compared with controls. No differences were observed in PiB binding across all 3 groups, with the majority being PiB negative. CONCLUSION These results suggest that dominant AOS is more similar to PPAOS than agPPA, with dominant AOS and PPAOS exhibiting a clinically distinguishable subtype of progressive AOS compared with agPPA.
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Affiliation(s)
- Keith A Josephs
- Department of Neurology-Behavioral Neurology, Mayo Clinic, Rochester, MN, USA.
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Whitwell JL, Jack CR, Parisi JE, Gunter JL, Weigand SD, Boeve BF, Ahlskog JE, Petersen RC, Dickson DW, Josephs KA. Midbrain atrophy is not a biomarker of progressive supranuclear palsy pathology. Eur J Neurol 2013; 20:1417-22. [PMID: 23746093 DOI: 10.1111/ene.12212] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/30/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Midbrain atrophy is a characteristic feature of progressive supranuclear palsy (PSP), although it is unclear whether it is associated with the PSP syndrome (PSPS) or PSP pathology. The aim of the present study was to determine whether midbrain atrophy is a useful biomarker of PSP pathology, or whether it is only associated with typical PSPS. METHODS All autopsy-confirmed subjects were identified with the PSP clinical phenotype (i.e. PSPS) or PSP pathology and a volumetric MRI. Of 24 subjects with PSP pathology, 11 had a clinical diagnosis of PSPS (PSP-PSPS), and 13 had a non-PSPS clinical diagnosis (PSP-other). Three subjects had PSPS and corticobasal degeneration pathology (CBD-PSPS). Healthy control and disease control groups (i.e. a group without PSPS or PSP pathology) and a group with CBD pathology and corticobasal syndrome (CBD-CBS) were selected. The midbrain area was measured in all subjects. [Correction added on 21 June 2013, after first online publication: the abbreviation of corticobasal degeneration pathology was changed from CBD-PSP to CBD-PSPS.] RESULTS The midbrain area was reduced in each group with clinical PSPS (with and without PSP pathology). The group with PSP pathology and non-PSPS clinical syndromes did not show reduced midbrain area. Midbrain area was smaller in the subjects with PSPS than in those without PSPS (P < 0.0001), with an area under the receiver operator curve of 0.99 (0.88, 0.99). A midbrain area cut-point of 92 mm(2) provided optimum sensitivity (93%) and specificity (89%) for differentiation. CONCLUSION Midbrain atrophy is associated with the clinical presentation of PSPS, but not with the pathological diagnosis of PSP in the absence of clinical PSPS. This finding has important implications for the utility of midbrain measurements as diagnostic biomarkers for PSP pathology.
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Affiliation(s)
- J L Whitwell
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Liscic RM, Srulijes K, Gröger A, Maetzler W, Berg D. Differentiation of progressive supranuclear palsy: clinical, imaging and laboratory tools. Acta Neurol Scand 2013; 127:362-70. [PMID: 23406296 DOI: 10.1111/ane.12067] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 11/28/2022]
Abstract
Progressive supranuclear palsy (PSP) is the most common atypical parkinsonian syndrome comprising two main clinical subtypes: Richardson's syndrome (RS), characterized by prominent postural instability, supranuclear vertical gaze palsy and frontal dysfunction; and PSP-parkinsonism (PSP-P) which is characterized by an asymmetric onset, tremor and moderate initial therapeutic response to levodopa. The early clinical features of PSP-P are often difficult to discern from idiopathic Parkinson's disease (PD), and other atypical parkinsonian disorders, including multiple system atrophy (MSA) and corticobasal syndrome (CBS). In addition, rare PSP subtypes may be overlooked or misdiagnosed if there are atypical features present. The differentiation between atypical parkinsonian disorders and PD is important because the prognoses are different, and there are different responses to therapy. Structural and functional imaging, although currently of limited diagnostic value for individual use in early disease, may contribute valuable information in the differential diagnosis of PSP. A growing body of evidence shows the importance of CSF biomarkers in distinguishing between atypical parkinsonian disorders particularly early in their course when disease-modifying therapies are becoming available. However, specific diagnostic CSF biomarkers have yet to be identified. In the absence of reliable disease-specific markers, we provide an update of the recent literature on the assessment of clinical symptoms, pathology, neuroimaging and biofluid markers that might help to distinguish between these overlapping conditions early in the course of the disease.
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Affiliation(s)
- R M Liscic
- Center of Neurology, Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Germany
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