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Alster P, Otto-Ślusarczyk D, Kutyłowski M, Migda B, Wiercińska-Drapało A, Jabłońska J, Struga M, Madetko-Alster N. The associations between common neuroimaging parameters of Progressive Supranuclear Palsy in magnetic resonance imaging and non-specific inflammatory factors - pilot study. Front Immunol 2024; 15:1458713. [PMID: 39176092 PMCID: PMC11338774 DOI: 10.3389/fimmu.2024.1458713] [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] [Received: 07/02/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024] Open
Abstract
Progressive Supranuclear Palsy is an atypical parkinsonism based on tauopathic pathology. Growing interest is associated with the pathomechanism of this disease. Among theories analyzing this issue can be mentioned the one highlighting the significance of inflammation. In this study authors examined 14 patients with PSP-Richardson syndrome (PSP-RS) and 13 healthy volunteers using laboratory testing based on the analysis of interleukins 1 and 6 (IL-1 and IL-6), tau in the cerebrospinal fluid (CSF) and non-specific parameters of peripheral inflammation in the serum (IL-1, IL-6, neutrophils, lymphocytes, monocytes, platelets and the ratios based on the factors). All of the patients underwent neuroimaging using magnetic resonance imaging using 3 Tesla. The serum levels of IL-1 were positively correlated with the area of the mesencephalon, suggesting that higher levels of IL-1 are not linked with atrophic changes in this region, whereas serum levels IL-6 was positively correlated with frontal horn width and negatively correlated with superior cerebellar area. Additionally IL-6 in the serum was found to be correlated with neutrophil-to-high density lipoprotein ratio. The observations were not confirmed in the analysis of the levels of interleukins in the CSF. To the best of our knowledge this work is one of the first analyzing this issue. The outcome of the work shows that the role of interleukins associated with microglial activation may possibly differ in the context of neurodegenerative changes, moreover the role of peripheral inflammation in PSP requires further analysis.
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Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, Warsaw, Masovian, Poland
| | | | - Michał Kutyłowski
- Department of Diagnostic Imaging, Mazowiecki Hospital Brodnowski, Warsaw, Poland
| | - Bartosz Migda
- Diagnostic Ultrasound Lab, Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Masovian, Poland
| | - Alicja Wiercińska-Drapało
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Masovian, Poland
| | - Joanna Jabłońska
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Masovian, Poland
| | - Marta Struga
- Department of Biochemistry, Medical University of Warsaw, Warsaw, Masovian, Poland
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Amrami A, Singh NA, Ali F, Pham NTT, Stephens YC, Josephs KA, Whitwell JL. Clinical Utility of Tectal Plate Measurements on Magnetic Resonance Imaging in Progressive Supranuclear Palsy. Mov Disord 2024; 39:1402-1407. [PMID: 38586905 PMCID: PMC11341258 DOI: 10.1002/mds.29806] [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: 10/25/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Midbrain atrophy is a characteristic feature of progressive supranuclear palsy (PSP), observed in PSP-Richardson's syndrome (PSP-RS) and to a lesser extent PSP-parkinsonism (PSP-P). OBJECTIVE Our aim was to critically evaluate the utility of manual magnetic resonance imaging measurements of the midbrain tectal plate as a diagnostic biomarker in PSP. METHODS Length of the tectal plate and width of the superior and inferior colliculi were measured in 40 PSP (20 PSP-RS and 20 PSP-P) patients and compared with 20 Parkinson's disease and 20 healthy control subjects. RESULTS Tectal plate length was reduced in both PSP groups compared with Parkinson's disease and control subjects and was most abnormal in PSP-RS followed by PSP-P. Reduced tectal plate length was associated with worse PSP Rating Scale scores. CONCLUSIONS Simple manual measurements of tectal plate length show utility as a diagnostic biomarker in PSP, particularly for PSP-RS.
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Affiliation(s)
- Abigail Amrami
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester-55905, MN, USA
| | | | - Farwa Ali
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester-55905, MN, USA
| | - Nha Trang Thu Pham
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester-55905, MN, USA
| | | | - Keith A. Josephs
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester-55905, MN, USA
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Dunning EE, Decourt B, Zawia NH, Shill HA, Sabbagh MN. Pharmacotherapies for the Treatment of Progressive Supranuclear Palsy: A Narrative Review. Neurol Ther 2024; 13:975-1013. [PMID: 38743312 PMCID: PMC11263316 DOI: 10.1007/s40120-024-00614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/26/2024] [Indexed: 05/16/2024] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder resulting from the deposition of misfolded and neurotoxic forms of tau protein in specific areas of the midbrain, basal ganglia, and cortex. It is one of the most representative forms of tauopathy. PSP presents in several different phenotypic variations and is often accompanied by the development of concurrent neurodegenerative disorders. PSP is universally fatal, and effective disease-modifying therapies for PSP have not yet been identified. Several tau-targeting treatment modalities, including vaccines, monoclonal antibodies, and microtubule-stabilizing agents, have been investigated and have had no efficacy. The need to treat PSP and other tauopathies is critical, and many clinical trials investigating tau-targeted treatments are underway. In this review, the PubMed database was queried to collect information about preclinical and clinical research on PSP treatment. Additionally, the US National Library of Medicine's ClinicalTrials.gov website was queried to identify past and ongoing clinical trials relevant to PSP treatment. This narrative review summarizes our findings regarding these reports, which include potential disease-modifying drug trials, modifiable risk factor management, and symptom treatments.
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Affiliation(s)
- Elise E Dunning
- Creighton University School of Medicine - Phoenix, Phoenix, AZ, USA
| | - Boris Decourt
- Department of Pharmacology and Neuroscience School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Laboratory on Neurodegeneration and Translational Research, College of Medicine, Roseman University of Health Sciences, Las Vegas, NV, USA
| | - Nasser H Zawia
- Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Doha, Qatar
- Department of Biomedical and Pharmaceutical Sciences, Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI, USA
| | - Holly A Shill
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Marwan N Sabbagh
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA.
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Scaravilli A, Negroni D, Senatore C, Ugga L, Cosottini M, Ricca I, Bender B, Traschütz A, Başak AN, Vural A, van de Warrenburg BP, Durr A, La Piana R, Timmann D, Schüle R, Synofzik M, Santorelli FM, Cocozza S. MRI-ARSACS: An Imaging Index for Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) Identification Based on the Multicenter PROSPAX Study. Mov Disord 2024; 39:1343-1351. [PMID: 38847051 DOI: 10.1002/mds.29871] [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: 02/13/2024] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) and hereditary spastic paraplegia type 7 (SPG7) represent the most common genotypes of spastic ataxia (SPAX). To date, their magnetic resonance imaging (MRI) features have only been described qualitatively, and a pure neuroradiological differential diagnosis between these two conditions is difficult to achieve. OBJECTIVES To test the performance of MRI measures to discriminate between ARSACS and SPG7 (as an index of common SPAX disease). METHODS In this prospective multicenter study, 3D-T1-weighted images of 59 ARSACS (35.4 ± 10.3 years, M/F = 33/26) and 78 SPG7 (54.8 ± 10.3 years, M/F = 51/27) patients of the PROSPAX Consortium were analyzed, together with 30 controls (45.9 ± 16.9 years, M/F = 15/15). Different linear and surface measures were evaluated. A receiver operating characteristic analysis was performed, calculating area under the curve (AUC) and corresponding diagnostic accuracy parameters. RESULTS The pons area proved to be the only metric increased exclusively in ARSACS patients (P = 0.02). Other different measures were reduced in ARSACS and SPG7 compared with controls (all with P ≤ 0.005). A cut-off value equal to 1.67 of the pons-to-superior vermis area ratio proved to have the highest AUC (0.98, diagnostic accuracy 93%, sensitivity 97%) in discriminating between ARSACS and SPG7. CONCLUSIONS Evaluation of the pons-to-superior vermis area ratio can discriminate ARSACS from other SPAX patients, as exemplified here by SPG7. Hence, we hereby propose this ratio as the Magnetic Resonance Index for the Assessment and Recognition of patients harboring SACS mutations (MRI-ARSACS), a novel diagnostic tool able to identify ARSACS patients and useful for discriminating ARSACS from other SPAX patients undergoing MRI. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alessandra Scaravilli
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Davide Negroni
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Claudio Senatore
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mirco Cosottini
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Ivana Ricca
- Department of Molecular Medicine, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Germany
| | - Andreas Traschütz
- Division Translational Genomics of Neurodegenerative Diseases, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Ayşe Nazli Başak
- Translational Medicine Research Center, KUTTAM-NDAL, Koç University, Istanbul, Turkey
| | - Atay Vural
- Department of Neurology, Koç University, Istanbul, Turkey
| | - Bart P van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexandra Durr
- ICM, Inserm, CNRS, AP-HP, Paris Brain Institute, Sorbonne University, Paris, France
| | - Roberta La Piana
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
- Department of Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, Essen, Germany
| | - Rebecca Schüle
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Division of Neurodegenerative Diseases, Department of Neurology, Heidelberg University Hospital and Faculty of Medicine, Heidelberg, Germany
- Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | | | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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Nigro S, Filardi M, Tafuri B, Nicolardi M, De Blasi R, Giugno A, Gnoni V, Milella G, Urso D, Zoccolella S, Logroscino G. Deep Learning-based Approach for Brainstem and Ventricular MR Planimetry: Application in Patients with Progressive Supranuclear Palsy. Radiol Artif Intell 2024; 6:e230151. [PMID: 38506619 PMCID: PMC11140505 DOI: 10.1148/ryai.230151] [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: 05/05/2023] [Revised: 02/01/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
Purpose To develop a fast and fully automated deep learning (DL)-based method for the MRI planimetric segmentation and measurement of the brainstem and ventricular structures most affected in patients with progressive supranuclear palsy (PSP). Materials and Methods In this retrospective study, T1-weighted MR images in healthy controls (n = 84) were used to train DL models for segmenting the midbrain, pons, middle cerebellar peduncle (MCP), superior cerebellar peduncle (SCP), third ventricle, and frontal horns (FHs). Internal, external, and clinical test datasets (n = 305) were used to assess segmentation model reliability. DL masks from test datasets were used to automatically extract midbrain and pons areas and the width of MCP, SCP, third ventricle, and FHs. Automated measurements were compared with those manually performed by an expert radiologist. Finally, these measures were combined to calculate the midbrain to pons area ratio, MR parkinsonism index (MRPI), and MRPI 2.0, which were used to differentiate patients with PSP (n = 71) from those with Parkinson disease (PD) (n = 129). Results Dice coefficients above 0.85 were found for all brain regions when comparing manual and DL-based segmentations. A strong correlation was observed between automated and manual measurements (Spearman ρ > 0.80, P < .001). DL-based measurements showed excellent performance in differentiating patients with PSP from those with PD, with an area under the receiver operating characteristic curve above 0.92. Conclusion The automated approach successfully segmented and measured the brainstem and ventricular structures. DL-based models may represent a useful approach to support the diagnosis of PSP and potentially other conditions associated with brainstem and ventricular alterations. Keywords: MR Imaging, Brain/Brain Stem, Segmentation, Quantification, Diagnosis, Convolutional Neural Network Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Mohajer in this issue.
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Affiliation(s)
- Salvatore Nigro
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Marco Filardi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Benedetta Tafuri
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Martina Nicolardi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Roberto De Blasi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Alessia Giugno
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Valentina Gnoni
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Giammarco Milella
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Daniele Urso
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Stefano Zoccolella
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Giancarlo Logroscino
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
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6
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Chougar L, Faucher A, Faouzi J, Lejeune FX, Gama Lobo G, Jovanovic C, Cormier F, Dupont G, Vidailhet M, Corvol JC, Colliot O, Lehéricy S, Grabli D, Degos B. Contribution of MRI for the Early Diagnosis of Parkinsonism in Patients with Diagnostic Uncertainty. Mov Disord 2024; 39:825-835. [PMID: 38486423 DOI: 10.1002/mds.29760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/16/2024] [Accepted: 02/16/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND International clinical criteria are the reference for the diagnosis of degenerative parkinsonism in clinical research, but they may lack sensitivity and specificity in the early stages. OBJECTIVES To determine whether magnetic resonance imaging (MRI) analysis, through visual reading or machine-learning approaches, improves diagnostic accuracy compared with clinical diagnosis at an early stage in patients referred for suspected degenerative parkinsonism. MATERIALS Patients with initial diagnostic uncertainty between Parkinson's disease (PD), progressive supranuclear palsy (PSP), and multisystem atrophy (MSA), with brain MRI performed at the initial visit (V1) and available 2-year follow-up (V2), were included. We evaluated the accuracy of the diagnosis established based on: (1) the international clinical diagnostic criteria for PD, PSP, and MSA at V1 ("Clin1"); (2) MRI visual reading blinded to the clinical diagnosis ("MRI"); (3) both MRI visual reading and clinical criteria at V1 ("MRI and Clin1"), and (4) a machine-learning algorithm ("Algorithm"). The gold standard diagnosis was established by expert consensus after a 2-year follow-up. RESULTS We recruited 113 patients (53 with PD, 31 with PSP, and 29 with MSA). Considering the whole population, compared with clinical criteria at the initial visit ("Clin1": balanced accuracy, 66.2%), MRI visual reading showed a diagnostic gain of 14.3% ("MRI": 80.5%; P = 0.01), increasing to 19.2% when combined with the clinical diagnosis at the initial visit ("MRI and Clin1": 85.4%; P < 0.0001). The algorithm achieved a diagnostic gain of 9.9% ("Algorithm": 76.1%; P = 0.08). CONCLUSION Our study shows the use of MRI analysis, whether by visual reading or machine-learning methods, for early differentiation of parkinsonism. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lydia Chougar
- Department of Neuroradiology, Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Paris, France
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France
- ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France
- Department of Neuroradiology, Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Paris, France
| | - Alice Faucher
- Assistance Publique Hôpitaux de Paris, Service de Neurologie, Hôpital Avicenne, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Sorbonne Paris Nord, NS-PARK/FCRIN Network, Bobigny, France
| | - Johann Faouzi
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
- CREST, ENSAI, Campus de Ker-Lann, Bruz, France
| | - François-Xavier Lejeune
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, Paris, France
- ICM, Data Analysis Core (DAC), Paris, France
| | - Gonçalo Gama Lobo
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Carna Jovanovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Florence Cormier
- Département de Neurologie, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Clinique des Mouvements Anormaux, Clinical Investigation Center for Neurosciences, Paris, France
| | - Gwendoline Dupont
- Université de Bourgogne, Dijon, France
- Département de Neurologie, Centre Hospitalier Universitaire François Mitterrand, Dijon, France
| | - Marie Vidailhet
- ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, Paris, France
- Département de Neurologie, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Clinique des Mouvements Anormaux, Clinical Investigation Center for Neurosciences, Paris, France
| | - Olivier Colliot
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Stéphane Lehéricy
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France
- ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France
- Department of Neuroradiology, Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Paris, France
| | - David Grabli
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inserm, Paris, France
- Département de Neurologie, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Clinique des Mouvements Anormaux, Clinical Investigation Center for Neurosciences, Paris, France
| | - Bertrand Degos
- Assistance Publique Hôpitaux de Paris, Service de Neurologie, Hôpital Avicenne, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Sorbonne Paris Nord, NS-PARK/FCRIN Network, Bobigny, France
- Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France
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7
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Georgiopoulos C, Papadimitriou S, Nyholm D, Kilander L, Löwenmark M, Fällmar D, Virhammar J. Quantitative brain stem assessment in discriminating neurodegenerative disorders from normal pressure hydrocephalus. J Neuroimaging 2024. [PMID: 38676300 DOI: 10.1111/jon.13204] [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: 02/28/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND AND PURPOSE Differentiating idiopathic normal pressure hydrocephalus (iNPH) from neurodegenerative disorders such as progressive supranuclear palsy (PSP), Multiple System Atrophy-parkinsonian type (MSA-P), and vascular dementia (VaD) is challenging due to overlapping clinical and neuroimaging findings. This study assesses if quantitative brain stem and cerebellum metrics can aid in this differentiation. METHODS We retrospectively compared the sagittal midbrain area, midbrain to pons ratio, MR parkinsonism index (MRPI), and cerebellar atrophy in 30 PSP patients, 31 iNPH patients, 27 MSA-P patients, 32 VaD patients, and 25 healthy controls. Statistical analyses determined group differences, sensitivity, specificity, and the area under the receiver operating characteristic curves. RESULTS There was an overlap in midbrain morphology between PSP and iNPH, as assessed with MRPI, midbrain to pons ratio, and midbrain area. A cutoff value of MRPI > 13 exhibited 84% specificity in distinguishing PSP from iNPH and 100% in discriminating PSP from all other conditions. A cutoff value of midbrain to pons ratio at <0.15 yielded 95% specificity for differentiating PSP from iNPH and 100% from all other conditions. A cutoff value of midbrain area at <87 mm2 exhibited 97% specificity for differentiating PSP from iNPH and 100% from all other conditions. All measures showed low sensitivity. Cerebellar atrophy did not differ significantly among groups. CONCLUSION Our study questions MRPI's diagnostic performance in distinguishing PSP from iNPH. Simpler indices such as midbrain to pons ratio and midbrain area showed similar or better accuracy. However, all these indices displayed low sensitivity despite significant differences among PSP, MSA-P, and VaD.
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Affiliation(s)
| | | | - Dag Nyholm
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Malin Löwenmark
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - David Fällmar
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Johan Virhammar
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
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8
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Kawabata K, Krismer F, Heim B, Hussl A, Mueller C, Scherfler C, Gizewski ER, Seppi K, Poewe W. A Blinded Evaluation of Brain Morphometry for Differential Diagnosis of Atypical Parkinsonism. Mov Disord Clin Pract 2024; 11:381-390. [PMID: 38314609 PMCID: PMC10982602 DOI: 10.1002/mdc3.13987] [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: 12/22/2023] [Accepted: 01/14/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Advanced imaging techniques have been studied for differential diagnosis between PD, MSA, and PSP. OBJECTIVES This study aims to validate the utility of individual voxel-based morphometry techniques for atypical parkinsonism in a blinded fashion. METHODS Forty-eight healthy controls (HC) T1-WI were used to develop a referential dataset and fit a general linear model after segmentation into gray matter (GM) and white matter (WM) compartments. Segmented GM and WM with PD (n = 96), MSA (n = 18), and PSP (n = 20) were transformed into z-scores using the statistics of referential HC and individual voxel-based z-score maps were generated. An imaging diagnosis was assigned by two independent raters (trained and untrained) blinded to clinical information and final diagnosis. Furthermore, we developed an observer-independent index for ROI-based automated differentiation. RESULTS The diagnostic performance using voxel-based z-score maps by rater 1 and rater 2 for MSA yielded sensitivities: 0.89, 0.94 (95% CI: 0.74-1.00, 0.84-1.00), specificities: 0.94, 0.80 (0.90-0.98, 0.73-0.87); for PSP, sensitivities: 0.85, 0.90 (0.69-1.00, 0.77-1.00), specificities: 0.98, 0.94 (0.96-1.00, 0.90-0.98). Interrater agreement was good for MSA (Cohen's kappa: 0.61), and excellent for PSP (0.84). Receiver operating characteristic analysis using the ROI-based new index showed an area under the curve (AUC): 0.89 (0.77-1.00) for MSA, and 0.99 (0.98-1.00) for PSP. CONCLUSIONS These evaluations provide support for the utility of this imaging technique in the differential diagnosis of atypical parkinsonism demonstrating a remarkably high differentiation accuracy for PSP, suggesting potential use in clinical settings in the future.
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Affiliation(s)
- Kazuya Kawabata
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Department of NeurologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Florian Krismer
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
| | - Beatrice Heim
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
| | - Anna Hussl
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | | | - Christoph Scherfler
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
| | - Elke R. Gizewski
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
- Department of NeuroradiologyMedical University InnsbruckInnsbruckAustria
| | - Klaus Seppi
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
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9
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Yamahara N, Yoshikura N, Shimohata T. [Clinical features and effects of shunt surgery in patients with progressive supranuclear palsy and idiopathic normal pressure hydrocephalus]. Rinsho Shinkeigaku 2024; 64:113-116. [PMID: 38246604 DOI: 10.5692/clinicalneurol.cn-001920] [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] [Indexed: 01/23/2024]
Abstract
This study aimed to retrospectively review the frequency and clinical features of 13 patients with progressive supranuclear palsy (PSP) and idiopathic normal pressure hydrocephalus (iNPH). All patients were found to have PSP-Richardson's syndrome (PSP-RS). Shunt surgery was effective in 5 of 11 patients (45.5%). A comparison of these 5 patients who responded to shunt surgery versus the remaining 6 patients revealed a significant difference in the reduction of frontal lobe blood flow on cerebral perfusion single-photon emission computed tomography (SPECT) (P = 0.018). These results suggest that PSP-RS is common in patients with PSP and iNPH and indicate the usefulness of cerebral perfusion SPECT in estimating the effect of shunt surgery.
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Affiliation(s)
- Naoki Yamahara
- Department of Neurology, Gifu University Graduate School of Medicine
| | - Nobuaki Yoshikura
- Department of Neurology, Gifu University Graduate School of Medicine
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10
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Stephen CD, Vangel M, Gupta AS, MacMore JP, Schmahmann JD. Rates of change of pons and middle cerebellar peduncle diameters are diagnostic of multiple system atrophy of the cerebellar type. Brain Commun 2024; 6:fcae019. [PMID: 38410617 PMCID: PMC10896291 DOI: 10.1093/braincomms/fcae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/01/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
Definitive diagnosis of multiple system atrophy of the cerebellar type (MSA-C) is challenging. We hypothesized that rates of change of pons and middle cerebellar peduncle diameters on MRI would be unique to MSA-C and serve as diagnostic biomarkers. We defined the normative data for anterior-posterior pons and transverse middle cerebellar peduncle diameters on brain MRI in healthy controls, performed diameter-volume correlations and measured intra- and inter-rater reliability. We studied an Exploratory cohort (2002-2014) of 88 MSA-C and 78 other cerebellar ataxia patients, and a Validation cohort (2015-2021) of 49 MSA-C, 13 multiple system atrophy of the parkinsonian type (MSA-P), 99 other cerebellar ataxia patients and 314 non-ataxia patients. We measured anterior-posterior pons and middle cerebellar peduncle diameters on baseline and subsequent MRIs, and correlated results with Brief Ataxia Rating Scale scores. We assessed midbrain:pons and middle cerebellar peduncle:pons ratios over time. The normative anterior-posterior pons diameter was 23.6 ± 1.6 mm, and middle cerebellar peduncle diameter 16.4 ± 1.4 mm. Pons diameter correlated with volume, r = 0.94, P < 0.0001. The anterior-posterior pons and middle cerebellar peduncle measures were smaller at first scan in MSA-C compared to all other ataxias; anterior-posterior pons diameter: Exploratory, 19.3 ± 2.6 mm versus 20.7 ± 2.6 mm, Validation, 19.9 ± 2.1 mm versus 21.1 ± 2.1 mm; middle cerebellar peduncle transverse diameter, Exploratory, 12.0 ± 2.6 mm versus 14.3 ±2.1 mm, Validation, 13.6 ± 2.1 mm versus 15.1 ± 1.8 mm, all P < 0.001. The anterior-posterior pons and middle cerebellar peduncle rates of change were faster in MSA-C than in all other ataxias; anterior-posterior pons diameter rates of change: Exploratory, -0.87 ± 0.04 mm/year versus -0.09 ± 0.02 mm/year, Validation, -0.89 ± 0.48 mm/year versus -0.10 ± 0.21 mm/year; middle cerebellar peduncle transverse diameter rates of change: Exploratory, -0.84 ± 0.05 mm/year versus -0.08 ± 0.02 mm/year, Validation, -0.94 ± 0.64 mm/year versus -0.11 ± 0.27 mm/year, all values P < 0.0001. Anterior-posterior pons and middle cerebellar peduncle diameters were indistinguishable between Possible, Probable and Definite MSA-C. The rate of anterior-posterior pons atrophy was linear, correlating with ataxia severity. Using a lower threshold anterior-posterior pons diameter decrease of -0.4 mm/year to balance sensitivity and specificity, area under the curve analysis discriminating MSA-C from other ataxias was 0.94, yielding sensitivity 0.92 and specificity 0.87. For the middle cerebellar peduncle, with threshold decline -0.5 mm/year, area under the curve was 0.90 yielding sensitivity 0.85 and specificity 0.79. The midbrain:pons ratio increased progressively in MSA-C, whereas the middle cerebellar peduncle:pons ratio was almost unchanged. Anterior-posterior pons and middle cerebellar peduncle diameters were smaller in MSA-C than in MSA-P, P < 0.001. We conclude from this 20-year longitudinal clinical and imaging study that anterior-posterior pons and middle cerebellar peduncle diameters are phenotypic imaging biomarkers of MSA-C. In the correct clinical context, an anterior-posterior pons and transverse middle cerebellar peduncle diameter decline of ∼0.8 mm/year is sufficient for and diagnostic of MSA-C.
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Affiliation(s)
- Christopher D Stephen
- Ataxia Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Cognitive Behavioral Neurology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Mark Vangel
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA
| | - Anoopum S Gupta
- Ataxia Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Cognitive Behavioral Neurology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Jason P MacMore
- Ataxia Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Cognitive Behavioral Neurology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Jeremy D Schmahmann
- Ataxia Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Cognitive Behavioral Neurology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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11
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Alster P, Otto-Ślusarczyk D, Szlufik S, Duszyńska-Wąs K, Drzewińska A, Wiercińska-Drapało A, Struga M, Kutyłowski M, Friedman A, Madetko-Alster N. The significance of glial cell line-derived neurotrophic factor analysis in Progressive Supranuclear Palsy. Sci Rep 2024; 14:2805. [PMID: 38307947 PMCID: PMC10837430 DOI: 10.1038/s41598-024-53355-y] [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: 11/26/2023] [Accepted: 01/31/2024] [Indexed: 02/04/2024] Open
Abstract
Progressive Supranuclear Palsy (PSP) is an atypical parkinsonism. Major subtypes of the disease: PSP-Richardson's Syndrome (PSP-RS) and PSP Parkinsonism Predominant (PSP-P) vary in clinical features, the pathomechanism remains unexplored. The aim of this work is to analyze the relevance of glial cell line-derived neurotrophic factor (GDNF) evaluation in the serum and cerebrospinal fluid (CSF) in PSP subtypes and to verify its significance as a possible factor in the in vivo examination. Authors assessed the concentration of GDNF in the serum and CSF of 12 patients with PSP-RS, 12 with PSP-P and 12 controls. Additionally authors evaluated patients using Unified Parkinson's Disease Rating Scale-III part (UPDRS-III), Frontal Assessment Battery (FAB) and Magnetic Resonance Imaging (MRI). The evaluation revealed significantly increased concentrations of GDNF in the CSF among PSP-RS patients and substantially increased concentrations of GDNF in the serum in PSP-P. Though the GDNF concentrations differentiated PSP subtypes, no correlations between with clinical factors were observed however certain correlations with atrophic changes in MRI were detected. GDNF is a factor which may impact the pathogenesis of PSP. Possible implementation of GDNF as a therapeutic factor could be a perspective in the search for therapy in this currently incurable disease.
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Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland.
| | | | - Stanisław Szlufik
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
| | - Karolina Duszyńska-Wąs
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
| | - Agnieszka Drzewińska
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Hepatology and Infectious and Tropical Diseases, Medical University of Warsaw, Provincial Infectious Diseases Hospital in Warsaw, Warsaw, Poland
| | - Marta Struga
- Department of Biochemistry, Medical University of Warsaw, Warsaw, Poland
| | - Michał Kutyłowski
- Department of Diagnostic Imaging, Brodno Mazovian Hospital, Warsaw, Poland
| | - Andrzej Friedman
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
| | - Natalia Madetko-Alster
- Department of Neurology, Medical University of Warsaw, Kondratowicza 8, 03-242, Warsaw, Poland
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12
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Satoh R, Ali F, Botha H, Lowe VJ, Josephs KA, Whitwell JL. Direct comparison between 18F-Flortaucipir tau PET and quantitative susceptibility mapping in progressive supranuclear palsy. Neuroimage 2024; 286:120509. [PMID: 38184157 PMCID: PMC10868646 DOI: 10.1016/j.neuroimage.2024.120509] [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: 09/11/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/08/2024] Open
Abstract
PURPOSE The pattern of flortaucipir tau PET uptake is topographically similar to the pattern of magnetic susceptibility in progressive supranuclear palsy (PSP); both with increased signal in subcortical structures such as the basal ganglia and midbrain, suggesting that they may be closely related. However, their relationship remains unknown since no studies have directly compared these two modalities in the same PSP cohort. We hypothesized that some flortaucipir uptake in PSP is associated with magnetic susceptibility, and hence iron deposition. The aim of this study was to evaluate the regional relationship between flortaucipir uptake and magnetic susceptibility and to examine the effects of susceptibility on flortaucipir uptake in PSP. METHODS Fifty PSP patients and 67 cognitively normal controls were prospectively recruited and underwent three Tesla MRI and flortaucipir tau PET scans. Quantitative susceptibility maps were reconstructed from multi-echo gradient-echo MRI images. Region of interest (ROI) analysis was performed to obtain flortaucipir and susceptibility values in the subcortical regions. Relationships between flortaucipir and susceptibility signals were evaluated using partial correlation analysis in the subcortical ROIs and voxel-based analysis in the whole brain. The effects of susceptibility on flortaucipir uptake were examined by using the framework of mediation analysis. RESULTS Both flortaucipir and susceptibility were greater in PSP compared to controls in the putamen, pallidum, subthalamic nucleus, red nucleus, and cerebellar dentate (p<0.05). The ROI-based and voxel-based analyses showed that these two signals were positively correlated in these five regions (r = 0.36-0.59, p<0.05). Mediation analysis showed that greater flortaucipir uptake was partially explained by susceptibility in the putamen, pallidum, subthalamic nucleus, and red nucleus, and fully explained in the cerebellar dentate. CONCLUSIONS These results suggest that some of the flortaucipir uptake in subcortical regions in PSP is related to iron deposition. These findings will contribute to our understanding of the mechanisms underlying flortaucipir tau PET findings in PSP and other neurodegenerative diseases.
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Affiliation(s)
- Ryota Satoh
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, 200 1st St SW, 55905, Rochester, MN, USA
| | | | - Jennifer L Whitwell
- Department of Radiology, Mayo Clinic, 200 1st St SW, 55905, Rochester, MN, USA.
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13
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Batheja V, Fish M, Balar AB, Hogg JP, Lakhani DA, Khan M. Progressive supranuclear palsy: A case report and brief review of the literature. Radiol Case Rep 2024; 19:250-253. [PMID: 38028282 PMCID: PMC10630753 DOI: 10.1016/j.radcr.2023.09.012] [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: 07/22/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Atypical Parkinsonian syndromes are a subset of progressive neurodegenerative disorders that present with signs of Parkinson's disease. However, due to multisystem degeneration, the atypical Parkinsonian syndromes have additional symptoms that are often referred to as Parkinson-plus syndromes. The most well-studied subsets include progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and Lewy body dementia. Specifically, progressive supranuclear palsy is a tauopathy neurodegenerative disorder that presents with parkinsonism symptoms along with postural instability, vertical saccade, and vertical gaze palsy. Here, we present a case of PSP and provide a brief review of the literature.
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Affiliation(s)
- Vivek Batheja
- Department of Internal Medicine, George Washington University Hospital, Washington, DC
| | - Morgan Fish
- Department of Radiology, West Virginia University, Morgantown, WV
| | - Aneri B. Balar
- Department of Radiology, West Virginia University, Morgantown, WV
| | - Jeffery P. Hogg
- Department of Radiology, West Virginia University, Morgantown, WV
| | | | - Musharaf Khan
- Department of Radiology, West Virginia University, Morgantown, WV
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14
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Savoie FA, Arpin DJ, Vaillancourt DE. Magnetic Resonance Imaging and Nuclear Imaging of Parkinsonian Disorders: Where do we go from here? Curr Neuropharmacol 2024; 22:1583-1605. [PMID: 37533246 DOI: 10.2174/1570159x21666230801140648] [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: 08/10/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 08/04/2023] Open
Abstract
Parkinsonian disorders are a heterogeneous group of incurable neurodegenerative diseases that significantly reduce quality of life and constitute a substantial economic burden. Nuclear imaging (NI) and magnetic resonance imaging (MRI) have played and continue to play a key role in research aimed at understanding and monitoring these disorders. MRI is cheaper, more accessible, nonirradiating, and better at measuring biological structures and hemodynamics than NI. NI, on the other hand, can track molecular processes, which may be crucial for the development of efficient diseasemodifying therapies. Given the strengths and weaknesses of NI and MRI, how can they best be applied to Parkinsonism research going forward? This review aims to examine the effectiveness of NI and MRI in three areas of Parkinsonism research (differential diagnosis, prodromal disease identification, and disease monitoring) to highlight where they can be most impactful. Based on the available literature, MRI can assist with differential diagnosis, prodromal disease identification, and disease monitoring as well as NI. However, more work is needed, to confirm the value of MRI for monitoring prodromal disease and predicting phenoconversion. Although NI can complement or be a substitute for MRI in all the areas covered in this review, we believe that its most meaningful impact will emerge once reliable Parkinsonian proteinopathy tracers become available. Future work in tracer development and high-field imaging will continue to influence the landscape for NI and MRI.
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Affiliation(s)
- Félix-Antoine Savoie
- Department of Applied Physiology and Kinesiology, Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
| | - David J Arpin
- Department of Applied Physiology and Kinesiology, Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
| | - David E Vaillancourt
- Department of Applied Physiology and Kinesiology, Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, FL, USA
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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15
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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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Strobel J, Müller HP, Ludolph AC, Beer AJ, Sollmann N, Kassubek J. New Perspectives in Radiological and Radiopharmaceutical Hybrid Imaging in Progressive Supranuclear Palsy: A Systematic Review. Cells 2023; 12:2776. [PMID: 38132096 PMCID: PMC10742083 DOI: 10.3390/cells12242776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by four-repeat tau deposition in various cell types and anatomical regions, and can manifest as several clinical phenotypes, including the most common phenotype, Richardson's syndrome. The limited availability of biomarkers for PSP relates to the overlap of clinical features with other neurodegenerative disorders, but identification of a growing number of biomarkers from imaging is underway. One way to increase the reliability of imaging biomarkers is to combine different modalities for multimodal imaging. This review aimed to provide an overview of the current state of PSP hybrid imaging by combinations of positron emission tomography (PET) and magnetic resonance imaging (MRI). Specifically, combined PET and MRI studies in PSP highlight the potential of [18F]AV-1451 to detect tau, but also the challenge in differentiating PSP from other neurodegenerative diseases. Studies over the last years showed a reduced synaptic density in [11C]UCB-J PET, linked [11C]PK11195 and [18F]AV-1451 markers to disease progression, and suggested the potential role of [18F]RO948 PET for identifying tau pathology in subcortical regions. The integration of quantitative global and regional gray matter analysis by MRI may further guide the assessment of reduced cortical thickness or volume alterations, and diffusion MRI could provide insight into microstructural changes and structural connectivity in PSP. Challenges in radiopharmaceutical biomarkers and hybrid imaging require further research targeting markers for comprehensive PSP diagnosis.
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Affiliation(s)
- Joachim Strobel
- Department of Nuclear Medicine, University Hospital Ulm, 89081 Ulm, Germany;
| | - Hans-Peter Müller
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (H.-P.M.); (A.C.L.); (J.K.)
| | - Albert C. Ludolph
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (H.-P.M.); (A.C.L.); (J.K.)
- German Center for Neurodegenerative Diseases (DZNE), Ulm University, 89081 Ulm, Germany
| | - Ambros J. Beer
- Department of Nuclear Medicine, University Hospital Ulm, 89081 Ulm, Germany;
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany;
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Jan Kassubek
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (H.-P.M.); (A.C.L.); (J.K.)
- German Center for Neurodegenerative Diseases (DZNE), Ulm University, 89081 Ulm, Germany
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Kim J, Young GS, Willett AS, Pitaro AT, Crotty GF, Mesidor M, Jones KA, Bay C, Zhang M, Feany MB, Xu X, Qin L, Khurana V. Toward More Accessible Fully Automated 3D Volumetric MRI Decision Trees for the Differential Diagnosis of Multiple System Atrophy, Related Disorders, and Age-Matched Healthy Subjects. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1098-1108. [PMID: 36156185 PMCID: PMC10657274 DOI: 10.1007/s12311-022-01472-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
Differentiating multiple system atrophy (MSA) from related neurodegenerative movement disorders (NMD) is challenging. MRI is widely available and automated decision-tree analysis is simple, transparent, and resistant to overfitting. Using a retrospective cohort of heterogeneous clinical MRIs broadly sourced from a tertiary hospital system, we aimed to develop readily translatable and fully automated volumetric diagnostic decision-trees to facilitate early and accurate differential diagnosis of NMDs. 3DT1 MRI from 171 NMD patients (72 MSA, 49 PSP, 50 PD) and 171 matched healthy subjects were automatically segmented using Freesurfer6.0 with brainstem module. Decision trees employing substructure volumes and a novel volumetric pons-to-midbrain ratio (3D-PMR) were produced and tenfold cross-validation performed. The optimal tree separating NMD from healthy subjects selected cerebellar white matter, thalamus, putamen, striatum, and midbrain volumes as nodes. Its sensitivity was 84%, specificity 94%, accuracy 84%, and kappa 0.69 in cross-validation. The optimal tree restricted to NMD patients selected 3D-PMR, thalamus, superior cerebellar peduncle (SCP), midbrain, pons, and putamen as nodes. It yielded sensitivities/specificities of 94/84% for MSA, 72/96% for PSP, and 73/92% PD, with 79% accuracy and 0.62 kappa. There was correct classification of 16/17 MSA, 5/8 PSP, 6/8 PD autopsy-confirmed patients, and 6/8 MRIs that preceded motor symptom onset. Fully automated decision trees utilizing volumetric MRI data distinguished NMD patients from healthy subjects and MSA from other NMDs with promising accuracy, including autopsy-confirmed and pre-symptomatic subsets. Our open-source methodology is well-suited for widespread clinical translation. Assessment in even more heterogeneous retrospective and prospective cohorts is indicated.
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Affiliation(s)
- Jisoo Kim
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Geoffrey S Young
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Andrew S Willett
- Division of Movement Disorders, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Ariana T Pitaro
- Division of Movement Disorders, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Grace F Crotty
- Division of Movement Disorders, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Merlyne Mesidor
- Division of Movement Disorders, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Kristie A Jones
- Division of Movement Disorders, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Camden Bay
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Min Zhang
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Mel B Feany
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Xiaoyin Xu
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Lei Qin
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, 02115, USA
| | - Vikram Khurana
- Division of Movement Disorders, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Hale Building for Transformative Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
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18
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Quattrone A, Nigro S, Bianco MG, Augimeri A, Quattrone A. Letter to the Editor: "Accurate measurement of magnetic resonance parkinsonism index by a fully automatic and deep learning quantification pipeline". Eur Radiol 2023; 33:8854-8855. [PMID: 37919407 DOI: 10.1007/s00330-023-10289-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/04/2023] [Accepted: 08/30/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Andrea Quattrone
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Lecce, Italy
| | - Maria Giovanna Bianco
- Neuroscience Research Centre, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Germaneto, 88100, Catanzaro, Italy
| | | | - Aldo Quattrone
- Neuroscience Research Centre, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Germaneto, 88100, Catanzaro, Italy.
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Satoh R, Weigand SD, Pham T, Ali F, Arani A, Senjem ML, Jack CR, Whitwell JL, Josephs KA. Magnetic Susceptibility in Progressive Supranuclear Palsy Variants, Parkinson's Disease, and Corticobasal Syndrome. Mov Disord 2023; 38:2282-2290. [PMID: 37772771 PMCID: PMC10840892 DOI: 10.1002/mds.29613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Previous studies have shown that magnetic susceptibility is increased in several subcortical regions in progressive supranuclear palsy (PSP). However, it is still unclear how subcortical and cortical susceptibilities vary across different PSP variants, Parkinson's disease (PD), and corticobasal syndrome (CBS). OBJECTIVE This study aims to clarify the susceptibility profiles in the subcortical and cortical regions in different PSP variants, PD, and CBS. METHODS Sixty-four patients, 20 PSP-Richardson syndrome (PSP-RS), 9 PSP-parkinsonism (PSP-P), 7 PSP-progressive gait freezing, 4 PSP-postural instability, 11 PD, and 13 CBS, and 20 cognitively normal control subjects underwent a 3-Tesla magnetic resonance imaging scan to reconstruct quantitative susceptibility maps. Region-of-interest analysis was performed to obtain susceptibility in several subcortical and cortical regions. Bayesian linear mixed effect models were used to estimate susceptibility within group and differences between groups. RESULTS In the subcortical regions, patients with PSP-RS and PSP-P showed greater susceptibility than control subjects in the pallidum, substantia nigra, red nucleus, and cerebellar dentate (P < 0.05). Patients with PSP-RS also showed greater susceptibility than patients with PSP-progressive gait freezing, PD, and CBS in the red nucleus and cerebellar dentate, and patients with PSP-P showed greater susceptibility than PD in the red nucleus. Patients with PSP-postural instability and CBS showed greater susceptibility than control subjects in the pallidum and substantia nigra. No significant differences were observed in any cortical region. CONCLUSIONS The PSP variants and CBS had different patterns of magnetic susceptibility in the subcortical regions. The findings will contribute to our understanding about iron profiles and pathophysiology of PSP and may provide a potential biomarker to differentiate PSP variants, PD, and CBS. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ryota Satoh
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Stephen D Weigand
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - Thu Pham
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Arvin Arani
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Matthew L. Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Information Technology, Mayo Clinic, Rochester, MN, 55905, USA
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20
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Street D, Bevan-Jones WR, Malpetti M, Jones PS, Passamonti L, Ghosh BC, Rittman T, Coyle-Gilchrist IT, Allinson K, Dawson CE, Rowe JB. Structural correlates of survival in progressive supranuclear palsy. Parkinsonism Relat Disord 2023; 116:105866. [PMID: 37804622 PMCID: PMC7615224 DOI: 10.1016/j.parkreldis.2023.105866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/12/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Many studies of the Richardson's syndrome phenotype of progressive supranuclear palsy (PSP) have elucidated regions of progressive atrophy and neural correlates of clinical severity. However, the neural correlates of survival and how these differ according to variant phenotypes are poorly understood. We set out to identify structural changes that predict severity and survival from scanning date to death. METHODS Structural magnetic resonance imaging data from 112 deceased people with clinically defined 'probable' or 'possible' PSP were analysed. Neuroanatomical regions of interest volumes, thickness and area were correlated with 'temporal stage', defined as the ratio of time from symptom onset to death, time from scan to death ('survival from scan'), and in a subset of patients, clinical severity, adjusting for age and total intracranial volume. Forty-nine participants had post mortem confirmation of the diagnosis. RESULTS Using T1-weighted magnetic resonance imaging, we confirmed the midbrain, and bilateral cortical structural correlates of contemporary disease severity. Atrophy of the striatum, cerebellum and frontotemporal cortex correlate with temporal stage and survival from scan, even after adjusting for severity. Subcortical structure-survival relationships were stronger in Richardson's syndrome than variant phenotypes. CONCLUSIONS Although the duration of PSP varies widely between people, an individual's progress from disease onset to death (their temporal stage) reflects atrophy in striatal, cerebellar and frontotemporal cortical regions. Our findings suggest magnetic resonance imaging may contribute to prognostication and stratification of patients with heterogenous clinical trajectories and clarify the processes that confer mortality risk in PSP.
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Affiliation(s)
- Duncan Street
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | | | - Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Consiglio Nazionale Delle Ricerche (CNR), Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Milano, Italy
| | - Boyd Cp Ghosh
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - Ian Ts Coyle-Gilchrist
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Norfolk and Norwich NHS Foundation Trust, Norwich, UK
| | - Kieren Allinson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Department of Pathology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Catherine E Dawson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
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21
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Persely A, Beszedics B, Paloczi K, Piroska M, Alijanpourotaghsara A, Strelnikov D, Vessal A, Szabo H, Hernyes A, Zoldi L, Jokkel Z, Fekete A, Juhasz J, Makra N, Szabo D, Buzas E, Tarnoki AD, Tarnoki DL. Analysis of Genetic and MRI Changes, Blood Markers, and Risk Factors in a Twin Pair Discordant of Progressive Supranuclear Palsy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1696. [PMID: 37893413 PMCID: PMC10608279 DOI: 10.3390/medicina59101696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Progressive supranuclear palsy (PSP) is a neurodegenerative disease, a tauopathy, which results in a wide clinical spectrum of neurological symptoms. The diagnosis is mostly based on clinical signs and neuroimaging; however, possible biomarkers for screening have been under investigation, and the role of the gut microbiome is unknown. The aim of our study was to identify potential blood biomarkers and observe variations in the gut microbiome within a PSP discordant monozygotic twin pair. Materials and Methods: Anthropometric measurements, neuropsychological tests, and the neurological state were evaluated. Blood was collected for metabolic profiling and for the detection of neurodegenerative and vascular biomarkers. Both the gut microbiome and brain MRI results were thoroughly examined. Results: We found a relevant difference between alpha-synuclein levels and moderate difference in the levels of MMP-2, MB, Apo-A1, Apo-CIII, and Apo-H. With respect to the ratios, a small difference was observed for ApoA1/SAA and ApoB/ApoA1. Using a microbiome analysis, we also discovered a relative dysbiosis, and the MRI results revealed midbrain and frontoparietal cortical atrophy along with a reduction in overall brain volumes and an increase in white matter lesions in the affected twin. Conclusions: We observed significant differences between the unaffected and affected twins in some risk factors and blood biomarkers, along with disparities in the gut microbiome. Additionally, we detected abnormalities in brain MRI results and alterations in cognitive functions.
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Affiliation(s)
- Aliz Persely
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
- Neurology Department, Medical Centre Hungarian Defence Forces, 1134 Budapest, Hungary
| | - Beatrix Beszedics
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Krisztina Paloczi
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 1085 Budapest, Hungary; (K.P.); (E.B.)
| | - Marton Piroska
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Amirreza Alijanpourotaghsara
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - David Strelnikov
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Arsalan Vessal
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Helga Szabo
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
- Central Radiological Diagnostic Department, Medical Centre Hungarian Defence Forces, 1134 Budapest, Hungary
| | - Anita Hernyes
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Luca Zoldi
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Zsofia Jokkel
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Andrea Fekete
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - Janos Juhasz
- Institute of Medical Microbiology, Semmelweis University, 1085 Budapest, Hungary; (J.J.); (N.M.); (D.S.)
- Faculty of Information Technology and Bionics, Pazmany Peter Catholic University, 1085 Budapest, Hungary
| | - Nora Makra
- Institute of Medical Microbiology, Semmelweis University, 1085 Budapest, Hungary; (J.J.); (N.M.); (D.S.)
| | - Dora Szabo
- Institute of Medical Microbiology, Semmelweis University, 1085 Budapest, Hungary; (J.J.); (N.M.); (D.S.)
| | - Edit Buzas
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 1085 Budapest, Hungary; (K.P.); (E.B.)
| | - Adam Domonkos Tarnoki
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
| | - David Laszlo Tarnoki
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary; (A.P.); (B.B.); (M.P.); (A.A.); (D.S.); (A.V.); (H.S.); (A.H.); (L.Z.); (Z.J.); (A.F.); (A.D.T.)
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Seada SA, van der Eerden AW, Boon AJW, Hernandez-Tamames JA. Quantitative MRI protocol and decision model for a 'one stop shop' early-stage Parkinsonism diagnosis: Study design. Neuroimage Clin 2023; 39:103506. [PMID: 37696098 PMCID: PMC10500558 DOI: 10.1016/j.nicl.2023.103506] [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] [Received: 03/30/2023] [Revised: 06/21/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
Differentiating among early-stage parkinsonisms is a challenge in clinical practice. Quantitative MRI can aid the diagnostic process, but studies with singular MRI techniques have had limited success thus far. Our objective is to develop a multi-modal MRI method for this purpose. In this review we describe existing methods and present a dedicated quantitative MRI protocol, a decision model and a study design to validate our approach ahead of a pilot study. We present example imaging data from patients and a healthy control, which resemble related literature.
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Affiliation(s)
- Samy Abo Seada
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Anke W van der Eerden
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Agnita J W Boon
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Juan A Hernandez-Tamames
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Department of Imaging Physics, TU Delft, The Netherlands.
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23
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Zhao J, Zeng W, Huang X, Hu M, Yuan K, Wu C, Qiu H, Chu J. Analysis and hierarchical clustering of infratentorial morphological MRI identifies SCAs phenogroups. J Neurol 2023; 270:4466-4477. [PMID: 37291395 DOI: 10.1007/s00415-023-11792-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Clinical decision-making in spinocerebellar ataxia spectrum diseases (SCAs) has mainly been based on genetic tests, not considering the SCAs' imaging and clinical heterogenicity. OBJECTIVE To identify SCAs phenogroups by analysis and hierarchical clustering of infratentorial morphological MRI for unveiling pathophysiological differences among common SCA subtypes. METHODS We prospectively enrolled 119 (62 women; mean age 37 years) genetically diagnosed SCAs (SCA1 n = 21, SCA2 n = 10, symptomatic SCA3 n = 59, presymptomatic SCA3 n = 22, SCA6 n = 7) and 35 healthy controls (HCs). All patients underwent MRI and detailed neurological and neuropsychology examinations. The width of each cerebellar peduncle (CP) and anteroposterior diameter of the spinal cord and pontine were measured. Twenty-five SCAs patients (15 women; mean age 35 years) were followed for at least a year (17 (15, 24) months), whose MRI and the Scale for the Assessment and Rating of Ataxia (SARA) were collected. RESULTS Infratentorial morphological MRI measurements could significantly discriminate SCAs from HCs, even among SCA subtypes. Two mutually exclusive and clinically distinct phenogroups were identified. Despite similar (CAG)n, phenogroup 1 (n = 66, 55.5%) presented more atrophied infratentorial brain structures and more severe clinical symptoms with older age and earlier age of onset when compared with phenogroup 2. More importantly, all SCA2, most of SCA1 (76%), and symptomatic SCA3 (68%) were classified into phenogroup 1, whereas all SCA6 and all presymptomatic SCA3 were in phenogroup 2. The right middle CP had the highest diagnostic value in predicting phenogroup 2 (AUC = 0.99; P < 0.01) with high specificity (95%). Consistent with the significantly increased SARA (7.5 vs 10, P = 0.021), the bilateral inferior CP, spinal cord, and pontine tegmentum were more atrophy during the follow-up (P < 0.05). CONCLUSION SCAs were with significant infratentorial brain atrophy than HCs. We identified two different SCAs phenogroups associated with substantial differences in infratentorial brain atrophy, clinical presentation, and may reflect the underlying molecular profiles to some extent, paving the way for a more personalized diagnostic and treatment approach.
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Affiliation(s)
- Jing Zhao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 518000, Guangdong, China
| | - Wenting Zeng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 518000, Guangdong, China
| | - Xiaolong Huang
- Intensive Care Unit, The First Affiliated Hospital of Xiamen University, Xiamen, 361001, Fujian, China
| | - Manshi Hu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 518000, Guangdong, China
| | - Kang Yuan
- Sun Yat-Sen University, Guangzhou, 518000, Guangdong, China
| | - Chao Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 518000, China.
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Guangzhou, China.
- National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China.
| | - Haishan Qiu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 518000, Guangdong, China.
| | - Jianping Chu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 518000, Guangdong, China.
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Kutyłowski M, Alster P, Madetko-Alster N, Migda AM, Królicki L, Migda B. The Role of the Evans Index and the Maximal Width of the Frontal Horns of the Lateral Ventricles in the Diagnostic Imaging of Progressive Supranuclear Palsy and Multiple-System Atrophy. Diagnostics (Basel) 2023; 13:2711. [PMID: 37627970 PMCID: PMC10453144 DOI: 10.3390/diagnostics13162711] [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: 06/30/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Progressive Supranuclear Palsy and Multiple-System Atrophy are entities within the spectrum of atypical parkinsonism. The role of imaging methods in the diagnosis and differentiation between PSP and MSA is limited and Magnetic Resonance Imaging (MRI) is currently used as a reference modality. In this study, the authors examined a group of patients with atypical parkinsonism using a 1.5 T MRI system and aimed to find simple and repeatable measurements that may be useful to distinguish between these diseases. The results of the study indicate that the maximal width of the frontal horns of the lateral ventricles and Evans' Index may, to some extent, be useful as basic and simple measurements in the diagnostic imaging of patients with atypical parkinsonism.
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Affiliation(s)
- Michał Kutyłowski
- Department of Radiology, Mazovian Brodnowski Hospital, 03-242 Warsaw, Poland
| | - Piotr Alster
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland; (P.A.); (N.M.-A.)
| | - Natalia Madetko-Alster
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland; (P.A.); (N.M.-A.)
| | - Anna Marta Migda
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, 03-242 Warsaw, Poland;
| | - Leszek Królicki
- Department of Nuclear Medicine, Mazovian Brodnowski Hospital, 03-242 Warsaw, Poland;
- Department of Nuclear Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Bartosz Migda
- Diagnostic Ultrasound Lab., Department of Pediatric Radiology, Medical Faculty, Medical University of Warsaw, 03-242 Warsaw, Poland;
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Klietz M, Mahmoudi N, Maudsley AA, Sheriff S, Bronzlik P, Almohammad M, Nösel P, Wegner F, Höglinger GU, Lanfermann H, Ding XQ. Whole-Brain Magnetic Resonance Spectroscopy Reveals Distinct Alterations in Neurometabolic Profile in Progressive Supranuclear Palsy. Mov Disord 2023; 38:1503-1514. [PMID: 37289057 DOI: 10.1002/mds.29456] [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] [Received: 10/31/2022] [Revised: 03/16/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is an atypical Parkinsonian syndrome characterized by supranuclear gaze palsy, early postural instability, and a frontal dysexecutive syndrome. Contrary to normal brain magnetic resonance imaging in Parkinson's disease (PD), PSP shows specific cerebral atrophy patterns and alterations, but these findings are not present in every patient, and it is still unclear if these signs are also detectable in early disease stages. OBJECTIVE The aim of the present study was to analyze the metabolic profile of patients with clinically diagnosed PSP in comparison with matched healthy volunteers and PD patients using whole-brain magnetic resonance spectroscopic imaging (wbMRSI). METHODS Thirty-nine healthy controls (HCs), 29 PD, and 22 PSP patients underwent wbMRSI. PSP and PD patients were matched for age and handedness with HCs. Clinical characterization was performed using the Movement Disorder Society Unified Parkinson's Disease Rating Scale, PSP rating scale, and DemTect (test for cognitive assessment). RESULTS In PSP patients a significant reduction in N-acetyl-aspartate (NAA) was detected in all brain lobes. Fractional volume of the cerebrospinal fluid significantly increased in PSP patients compared to PD and healthy volunteers. CONCLUSIONS In PSP much more neuronal degeneration and cerebral atrophy have been detected compared with PD. The most relevant alteration is the decrease in NAA in all lobes of the brain, which also showed a partial correlation with clinical symptoms. However, more studies are needed to confirm the additional value of wbMRSI in clinical practice. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Martin Klietz
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Nima Mahmoudi
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Andrew A Maudsley
- Department of Radiology, University of Miami School of Medicine, Miami, Florida, USA
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami School of Medicine, Miami, Florida, USA
| | - Paul Bronzlik
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Patrick Nösel
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | | | - Xiao-Qi Ding
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
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26
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Shir D, Pham NTT, Botha H, Koga S, Kouri N, Ali F, Knopman DS, Petersen RC, Boeve BF, Kremers WK, Nguyen AT, Murray ME, Reichard RR, Dickson DW, Graff-Radford N, Josephs KA, Whitwell J, Graff-Radford J. Clinicoradiologic and Neuropathologic Evaluation of Corticobasal Syndrome. Neurology 2023; 101:e289-e299. [PMID: 37268436 PMCID: PMC10382268 DOI: 10.1212/wnl.0000000000207397] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/23/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Corticobasal syndrome (CBS) is a clinical phenotype characterized by asymmetric parkinsonism, rigidity, myoclonus, and apraxia. Originally believed secondary to corticobasal degeneration (CBD), mounting clinicopathologic studies have revealed heterogenous neuropathologies. The objectives of this study were to determine the pathologic heterogeneity of CBS, the clinicoradiologic findings associated with different underlying pathologies causing CBS, and the positive predictive value (PPV) of current diagnostic criteria for CBD among patients with a CBS. METHODS Clinical data, brain MRI, and neuropathologic data of patients followed at Mayo Clinic and diagnosed with CBS antemortem were reviewed according to neuropathology category at autopsy. RESULTS The cohort consisted of 113 patients with CBS, 61 (54%) female patients. Mean ± SD disease duration was 7 ± 3.7 years; mean ± SD age at death was 70.5 ± 9.1 years. The primary neuropathologic diagnoses were 43 (38%) CBD, 27 (24%) progressive supranuclear palsy (PSP), 17 (15%) Alzheimer disease (AD), 10 (9%) frontotemporal lobar degeneration (FTLD) with TAR DNA-binding protein 43 (TDP) inclusions, 7 (6%) diffuse Lewy body disease (DLBD)/AD, and 9 (8%) with other diagnoses. Patients with CBS-AD or CBS-DLBD/AD were youngest at death (median [interquartile range]: 64 [13], 64 [11] years) while CBS-PSP were oldest (77 [12.5] years, p = 0.024). Patients with CBS-DLBD/AD had the longest disease duration (9 [6] years), while CBS-other had the shortest (3 [4.25] years, p = 0.04). Posterior cortical signs and myoclonus were more characteristic of patients with CBS-AD and patients with CBS-DLBD/AD. Patients with CBS-DLBD/AD displayed more features of Lewy body dementia. Voxel-based morphometry revealed widespread cortical gray matter loss characteristic of CBS-AD, while CBS-CBD and CBS-PSP predominantly involved premotor regions with greater amount of white matter loss. Patients with CBS-DLBD/AD showed atrophy in a focal parieto-occipital region, and patients with CBS-FTLD-TDP had predominant prefrontal cortical loss. Patients with CBS-PSP had the lowest midbrain/pons ratio (p = 0.012). Of 67 cases meeting clinical criteria for possible CBD at presentation, 27 were pathology-proven CBD, yielding a PPV of 40%. DISCUSSION A variety of neurodegenerative disorders can be identified in patients with CBS, but clinical and regional imaging differences aid in predicting underlying neuropathology. PPV analysis of the current CBD diagnostic criteria revealed suboptimal performance. Biomarkers adequately sensitive and specific for CBD are needed.
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Affiliation(s)
- Dror Shir
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Nha Trang Thu Pham
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Hugo Botha
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Shunsuke Koga
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Naomi Kouri
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Farwa Ali
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - David S Knopman
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Ronald C Petersen
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Brad F Boeve
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Walter K Kremers
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Aivi T Nguyen
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Melissa E Murray
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - R Ross Reichard
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Dennis W Dickson
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Neill Graff-Radford
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL.
| | - Keith Anthony Josephs
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Jennifer Whitwell
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Jonathan Graff-Radford
- From the Department of Neurology (D.S., H.B., F.A., D.S.K., R.C.P., B.F.B., K.A.J., J.G.-R.), and Department of Radiology (N.T.T.P., J.W.), Mayo Clinic, Rochester, MN; Department of Neuroscience (S.K., N.K., M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL; Department of Quantitative Health Sciences (R.C.P., W.K.K.), and Department of Laboratory Medicine and Pathology (A.T.N., R.R.R.), Mayo Clinic, Rochester, MN; and Department of Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL.
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27
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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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Lupascu N, Lupescu IC, Caloianu I, Naftanaila F, Glogojeanu RR, Sirbu CA, Mitrica M. Imaging Criteria for the Diagnosis of Progressive Supranuclear Palsy: Supportive or Mandatory? Diagnostics (Basel) 2023; 13:diagnostics13111967. [PMID: 37296819 DOI: 10.3390/diagnostics13111967] [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: 05/02/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023] Open
Abstract
We present the case of a 54-year-old male, without any significant medical history, who insidiously developed speech disturbances and walking difficulties, accompanied by backward falls. The symptoms progressively worsened over time. The patient was initially diagnosed with Parkinson's disease; however, he failed to respond to standard therapy with Levodopa. He came to our attention for worsening postural instability and binocular diplopia. A neurological exam was highly suggestive of a Parkinson-plus disease, most likely progressive supranuclear gaze palsy. Brain MRI was performed and revealed moderate midbrain atrophy with the characteristic "hummingbird" and "Mickey mouse" signs. An increased MR parkinsonism index was also noted. Based on all clinical and paraclinical data, a diagnosis of probable progressive supranuclear palsy was established. We review the main imaging features of this disease and their current role in diagnosis.
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Affiliation(s)
- Nicoleta Lupascu
- Department of Neurology, "Dr. Carol Davila" Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Ioan Cristian Lupescu
- Clinical Neurosciences Department, University of Medicine and Pharmacy "Carol Davila" Bucharest, 050474 Bucharest, Romania
- Department of Neurology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Ionuț Caloianu
- Department of Neurology, "Dr. Carol Davila" Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Florin Naftanaila
- Radiology and Medical Imaging Department, "Dr. Carol Davila" Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Remus Relu Glogojeanu
- Department of Special Motricity and Medical Recovery, The National University of Physical Education and Sports, 060057 Bucharest, Romania
| | - Carmen Adella Sirbu
- Clinical Neurosciences Department, University of Medicine and Pharmacy "Carol Davila" Bucharest, 050474 Bucharest, Romania
- Center for Cognitive Research in Neuropsychiatric Pathology (Neuropsy-Cog), Department of Neurology, Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marian Mitrica
- Clinical Neurosciences Department, University of Medicine and Pharmacy "Carol Davila" Bucharest, 050474 Bucharest, Romania
- Department of Neurosurgery, "Dr. Carol Davila" Central Military Emergency University Hospital, 010242 Bucharest, Romania
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Dewey C, Feltrin F, Shah B, Pinho M, DeBevits J, Achilleos M, McCreary M, Lynch S, Chitnis S, Dewey R. Structural MRI Ratios Fail to Distinguish Progressive Supranuclear Palsy From Parkinson Disease in Individual Patients. Neurol Clin Pract 2023; 13:e200157. [PMID: 37124461 PMCID: PMC10139740 DOI: 10.1212/cpj.0000000000200157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/24/2023] [Indexed: 05/02/2023]
Abstract
Background and Objectives Parkinson disease (PD) and progressive supranuclear palsy (PSP) are often difficult to differentiate in the clinic. The MR parkinsonism index (MRPI) has been recommended to assist in making this distinction. We aimed to assess the usefulness of this tool in our real-world practice of movement disorders. Methods We prospectively obtained MRI scans on consecutive patients with movement disorders with a clinical indication for imaging and obtained measures of MRI regions of interest (ROIs) from our neuroradiologists. The authors reviewed all MRI scans and corrected any errors in the original ROI drawings for this analysis. We retrospectively assigned diagnoses using established consensus criteria from progress notes stored in our electronic medical record. We analyzed the data using multinomial logistic regression models and receiver operating curve analysis to determine the predictive accuracy of the MRI ratios. Results MRI measures and consensus diagnoses were available on 130 patients with PD, 54 with PSP, and 77 diagnosed as other. The out-of-sample prediction error rate of our 5 regression models ranged from 45% to 59%. The average sensitivity and specificity of the 5 models in the testing sample were 53% and 80%, respectively. The positive predictive value of an MRPI ≥13.55 (the published cutoff) in our patients was 79%. Discussion These results indicate that MRI measures of brain structures were not effective at predicting diagnosis in individual patients. We conclude that the search for a biomarker that can differentiate PSP from PD must continue.
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Affiliation(s)
- Chadrick Dewey
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Fabricio Feltrin
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Bhavya Shah
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Marco Pinho
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - John DeBevits
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Michael Achilleos
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Morgan McCreary
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Sloan Lynch
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Shilpa Chitnis
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
| | - Richard Dewey
- Department of Neurology (CD, SL, SC, RD), Department of Radiology (FF, BS, MP, JD, MA), Division of Neuroradiology, and Perot Foundation Neuroscience Translational Research Center (MM), O'Donnell Brain Institute, University of Texas Southwestern Medical Center
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Welter ML, Vasseur A, Edragas R, Chaumont H, Pineau F, Mangone G, Olivier C, Leber I, Rivaud-Pechoux S, Lehericy S, Gallea C, Yahia-Cherif L, Lannuzel A. Brain dysfunction in gait disorders of Caribbean atypical Parkinsonism and progressive supranuclear palsy patients: A comparative study. Neuroimage Clin 2023; 38:103443. [PMID: 37247501 PMCID: PMC10236465 DOI: 10.1016/j.nicl.2023.103443] [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] [Received: 03/14/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Gait disorders and falls occur early in progressive supranuclear palsy (PSP-RS) and Caribbean atypical parkinsonism (Caribbean AP). However, the link between these signs and brain lesions has never been explored in these patient populations. Here, we investigate and compare the imaging factors that relate to gait and balance disorders in Caribbean AP and PSP-RS patients. METHODS We assessed gait and balance using clinical scales and gait recordings in 16 Caribbean AP and 15 PSP-RS patients and 17 age-matched controls. We measured the grey and white matter brain volumes on 3 T brain MRI images. We performed a principal component analysis (PCA) including all the data to determine differences and similarities between groups, and explore the relationship between gait disorders and brain volumes. RESULTS Both Caribbean AP patients and PSP-RS have marked gait and balance disorders with similar severity. In both groups, gait and balance disorders were found to be most strongly related to structural changes in the lateral cerebellum, caudate nucleus, and fronto-parietal areas. In Caribbean AP patients, gait disorders were also related to additional changes in the cortex, including frontal, insular, temporal and cuneus lobes, whereas in PSP-RS patients, additional white matter changes involved the mesencephalon and parahippocampal gyrus. CONCLUSION Gait and balance disorders in Caribbean AP patients are mainly related to dysfunction of cortical brain areas involved in visuo-sensorimotor processing and self-awareness, whereas these signs mainly result from premotor-brainstem-cerebellar network dysfunction in PSP-RS patients, brain areas involved in initiation and maintenance of locomotor pattern and postural adaptation.
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Affiliation(s)
- Marie-Laure Welter
- Neurophysiology Department, Rouen University Hospital, Université de Normandie, Rouen, France; INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie-Paris Université, Paris 06, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Paris Brain Institute, Paris, France; Plateforme d'analyse du mouvement (PANAM), Paris Brain Institute, Paris, France.
| | - Alexandre Vasseur
- Neurophysiology Department, Rouen University Hospital, Université de Normandie, Rouen, France
| | - Regine Edragas
- Rehabilitation Department, University Hospital of Martinique, F.W.I, France
| | - Hugo Chaumont
- INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie-Paris Université, Paris 06, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Paris Brain Institute, Paris, France; Neurology Department, Clinical Investigation Centre 1424, University Hospital of Guadeloupe, Université des Antilles, Pointe-à-Pitre, Guadeloupe, F.W.I, France
| | - Fanny Pineau
- Clinical Investigation Centre, Paris Brain Institute, Pitié-Salpêtrière Hospital, Paris, France
| | - Graziella Mangone
- Clinical Investigation Centre, Paris Brain Institute, Pitié-Salpêtrière Hospital, Paris, France
| | - Claire Olivier
- INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie-Paris Université, Paris 06, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Paris Brain Institute, Paris, France; Plateforme d'analyse du mouvement (PANAM), Paris Brain Institute, Paris, France
| | - Isabelle Leber
- INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie-Paris Université, Paris 06, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Paris Brain Institute, Paris, France
| | - Sophie Rivaud-Pechoux
- INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie-Paris Université, Paris 06, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Paris Brain Institute, Paris, France
| | - Stéphane Lehericy
- INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie-Paris Université, Paris 06, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Paris Brain Institute, Paris, France; CENIR, Paris Brain Institute, Paris, France
| | - Cecile Gallea
- INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie-Paris Université, Paris 06, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Paris Brain Institute, Paris, France; CENIR, Paris Brain Institute, Paris, France
| | - Lydia Yahia-Cherif
- INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie-Paris Université, Paris 06, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Paris Brain Institute, Paris, France; CENIR, Paris Brain Institute, Paris, France
| | - Annie Lannuzel
- INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie-Paris Université, Paris 06, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Paris Brain Institute, Paris, France; Neurology Department, Clinical Investigation Centre 1424, University Hospital of Guadeloupe, Université des Antilles, Pointe-à-Pitre, Guadeloupe, F.W.I, France
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Onder H, Kocer BG, Turan A, Comoglu S. The utility of quantitative MRI parameters in discriminating progressive supranuclear palsy from Parkinson's disease. Neurol Res 2023:1-7. [PMID: 37068211 DOI: 10.1080/01616412.2023.2203612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE We sought to re-evaluate the utility of all the quantitative neuroimaging parameters attributed to progressive supranuclear palsy (PSP) in discrimination between PSP and Parkinson' s disease (PD) subjects in our cohort. We aimed to propose some practical clinical remarks in this field. METHODS In our retrospective study, 19 patients with 'probable' PSP and 37 patients with PD were enrolled. The radiological measurements of PSP, described in the previous reports, have been calculated in all subjects. The comparisons between the groups were performed and the measures regarding the accuracy of these parameters in the differentiation of PSP from PD subjects were analyzed. RESULTS We found that the values of magnetic resonance parkinsonism index-2 (MRPI-2), pontine-to-midbrain area (P/M) ratio, P/M 2 ratio, and 3rdV/bifrontal width ratio had high AUC values and very good discriminative powers. The analyses revealed that; for the discrimination of PSP from PD subjects, a 3rdvent/bifrontal width cut-off value of 0.30 had 42.1 % sensitivity and 97.3 % specificity; a P/M cut-off value of 6.03 had a 52.6 % sensitivity and 97.3 % specificity; and an MRPI-2 cut-off value of 7.43 had 57.9 % sensitivity and 97.3 % specificity. Remarkably, we also found that the presence of high values for both P/M and 3rdV/bifrontal ventricle rate had a positive predictive value of 100% for the diagnosis of PSP. CONCLUSION Our study results support the utility of previously defined neuroimaging parameters in distinguishing PSP and PD subjects. Besides, combined use of a high P/M ratio and 3rdV/bifrontal width may be practical and present strictly high evidence for the diagnosis of PSP.
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Affiliation(s)
- Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Bilge Gonenli Kocer
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Aynur Turan
- Radiology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Selcuk Comoglu
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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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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Müller SJ, Khadhraoui E, Hansen N, Jamous A, Langer P, Wiltfang J, Riedel CH, Bouter C, van Riesen C, Maass F, Bartl M, Lange C, Ernst M. Brainstem atrophy in dementia with Lewy bodies compared with progressive supranuclear palsy and Parkinson's disease on MRI. BMC Neurol 2023; 23:114. [PMID: 36944914 PMCID: PMC10029226 DOI: 10.1186/s12883-023-03151-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Although Dementia with Lewy bodies (DLB) is the second most common form of dementia in elderly patients, it remains underdiagnosed compared with Alzheimer's (AD) and Parkinson's diseases (PD). This may be explained by overlapping clinical symptoms, e.g. Parkinsonism. While current MRI research focuses primarily on atrophy patterns of the frontal and temporal lobes, we focus on brainstem characteristics of DLB. In particular, we focused on brainstem atrophy patterns distinguishing DLB from Progressive Supranuclear Palsy (PSP) and PD based as the most common differential diagnoses. METHODS We identified patients diagnosed with DLB, PD, PSP, and a control group (CTRL) in our psychiatric and neurological archives. All patients with competing diagnoses and without a high-quality T1 MPRAGE 3D dataset were excluded. We assessed atrophy patterns in all patients (1) manually and (2) using FastSurfer's segmentation algorithm in combination with FreeSurfer's brainstem volumetric calculations. We compared classical measurement methods and ratios with automated volumetric approaches. RESULTS One hundred two patients were enrolled and evaluated in this study. Patients with DLB (n = 37) showed on average less atrophy of the brainstem than patients with PSP (n = 21), but a significantly more pronounced atrophy than patients with PD (n = 36) and the control group (CTRL, n = 8). The mean measured sagittal diameters of the midbrain were 8.17 ± 1.06 mm (mean ± standard deviation) for PSP, 9.45 ± 0.95 mm for DLB, 10.37 ± 0.99 mm for PD and 10.74 ± 0.70 for CTRL. The mean measured areas of the midbrain were 81 ± 18 mm2 for PSP, 105 ± 17 mm2 for DLB, 130 ± 26 mm2 for PD and 135 ± 23 mm2 for CTRL. The mean segmented volumes of the midbrain were 5595 ± 680 mm3 for PSP, 6051 ± 566 mm3 for DLB, 6646 ± 802 mm3 for PD and 6882 ± 844 mm3 for CTRL. The calculated midbrain pons ratios did not show superiority over the absolute measurements of the midbrain for distinguishing PSP from DLB. Because of the relatively uniform atrophy throughout the brainstem, the ratios were not suitable for distinguishing DLB from PD. CONCLUSIONS DLB patients exhibit homogenous atrophy of the brainstem and can be distinguished from patients with PSP and PD by both manual measurement methods and automated volume segmentation using absolute values or ratios.
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Affiliation(s)
- Sebastian Johannes Müller
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Eya Khadhraoui
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Ala Jamous
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Philip Langer
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Medical Sciences, Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Christian Heiner Riedel
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Caroline Bouter
- Department of Nuclear Medicine, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Christoph van Riesen
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Neurology, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Fabian Maass
- Department of Neurology, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Michael Bartl
- Department of Neurology, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Claudia Lange
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Marielle Ernst
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Pathomechanisms of cognitive impairment in progressive supranuclear palsy. J Neural Transm (Vienna) 2023; 130:481-493. [PMID: 36862189 DOI: 10.1007/s00702-023-02613-w] [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: 01/16/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterized by early postural instability and falls, oculomotor dysfunction (vertical supranuclear gaze palsy), parkinsonism with poor response to levodopa, pseudobulbar palsy, and cognitive impairment. This four-repeat tauopathy is morphologically featured by accumulation of tau protein in neurons and glia causing neuronal loss and gliosis in the extrapyramidal system associated with cortical atrophy and white matter lesions. Cognitive impairment being frequent in PSP and more severe than in multiple system atrophy and Parkinson disease, is dominated by executive dysfunction, with milder difficulties in memory, and visuo-spatial and naming dysfunctions. Showing longitudinal decline, it has been related to a variety of pathogenic mechanisms associated with the underlying neurodegenerative process, such as involvement of cholinergic and muscarinergic dysfunctions, and striking tau pathology in frontal and temporal cortical regions associated with reduced synaptic density. Altered striatofrontal, fronto-cerebellar, parahippocampal, and multiple subcortical structures, as well as widespread white matter lesions causing extensive connectivity disruptions in cortico-subcortical and cortico-brainstem connections, support the concept that PSP is a brain network disruption disorder. The pathophysiology and pathogenesis of cognitive impairment in PSP, as in other degenerative movement disorders, are complex and deserve further elucidation as a basis for adequate treatment to improve the quality of life of patients with this fatal disease.
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Comparative validation of AI and non-AI methods in MRI volumetry to diagnose Parkinsonian syndromes. Sci Rep 2023; 13:3439. [PMID: 36859498 PMCID: PMC10156821 DOI: 10.1038/s41598-023-30381-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
Automated segmentation and volumetry of brain magnetic resonance imaging (MRI) scans are essential for the diagnosis of Parkinson's disease (PD) and Parkinson's plus syndromes (P-plus). To enhance the diagnostic performance, we adopt deep learning (DL) models in brain MRI segmentation and compared their performance with the gold-standard non-DL method. We collected brain MRI scans of healthy controls ([Formula: see text]) and patients with PD ([Formula: see text]), multiple systemic atrophy ([Formula: see text]), and progressive supranuclear palsy ([Formula: see text]) at Samsung Medical Center from January 2017 to December 2020. Using the gold-standard non-DL model, FreeSurfer (FS), we segmented six brain structures: midbrain, pons, caudate, putamen, pallidum, and third ventricle, and considered them as annotated data for DL models, the representative convolutional neural network (CNN) and vision transformer (ViT)-based models. Dice scores and the area under the curve (AUC) for differentiating normal, PD, and P-plus cases were calculated to determine the measure to which FS performance can be reproduced as-is while increasing speed by the DL approaches. The segmentation times of CNN and ViT for the six brain structures per patient were 51.26 ± 2.50 and 1101.82 ± 22.31 s, respectively, being 14 to 300 times faster than FS (15,735 ± 1.07 s). Dice scores of both DL models were sufficiently high (> 0.85) so their AUCs for disease classification were not inferior to that of FS. For classification of normal vs. P-plus and PD vs. P-plus (except multiple systemic atrophy - Parkinsonian type) based on all brain parts, the DL models and FS showed AUCs above 0.8, demonstrating the clinical value of DL models in addition to FS. DL significantly reduces the analysis time without compromising the performance of brain segmentation and differential diagnosis. Our findings may contribute to the adoption of DL brain MRI segmentation in clinical settings and advance brain research.
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Chougar L, Lejeune FX, Faouzi J, Morino B, Faucher A, Hoyek N, Grabli D, Cormier F, Vidailhet M, Corvol JC, Colliot O, Degos B, Lehéricy S. Comparison of mean diffusivity, R2* relaxation rate and morphometric biomarkers for the clinical differentiation of parkinsonism. Parkinsonism Relat Disord 2023; 108:105287. [PMID: 36706616 DOI: 10.1016/j.parkreldis.2023.105287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/15/2022] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Quantitative biomarkers for clinical differentiation of parkinsonian syndromes are still lacking. Our aim was to evaluate the value of combining clinically feasible manual measurements of R2* relaxation rates and mean diffusivity (MD) in subcortical regions and brainstem morphometric measurements to improve the discrimination of parkinsonian syndromes. METHODS Twenty-two healthy controls (HC), 25 patients with Parkinson's disease (PD), 19 with progressive supranuclear palsy (PSP) and 27 with multiple system atrophy (MSA, 21 with the parkinsonian variant -MSAp, 6 with the cerebellar variant -MSAc) were recruited. R2*, MD measurements and morphometric biomarkers including the midbrain to pons area ratio and the Magnetic Resonance Parkinsonism Index (MRPI) were compared between groups and their diagnostic performances were assessed. RESULTS Morphometric biomarkers discriminated better patients with PSP (ratio: AUC 0.89, MRPI: AUC 0.89) and MSAc (ratio: AUC 0.82, MRPI: AUC 0.75) from other groups. R2* and MD measurements in the posterior putamen performed better in separating patients with MSAp from PD (R2*: AUC 0.89; MD: AUC 0.89). For the three-class classification "MSA vs PD vs PSP", the combination of MD and R2* measurements in the posterior putamen with morphometric biomarkers (AUC: 0.841) outperformed each marker separately. At the individual-level, there were seven discordances between imaging-based prediction and clinical diagnosis involving MSA. Using the new Movement Disorder Society criteria for the diagnosis of MSA, three of these seven patients were clinically reclassified as predicted by quantitative imaging. CONCLUSION Combining R2* and MD measurements in the posterior putamen with morphometric biomarkers improves the discrimination of parkinsonism.
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Affiliation(s)
- Lydia Chougar
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Department of Neuroradiology, F-75013, Paris, France; ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France; ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France; Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Department of Neuroradiology, F-75013, Paris, France.
| | - François-Xavier Lejeune
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France; ICM, Data and Analysis Core, Paris, France
| | - Johann Faouzi
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France; Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013, Paris, France
| | - Benjamin Morino
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Department of Neuroradiology, F-75013, Paris, France
| | - Alice Faucher
- Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France; Service de Neurologie, Hôpital Avicenne, Hôpitaux Universitaires de Paris Seine-Saint-Denis, APHP, Bobigny, France
| | - Nadine Hoyek
- Department of Radiology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - David Grabli
- Clinique des mouvements anormaux, Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France; ICM, Centre d'Investigation Clinique Neurosciences, Paris, France
| | - Florence Cormier
- Clinique des mouvements anormaux, Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France; ICM, Centre d'Investigation Clinique Neurosciences, Paris, France
| | - Marie Vidailhet
- ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France; Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France; Clinique des mouvements anormaux, Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France; ICM, Centre d'Investigation Clinique Neurosciences, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France; Clinique des mouvements anormaux, Département de Neurologie, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France; ICM, Centre d'Investigation Clinique Neurosciences, Paris, France
| | - Olivier Colliot
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, F-75013, Paris, France; Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, F-75013, Paris, France
| | - Bertrand Degos
- Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France; Service de Neurologie, Hôpital Avicenne, Hôpitaux Universitaires de Paris Seine-Saint-Denis, APHP, Bobigny, France
| | - Stéphane Lehéricy
- ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France; ICM, Team "Movement Investigations and Therapeutics" (MOV'IT), Paris, France; Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, AP-HP, Hôpital de la Pitié Salpêtrière, DMU DIAMENT, Department of Neuroradiology, F-75013, Paris, France
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Doan TT, Pham TD, Nguyen DD, Ngo DHA, Le TB, Nguyen TT. Multiple system atrophy-cerebellar: A case report and literature review. Radiol Case Rep 2023; 18:1121-1126. [PMID: 36660581 PMCID: PMC9842541 DOI: 10.1016/j.radcr.2022.12.046] [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: 11/17/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023] Open
Abstract
We reported a case of a 48-year-old female patient admitted to the hospital due to balance disorder which progressed rapidly within 1 week. Cerebral magnetic resonance imaging showed significant atrophy and hyperintensities at the middle cerebellar peduncles and the "hot cross bun" sign of the pons. The final diagnosis was probable multiple system atrophy, cerebellar subtype. The clinical and imaging findings will be discussed as well as a brief literature review.
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Affiliation(s)
- Thi Thuong Doan
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen str., 530000 Hue city, Vietnam
| | - Thuy Dung Pham
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen str., 530000 Hue city, Vietnam
| | - Duy Duan Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Dac Hong An Ngo
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen str., 530000 Hue city, Vietnam,Corresponding author.
| | - Trong Binh Le
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen str., 530000 Hue city, Vietnam
| | - Thanh Thao Nguyen
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen str., 530000 Hue city, Vietnam
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Nunomura H, Kasahara T, Hatano T, Shimada H, Takado Y, Endo H, Inoshita A, Inomata A, Murofushi T, Misawa S, Machida Y, Imai H. Case report: Saccadic ping-pong gaze in progressive supranuclear palsy with predominant postural instability. Front Neurol 2023; 14:1100931. [PMID: 36937509 PMCID: PMC10014735 DOI: 10.3389/fneur.2023.1100931] [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: 11/17/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023] Open
Abstract
We report a 63-year-old female patient with progressive supranuclear palsy (PSP). She presented predominant postural instability and "saccadic ping-pong gaze" (SPPG). She had unprovoked falls recurrently within a year from the onset of gait disturbance. She tended to fall backward with eye closure but had no freezing of gait on examination. She showed no signs of nuchal dystonia, limb tremor, rigidity, spasticity, or ataxia. The dopaminergic response was negative. On the initial examination, her vertical eye movements were normal, but frequent macro square wave jerks and SPPG were observed. SPPG consisted of short-cycle, horizontal conjugate irregular pendular oscillations of the eye position from the midpoint with superimposed small saccades. SPPG was observed usually in the dark, not in the daylight, and with eye closure by using electrooculogram and infrared charge-coupled device imaging. One and a half years after the first examination, she was diagnosed as probable PSP with vertical supranuclear gaze palsy. SPPG was first described in patients who are unconscious by Johkura in 1998 as a "saccadic" variant of "ping-pong gaze (PPG)." PPG, short-cycle periodic alternating gaze, has been described in comatose patients since 1967. On the other hand, abnormal eye movement, which looks the same as SPPG in coma, has been described in conscious patients with PSP or spinocerebellar degeneration (SCD) in Japanese literature since 1975. However, it has been called "transient alternating saccades (TAS)." Nowadays, we believe it is more appropriate to call this abnormal eye movement "SPPG" instead of TAS. Here, we propose that PSP, a neuro-degenerative disease, should be added as one of the etiologies of SPPG. We discuss the differences between PPG/SPPG in coma and SPPG in PSP and the possible pathophysiological mechanism of SPPG in relation to cerebellar oculomotor dysfunctions.
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Affiliation(s)
- Hikari Nunomura
- Department of Neurology, Tokyo Rinkai Hospital, Tokyo, Japan
- *Correspondence: Hikari Nunomura
| | | | - Taku Hatano
- Department of Neurology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Hitoshi Shimada
- Department of Functional Neurology & Neurosurgery, Center for Integrated Human Brain Science, Niigata University, Niigata, Japan
- Department of Functional Brain Imaging Research, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Yuhei Takado
- Department of Functional Brain Imaging Research, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Hironobu Endo
- Department of Functional Brain Imaging Research, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Ayako Inoshita
- Department of Otorhinolaryngology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Atsuko Inomata
- Department of Otorhinolaryngology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Toshihisa Murofushi
- Department of Otorhinolaryngology, Mizonokuchi Hospital, Teikyo University, Kawasaki, Japan
| | - Shihoko Misawa
- Department of Neurology, Tokyo Rinkai Hospital, Tokyo, Japan
| | - Yutaka Machida
- Department of Neurology, Tokyo Rinkai Hospital, Tokyo, Japan
| | - Hisamasa Imai
- Department of Neurology, Tokyo Rinkai Hospital, Tokyo, Japan
- Hisamasa Imai
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Tinaz S. Magnetic resonance imaging modalities aid in the differential diagnosis of atypical parkinsonian syndromes. Front Neurol 2023; 14:1082060. [PMID: 36816565 PMCID: PMC9932598 DOI: 10.3389/fneur.2023.1082060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Accurate and timely diagnosis of atypical parkinsonian syndromes (APS) remains a challenge. Especially early in the disease course, the clinical manifestations of the APS overlap with each other and with those of idiopathic Parkinson's disease (PD). Recent advances in magnetic resonance imaging (MRI) technology have introduced promising imaging modalities to aid in the diagnosis of APS. Some of these MRI modalities are also included in the updated diagnostic criteria of APS. Importantly, MRI is safe for repeated use and more affordable and accessible compared to nuclear imaging. These advantages make MRI tools more appealing for diagnostic purposes. As the MRI field continues to advance, the diagnostic use of these techniques in APS, alone or in combination, are expected to become commonplace in clinical practice.
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Affiliation(s)
- Sule Tinaz
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, New Haven, CT, United States
- Department of Neurology, Clinical Neurosciences Imaging Center, Yale School of Medicine, New Haven, CT, United States
- *Correspondence: Sule Tinaz ✉
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Tessema AW, Lee H, Gong Y, Cho H, Adem HM, Lyu I, Lee JH, Cho H. Automated volumetric determination of high R 2 * regions in substantia nigra: A feasibility study of quantifying substantia nigra atrophy in progressive supranuclear palsy. NMR IN BIOMEDICINE 2022; 35:e4795. [PMID: 35775868 DOI: 10.1002/nbm.4795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
The establishment of an unbiased protocol for the automated volumetric measurement of iron-rich regions in the substantia nigra (SN) is clinically important for diagnosing neurodegenerative diseases exhibiting midbrain atrophy, such as progressive supranuclear palsy (PSP). This study aimed to automatically quantify the volume and surface properties of the iron-rich 3D regions in the SN using the quantitative MRI-R2 * map. Three hundred and sixty-seven slices of R2 * map and susceptibility-weighted imaging (SWI) at 3-T MRI from healthy control (HC) individuals and Parkinson's disease (PD) patients were used to train customized U-net++ convolutional neural network based on expert-segmented masks. Age- and sex-matched participants were selected from HC, PD, and PSP groups to automate the volumetric determination of iron-rich areas in the SN. Dice similarity coefficient values between expert-segmented and detected masks from the proposed network were 0.91 ± 0.07 for R2 * maps and 0.89 ± 0.08 for SWI. Reductions in iron-rich SN volume from the R2 * map (SWI) were observed in PSP with area under the receiver operating characteristic curve values of 0.96 (0.89) and 0.98 (0.92) compared with HC and PD, respectively. The mean curvature of the PSP showed SN deformation along the side closer to the red nucleus. We demonstrated the automated volumetric measurement of iron-rich regions in the SN using deep learning can quantify the SN atrophy in PSP compared with PD and HC.
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Affiliation(s)
- Abel Worku Tessema
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Hansol Lee
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Yelim Gong
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Hwapyeong Cho
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Hamdia Murad Adem
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Ilwoo Lyu
- Department of Computer Science and Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Jae-Hyeok Lee
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - HyungJoon Cho
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
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Hosapatna M, Aparna Verma, Antony Sylvan D’Souza, L. C. P. The role of width of pars compacta of substantia nigra and the midbrain area in patients with Parkinson’s disease and progressive supranuclear palsy with healthy aged individuals. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i4.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: Though numerous image processing software exists to analyse the images, measurement of substantia nigra width and midbrain area are simple yet definite tools to distinguish and diagnose the Parkinson’s disease (PD) and progressive supranuclear palsy (PSP) when complimented with clinical findings. Comparing the brainstem parameters in healthy, (neurodegenerative) diseased, and during the treatment helps us to assess the disease monitoring i.e., severity and progress of the disease, and formulate the best treatment strategies. This study aimed at comparison of the thickness of substantia nigra (SN) in Parkinson's disease (PD) and progressive supranuclear palsy (PSP) with aged healthy individuals by magnetic resonance (MR) imaging.
Material and Methods: This observational study includes the evaluation of MR images of 50 aged healthy individuals with no obvious neurological diseases, 35 classical PD, and 15 PSP patients from the Department of Radiology. Quantitative planimetric evaluation of midbrain area was calculated and the width of substantia nigra (SN) was evaluated as per standard reference criteria with computer assisted image analysis and interpretation program.
Results: The parameters like means of midbrain area and the pars compacta thickness on both right and left sides were compared both in PD and PSP patients with healthy individuals. MR image analysis showed significant decrease in the thickness of pars compacta of SN in PD patients than in PSP patients when compared with age matched healthy aged individuals.
Conclusion: Parkinsonian diseases are always associated with the neuronal loss leading to volume alterations by causing midbrain atrophy. Magnetic resonance imaging of the thickness of SN is simple and reliable imaging markers to differentiate PD and PSP when combined with clinical symptomatology.
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Cortical atrophy distinguishes idiopathic normal-pressure hydrocephalus from progressive supranuclear palsy: A machine learning approach. Parkinsonism Relat Disord 2022; 103:7-14. [PMID: 35988437 DOI: 10.1016/j.parkreldis.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/25/2022] [Accepted: 08/07/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Progressive supranuclear palsy (PSP) and idiopathic normal pressure hydrocephalus (iNPH) share several clinical and radiological features, making the differential diagnosis challenging. In this study, we aimed to differentiate between these two diseases using a machine learning approach based on cortical thickness and volumetric data. METHODS Twenty-three iNPH patients, 50 PSP patients and 55 control subjects were enrolled. All participants underwent a brain 3T-MRI, and cortical thickness and volumes were extracted using Freesurfer 6 on T1-weighted images and compared among groups. Finally, the performance of a machine learning approach with random forest using the extracted cortical features was investigated to differentiate between iNPH and PSP patients. RESULTS iNPH patients showed cortical thinning and volume loss in the frontal lobe, temporal lobe and cingulate cortex, and thickening in the superior parietal gyrus in comparison with controls and PSP patients. PSP patients only showed mild thickness and volume reduction in the frontal lobe, compared to control subjects. Random Forest algorithm distinguished iNPH patients from controls with AUC of 0.96 and from PSP patients with AUC of 0.95, while a lower performance (AUC 0.76) was reached in distinguishing PSP from controls. CONCLUSION This study demonstrated a more severe and widespread cortical involvement in iNPH than in PSP, possibly due to the marked lateral ventricular enlargement which characterizes iNPH. A machine learning model using thickness and volumetric data led to accurate differentiation between iNPH and PSP patients, which may help clinicians in the differential diagnosis and in the selection of patients for shunt procedures.
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Magnetic Resonance Planimetry in the Differential Diagnosis between Parkinson’s Disease and Progressive Supranuclear Palsy. Brain Sci 2022; 12:brainsci12070949. [PMID: 35884755 PMCID: PMC9313181 DOI: 10.3390/brainsci12070949] [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: 06/19/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/10/2022] Open
Abstract
The clinical differential diagnosis between Parkinson’s disease (PD) and progressive supranuclear palsy (PSP) is often challenging. The description of milder PSP phenotypes strongly resembling PD, such as PSP-Parkinsonism, further increased the diagnostic challenge and the need for reliable neuroimaging biomarkers to enhance the diagnostic certainty. This review aims to summarize the contribution of a relatively simple and widely available imaging technique such as MR planimetry in the differential diagnosis between PD and PSP, focusing on the recent advancements in this field. The development of accurate MR planimetric biomarkers, together with the implementation of automated algorithms, led to robust and objective measures for the differential diagnosis of PSP and PD at the individual level. Evidence from longitudinal studies also suggests a role of MR planimetry in predicting the development of the PSP clinical signs, allowing to identify PSP patients before they meet diagnostic criteria when their clinical phenotype can be indistinguishable from PD. Finally, promising evidence exists on the possible association between MR planimetric measures and the underlying pathology, with important implications for trials with new disease-modifying target therapies.
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Ransmayr L, Fuchs A, Ransmayr-Tepser S, Kommenda R, Kögl M, Schwingenschuh P, Fellner F, Guger M, Eggers C, Darkow R, Mangesius S, Ransmayr G. Differences in aphasia syndromes between progressive supranuclear palsy-Richardson's syndrome, behavioral variant frontotemporal dementia and Alzheimer's dementia. J Neural Transm (Vienna) 2022; 129:1039-1048. [PMID: 35821453 DOI: 10.1007/s00702-022-02524-2] [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: 03/30/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
Language impairments, hallmarks of speech/language variant progressive supranuclear palsy, also occur in Richardson's syndrome (PSP-RS). Impaired communication may interfere with daily activities. Therefore, assessment of language functions is crucial. It is uncertain whether the Aachen Aphasia Test (AAT) is practicable in PSP-RS, behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's dementia (AD) and language deficits differ in these disorders. 28 PSP-RS, 24 AD, and 24 bvFTD patients were investigated using the AAT and the CERAD-Plus battery. 16-25% of all patients failed in AAT subtests for various reasons. The AAT syndrome algorithm diagnosed amnestic aphasia in 5 (23%) PSP-RS, 7 (36%) bvFTD and 6 (30%) AD patients, Broca aphasia in 1 PSP-RS and 1 bvFTD patient, Wernicke aphasia in 1 bvFTD and 3 (15%) AD patients. However, aphasic symptoms resembled non-fluent primary progressive aphasia in 14 PSP-RS patients. In up to 46% of PSP-RS patients, 61% of bvFTD and 64% of AD patients significant impairments were found in the AAT subtests spontaneous speech, written language, naming, language repetition, language comprehension and the Token subtest. The CERAD-Plus subtest semantic fluency revealed significant impairment in 81% of PSP-RS, 61% of bvFTD, 44% of AD patients, the phonemic fluency subtest in 31, 40 and 31%, respectively. In contrast to bvFTD and AD, severity of language impairment did not correlate with cognitive decline in PSP-RS. In summary, the patterns of aphasia differ between the diagnoses. Local frontal language networks might be impaired in PSP-RS, whereas in AD and bvFTD, more widespread neuropathology might underly language impairment.
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Affiliation(s)
- Lucia Ransmayr
- Institute for Logopedics, FH Joanneum, University of Applied Sciences, Graz, Austria.,Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria
| | - Alexandra Fuchs
- Department of Clinical and Health Psychology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Sibylle Ransmayr-Tepser
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria
| | - Romana Kommenda
- Department of Clinical and Health Psychology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Mariella Kögl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Franz Fellner
- Central Institute of Radiology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Michael Guger
- Department of Neurology, Pyhrn-Eisenwurzen Hospital Steyr, Steyr, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Christian Eggers
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Robert Darkow
- Institute for Logopedics, FH Joanneum, University of Applied Sciences, Graz, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Krankenhausstr. 9, 4021, Linz, Austria. .,Faculty of Medicine, Johannes Kepler University, Linz, Austria.
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Cicero CE, Donzuso G, Luca A, Davì M, Baschi R, Mostile G, Giuliano L, Palmucci S, Salerno A, Monastero R, Nicoletti A, Zappia M. Morphometric
MRI
Cortico‐subcortical features in Parkinson’s Disease with mild cognitive impairment. Eur J Neurol 2022; 29:3197-3204. [DOI: 10.1111/ene.15489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Calogero Edoardo Cicero
- Department of Medical, Surgical Sciences and Advanced technologies G.F. Ingrassia, Section of Neurosciences University of Catania, Via Santa Sofia 78 Catania Italy
| | - Giulia Donzuso
- Department of Medical, Surgical Sciences and Advanced technologies G.F. Ingrassia, Section of Neurosciences University of Catania, Via Santa Sofia 78 Catania Italy
| | - Antonina Luca
- Department of Medical, Surgical Sciences and Advanced technologies G.F. Ingrassia, Section of Neurosciences University of Catania, Via Santa Sofia 78 Catania Italy
| | - Marco Davì
- Department of Biomedicine, Neuroscience and advanced Diagnostics University of Palermo, Via La Loggia 1 Palermo Italy
| | - Roberta Baschi
- Department of Biomedicine, Neuroscience and advanced Diagnostics University of Palermo, Via La Loggia 1 Palermo Italy
| | - Giovanni Mostile
- Department of Medical, Surgical Sciences and Advanced technologies G.F. Ingrassia, Section of Neurosciences University of Catania, Via Santa Sofia 78 Catania Italy
- Oasi Research Institute ‐ IRCCS Troina Italy
| | - Loretta Giuliano
- Department of Medical, Surgical Sciences and Advanced technologies G.F. Ingrassia, Section of Neurosciences University of Catania, Via Santa Sofia 78 Catania Italy
| | - Stefano Palmucci
- Department of Medical, Surgical Sciences and Advanced technologies G.F. Ingrassia, Radiodiagnostic and Radiotherapy Unit University of Catania, Via Santa Sofia 78 Catania Italy
| | - Andrea Salerno
- Department of Medical, Surgical Sciences and Advanced technologies G.F. Ingrassia, Section of Neurosciences University of Catania, Via Santa Sofia 78 Catania Italy
| | - Roberto Monastero
- Department of Biomedicine, Neuroscience and advanced Diagnostics University of Palermo, Via La Loggia 1 Palermo Italy
| | - Alessandra Nicoletti
- Department of Medical, Surgical Sciences and Advanced technologies G.F. Ingrassia, Section of Neurosciences University of Catania, Via Santa Sofia 78 Catania Italy
| | - Mario Zappia
- Department of Medical, Surgical Sciences and Advanced technologies G.F. Ingrassia, Section of Neurosciences University of Catania, Via Santa Sofia 78 Catania Italy
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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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Tsai CC, Chen YL, Lu CS, Cheng JS, Weng YH, Lin SH, Wu YM, Wang JJ. Diffusion Tensor Imaging for the differential diagnosis of Parkinsonism by machine learning. Biomed J 2022; 46:100541. [DOI: 10.1016/j.bj.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 04/28/2022] [Accepted: 05/27/2022] [Indexed: 11/02/2022] Open
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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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Madetko N, Alster P, Kutyłowski M, Migda B, Nieciecki M, Koziorowski D, Królicki L. Is MRPI 2.0 More Useful than MRPI and M/P Ratio in Differential Diagnosis of PSP-P with Other Atypical Parkinsonisms? J Clin Med 2022; 11:jcm11102701. [PMID: 35628828 PMCID: PMC9147601 DOI: 10.3390/jcm11102701] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023] Open
Abstract
Differential diagnosis of progressive supranuclear palsy remains difficult, especially when it comes to the parkinsonism predominant type (PSP-P), which has a more favorable clinical course. In this entity, especially during the advanced stages, significant clinical overlaps with other tauopathic parkinsonian syndromes and multiple system atrophy (MSA) can be observed. Among the available additional diagnostic methods in every-day use, magnetic resonance imaging (MRI) focused specifically on the evaluation of the mesencephalon seems to be crucial as it is described as a parameter associated with PSP. There is growing interest in relation to more advanced mesencephalic parameters, such as the magnetic resonance parkinsonism index (MRPI) and MRPI 2.0. Based on the evaluation of 74 patients, we demonstrate that only the mesencephalon/pons ratio and MRPI show a significant difference between PSP-P and MSA-parkinsonian type (MSA-P). Interestingly, this differential feature was not maintained by MRPI 2.0. The mesencephalon to pons ratio (M/P), MRPI and MRPI 2.0 were not found to be feasible for the differentiation of PSP-P from other atypical tauopathic syndromes.
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Affiliation(s)
- Natalia Madetko
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland;
- Correspondence: (N.M.); (P.A.)
| | - Piotr Alster
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland;
- Correspondence: (N.M.); (P.A.)
| | - Michał Kutyłowski
- Department of Radiology, Mazovian Brodnowski Hospital, 03-242 Warsaw, Poland;
| | - Bartosz Migda
- Diagnostic Ultrasound Lab, Department of Pediatric Radiology, Medical Faculty, Medical University of Warsaw, 03-242 Warsaw, Poland;
| | - Michał Nieciecki
- Department of Nuclear Medicine, Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Dariusz Koziorowski
- Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland;
| | - Leszek Królicki
- Department of Nuclear Medicine, Mazovian Brodno Hospital, 03-242 Warsaw, Poland;
- Department of Nuclear Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
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