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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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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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Shetty N, Koteshwar P, Priyanka. Identification of optimal value of magnetic resonance planimetry and the parkinsonism index for the diagnosis of Parkinson's disease and progressive supranuclear palsy. J Taibah Univ Med Sci 2023; 18:1577-1585. [PMID: 37701844 PMCID: PMC10494174 DOI: 10.1016/j.jtumed.2023.07.004] [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: 04/24/2023] [Revised: 05/30/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Parkinson's disease (PD) and progressive supranuclear palsy (PSP) are neurodegenerative conditions that have overlapping clinical and imaging features, thus making it difficult to distinguish and diagnose PSP from PD. Therefore, in this study, we aimed to investigate the optimal value of magnetic resonance planimetry and the parkinsonism index to differentiate between PSP and PD. Methods In this retrospective study, we recruited a total of 84 patients (27 patients with PSP, 27 patients with PD and 27 normal controls) who underwent MRI brain examinations. For each subject, we calculated the corpus callosum area, midbrain area, pons area, middle cerebellar peduncle (MCP) width and superior cerebellar peduncle (SCP) width on MRI brain images. We also calculated the pons to midbrain area (P/M) ratio, MCP/SCP ratio and magnetic resonance parkinsonism index (MRPI). Results Receiver operating characteristic curve (ROC) analysis was used to identify the diagnostic value of each biomarker. MRPI had a sensitivity of 70.4%, a specificity of 88.9%, and a diagnostic accuracy of 79.6% with an optimum cut off of 24.3 for differentiating PSP from PD. P/M ratio had a sensitivity of 74.1%, a specificity of 77.8%, and a diagnostic accuracy of 75.9% with an optimal cutoff of 24.3 for differentiating PSP from PD. The MCP/SCP ratio had a sensitivity of 66.7%, a specificity of 77.8%, and an accuracy of 72.2% with an optimal cut off of 4.65 for differentiating PSP from PD. Conclusions The study revealed that MRPI and P/M ratio are accurate markers for differentiating PSP from PD. The optimal cut-off values derived from our study can help in the early diagnosis of PD.
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Affiliation(s)
- Nikhitha Shetty
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Medical Imaging Sciences, College of Health Sciences, Gulf Medical University, Ajman, UAE
| | - Prakashini Koteshwar
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Priyanka
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Sun F, Lyu J, Jian S, Qin Y, Tang X. Accurate measurement of magnetic resonance parkinsonism index by a fully automatic and deep learning quantification pipeline. Eur Radiol 2023; 33:8844-8853. [PMID: 37480547 DOI: 10.1007/s00330-023-09979-1] [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: 02/01/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES This study aims at a fully automatic pipeline for measuring the magnetic resonance parkinsonism index (MRPI) using deep learning methods. METHODS MRPI is defined as the product of the pons area to the midbrain area ratio and the middle cerebellar peduncle (MCP) width to the superior cerebellar peduncle (SCP) width ratio. In our proposed pipeline, we first used nnUNet to segment the brainstem and then employed HRNet to identify two key boundary points so as to sub-divide the whole brainstem into midbrain and pons. HRNet was also employed to predict the MCP endpoints for measuring the MCP width. Finally, we segmented the SCP on an oblique coronal plane and calculated its width. A total of 400 T1-weighted magnetic resonance images (MRIs) were used to train the nnUNet and HRNet models. Five-fold cross-validation was conducted to evaluate our proposed pipeline's performance on the training dataset. We also evaluated the performance of our proposed pipeline on three external datasets. Two of them had two raters manually measuring the MRPI values, providing insights into automatic accuracy versus inter-rater variability. RESULTS We obtained average absolute percentage errors (APEs) of 17.21%, 18.17%, 20.83%, and 22.83% on the training dataset and the three external validation datasets, while the inter-rater average APE measured on the first two external validation datasets was 11.31%. Our proposed pipeline significantly improved the MRPI quantification accuracy over a representative state-of-the-art traditional approach (p < 0.001). CONCLUSION The proposed automatic pipeline can accurately predict MRPI that is comparable with manual measurement. CLINICAL RELEVANCE STATEMENT This study presents an automated magnetic resonance parkinsonism index measurement tool that can analyze large amounts of magnetic resonance images, enhance the efficiency of Parkinsonism-Plus syndrome diagnosis, reduce the workload of clinicians, and minimize the impact of human factors on diagnosis. KEY POINTS • We propose an automatic pipeline for measuring the magnetic resonance parkinsonism index from magnetic resonance images. • The effectiveness of the proposed pipeline is successfully established on multiple datasets and comparisons with inter-rater measurements. • The proposed pipeline significantly outperforms a state-of-the-art quantification approach, being much closer to ground truth.
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Affiliation(s)
- Fuhai Sun
- Department of Electronic and Electrical Engineering, College of Engineering, Southern University of Science and Technology, Xili, Nanshan, Shenzhen, 518055, People's Republic of China
| | - Junyan Lyu
- Department of Electronic and Electrical Engineering, College of Engineering, Southern University of Science and Technology, Xili, Nanshan, Shenzhen, 518055, People's Republic of China
| | - Si Jian
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, People's Republic of China
| | - Yuanyuan Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 430030, People's Republic of China.
| | - Xiaoying Tang
- Department of Electronic and Electrical Engineering, College of Engineering, Southern University of Science and Technology, Xili, Nanshan, Shenzhen, 518055, People's Republic of China.
- Jiaxing Research Institute, Southern University of Science and Technology, Jiaxing, People's Republic of China.
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Wen Y, Yang Q, Jiao B, Zhang W, Lin J, Zhu Y, Xu Q, Zhou H, Weng L, Liao X, Zhou Y, Wang J, Guo J, Yan X, Jiang H, Tang B, Shen L. Clinical features of progressive supranuclear palsy. Front Aging Neurosci 2023; 15:1229491. [PMID: 37711994 PMCID: PMC10498458 DOI: 10.3389/fnagi.2023.1229491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023] Open
Abstract
Background Progressive supranuclear palsy (PSP) is a clinically heterogenous atypical parkinsonian syndrome. Therefore, early recognition and correct diagnosis of PSP is challenging but essential. This study aims to characterize the clinical manifestations, magnetic resonance imaging (MRI), and longitudinal MRI changes of PSP in China. Method Clinical and MRI presentations were compared among 150 cases with PSP. Then the longitudinal MRI changes among 20 patients with PSP were further explored. Additionally, a series of midbrain-based MRI parameters was compared between PSP-P and PD. Results Throughout the course of the disease, there were differences in the symptoms of the fall and hand tremor between the PSP-RS and PSP-P. There were significant differences in the six midbrain-based MRI parameters between the PSP-RS and the PSP-P, including hummingbird sign, midbrain diameter, midbrain to pons ratio (MTPR), midbrain area, midbrain area to pons area ratio (Ma/Pa), and midbrain tegmental length (MBTegm). Longitudinal MRI studies revealed that the annual rel.ΔMTPR and rel.Δ (Ma/Pa) for PSP were 5.55 and 6.52%, respectively; additionally, PSP-RS presented a higher decline rate than PSP-P. Moreover, MTPR ≤0.56, midbrain diameter ≤ 0.92, midbrain area ≤ 1.00, and third ventricle width ≤ 0.75 could identify PSP-P from PD. Conclusion PSP-P differs from PSP-RS regarding clinical manifestations, MRI, and longitudinal MRI changes. MRI parameters could be potential imaging markers to identify PSP-P from PD.
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Affiliation(s)
- Yafei Wen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qijie Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Jiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Weiwei Zhang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jingyi Lin
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
| | - Yuan Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China
| | - Hui Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ling Weng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China
| | - Xinxin Liao
- Department of Geriatrics Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yafang Zhou
- Department of Geriatrics Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Junling Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jifeng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Xinxiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 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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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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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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10
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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: 0] [Impact Index Per Article: 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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11
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Clinical, cognitive, and morphometric profiles of progressive supranuclear palsy phenotypes. J Neural Transm (Vienna) 2023; 130:97-109. [PMID: 36701008 PMCID: PMC9902314 DOI: 10.1007/s00702-023-02591-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023]
Abstract
The International Parkinson's and Movement Disorder Society (MDS) criteria for progressive supranuclear palsy (PSP) have broadened the clinical spectrum of the disease and established phenotypic characterization according to the predominant manifestation at onset. The objective of this study is to describe clinical/cognitive and imaging features of a monocentric cohort of PSP patients, highlighting different patterns of functional disability according to the assigned phenotype. We retrospectively reviewed clinical/imaging data of 53 PSP patients diagnosed with probable PSP according to the MDS criteria and 40 age/sex-matched healthy controls (HCs). Neurological/neuropsychological assessments were performed using standardized scales, as well as comprehensive magnetic resonance imaging (MRI) morphometric measurements. In our cohort, there were 24/53 PSP-RS (Richardson's syndrome), 13/53 PSP-P (Parkinsonism), 7/53 PSP-PGF (Progressive gait freezing), and 9/53 PSP-Cog (Cognitive impairment). PSP-Cog presented the worst motor profiles, the highest percentages of dementia and impaired functional autonomy; 4/9 PSP-Cog and 2/7 PSP-PGF died. PSP-P had the lowest motor/cognitive burden. All MRI parameters had good discriminative efficacy vs. HCs, with P/M 2.0 discriminating PSP-PGF from PSP-RS and PSP-Cog. We highlighted discrete clinical and imaging patterns that best characterize different PSP phenotypes. PSP-Cog and PSP-PGF/RS manifest greater incidence of dementia and motor disability, respectively, while PSP-P has a more benign course. The identification of different phenotypes may be the expression of different progression patterns requiring tailored approaches in terms of follow-up and treatment. These findings support the concept of discrete patterns of Tau pathology within the PSP spectrum and encourage research for phenotype-specific outcome measures.
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12
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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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13
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Quattrone A, Bianco MG, Antonini A, Vaillancourt DE, Seppi K, Ceravolo R, Strafella AP, Tedeschi G, Tessitore A, Cilia R, Morelli M, Nigro S, Vescio B, Arcuri PP, De Micco R, Cirillo M, Weis L, Fiorenzato E, Biundo R, Burciu RG, Krismer F, McFarland NR, Mueller C, Gizewski ER, Cosottini M, Del Prete E, Mazzucchi S, Quattrone A. Development and Validation of Automated
Magnetic Resonance
Parkinsonism Index 2.0 to Distinguish
Progressive Supranuclear Palsy‐Parkinsonism
From
Parkinson's Disease. Mov Disord 2022; 37:1272-1281. [PMID: 35403258 PMCID: PMC9321546 DOI: 10.1002/mds.28992] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/11/2022] Open
Abstract
Background Differentiating progressive supranuclear palsy‐parkinsonism (PSP‐P) from Parkinson's disease (PD) is clinically challenging. Objective This study aimed to develop an automated Magnetic Resonance Parkinsonism Index 2.0 (MRPI 2.0) algorithm to distinguish PSP‐P from PD and to validate its diagnostic performance in two large independent cohorts. Methods We enrolled 676 participants: a training cohort (n = 346; 43 PSP‐P, 194 PD, and 109 control subjects) from our center and an independent testing cohort (n = 330; 62 PSP‐P, 171 PD, and 97 control subjects) from an international research group. We developed a new in‐house algorithm for MRPI 2.0 calculation and assessed its performance in distinguishing PSP‐P from PD and control subjects in both cohorts using receiver operating characteristic curves. Results The automated MRPI 2.0 showed excellent performance in differentiating patients with PSP‐P from patients with PD and control subjects both in the training cohort (area under the receiver operating characteristic curve [AUC] = 0.93 [95% confidence interval, 0.89–0.98] and AUC = 0.97 [0.93–1.00], respectively) and in the international testing cohort (PSP‐P versus PD, AUC = 0.92 [0.87–0.97]; PSP‐P versus controls, AUC = 0.94 [0.90–0.98]), suggesting the generalizability of the results. The automated MRPI 2.0 also accurately distinguished between PSP‐P and PD in the early stage of the diseases (AUC = 0.91 [0.84–0.97]). A strong correlation (r = 0.91, P < 0.001) was found between automated and manual MRPI 2.0 values. Conclusions Our study provides an automated, validated, and generalizable magnetic resonance biomarker to distinguish PSP‐P from PD. The use of the automated MRPI 2.0 algorithm rather than manual measurements could be important to standardize measures in patients with PSP‐P across centers, with a positive impact on multicenter studies and clinical trials involving patients from different geographic regions. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Andrea Quattrone
- Institute of Neurology, University “Magna Graecia” Catanzaro Italy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology University College London London United Kingdom
| | - Maria G. Bianco
- Department of Medical and Surgical Sciences University “Magna Graecia” Catanzaro Italy
- Neuroscience Research Center University “Magna Graecia” Catanzaro Italy
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration CESNE, Department of Neuroscience University of Padua Padua Italy
| | - David E. Vaillancourt
- Department of Applied Physiology and Kinesiology University of Florida Gainesville Florida USA
- Department of Neurology and Biomedical Engineering University of Florida Gainesville Florida USA
| | - Klaus Seppi
- Department of Neurology Medical University Innsbruck Innsbruck Austria
- Neuroimaging Core Facility Medical University Innsbruck Innsbruck Austria
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, Center for NeuroDegenerative Diseases University of Pisa Pisa Italy
| | - Antonio P. Strafella
- Krembil Brain Institute, UHN & Research Imaging Center, Campbell Family Mental Health Research Institute, CAMH University of Toronto Toronto Ontario Canada
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Center SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Center SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Roberto Cilia
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta Parkinson and Movement Disorders Unit Milan Italy
| | - Maurizio Morelli
- Institute of Neurology, University “Magna Graecia” Catanzaro Italy
| | - Salvatore Nigro
- Institute of Nanotechnology (NANOTEC) National Research Council Lecce Italy
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico" Tricase Italy
| | - Basilio Vescio
- Institute of Molecular Bioimaging and Physiology National Research Council (IBFM‐CNR) Catanzaro Italy
| | | | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Center SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Center SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Luca Weis
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration CESNE, Department of Neuroscience University of Padua Padua Italy
| | | | - Roberta Biundo
- Department of General Psychology University of Padua Padua Italy
| | - Roxana G. Burciu
- Department of Kinesiology and Applied Physiology University of Delaware Newark Delaware USA
| | - Florian Krismer
- Department of Neurology Medical University Innsbruck Innsbruck Austria
- Neuroimaging Core Facility Medical University Innsbruck Innsbruck Austria
| | - Nikolaus R. McFarland
- Department of Neurology and Biomedical Engineering University of Florida Gainesville Florida USA
| | - Christoph Mueller
- Department of Neurology Medical University Innsbruck Innsbruck Austria
| | - Elke R. Gizewski
- Neuroimaging Core Facility Medical University Innsbruck Innsbruck Austria
- Department of Neuroradiology Medical University Innsbruck Innsbruck Austria
| | - Mirco Cosottini
- Department of Translational Research and New Technologies University of Pisa Pisa Italy
| | - Eleonora Del Prete
- Department of Clinical and Experimental Medicine, Center for NeuroDegenerative Diseases University of Pisa Pisa Italy
| | - Sonia Mazzucchi
- Department of Clinical and Experimental Medicine, Center for NeuroDegenerative Diseases University of Pisa Pisa Italy
| | - Aldo Quattrone
- Neuroscience Research Center University “Magna Graecia” Catanzaro Italy
- Institute of Molecular Bioimaging and Physiology National Research Council (IBFM‐CNR) Catanzaro Italy
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14
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Ruiz ST, Bakklund RV, Håberg AK, Berntsen EM. Normative Data for Brainstem Structures, the Midbrain-to-Pons Ratio, and the Magnetic Resonance Parkinsonism Index. AJNR Am J Neuroradiol 2022; 43:707-714. [PMID: 35393362 PMCID: PMC9089261 DOI: 10.3174/ajnr.a7485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/11/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Imaging biomarkers derived from different brainstem structures are suggested to differentiate among parkinsonian disorders, but clinical implementation requires normative data. The main objective was to establish high-quality, sex-specific data for relevant brainstem structures derived from MR imaging in healthy subjects from the general population in their sixth and seventh decades of life. MATERIALS AND METHODS 3D T1WI acquired on the same 1.5T scanner of 996 individuals (527 women) between 50 and 66 years of age from a prospective population study was used. The area of the midbrain and pons and the widths of the middle cerebellar peduncles and superior cerebellar peduncles were measured, from which the midbrain-to-pons ratio and Magnetic Resonance Parkinsonism Index [MRPI = (Pons Area / Midbrain Area) × (Middle Cerebellar Peduncles / Superior Cerebellar Peduncles)] were calculated. Sex differences in brainstem measures and correlations to age, height, weight, and body mass index were investigated. RESULTS Inter- and intrareliability for measuring the different brainstem structures showed good-to-excellent reliability (intraclass correlation coefficient = 0.785-0.988). There were significant sex differences for the pons area, width of the middle cerebellar peduncles and superior cerebellar peduncles, midbrain-to-pons ratio, and MRPI (all, P < .001; Cohen D = 0.44-0.98), but not for the midbrain area (P = .985). There were significant very weak-to-weak correlations between several of the brainstem measures and age, height, weight, and body mass index in both sexes. However, no systematic difference in distribution caused by these variables was found, and because age had the highest and most consistent correlations, age-/sex-specific percentiles for the brainstem measures were created. CONCLUSIONS We present high-quality, sex-specific data and age-/sex-specific percentiles for the mentioned brainstem measures. These normative data can be implemented in the neuroradiologic work-up of patients with suspected brainstem atrophy to avoid the risk of misdiagnosis.
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Affiliation(s)
- S T Ruiz
- From the Department of Circulation and Medical Imaging (S.T.R., R.V.B., E.M.B.)
| | - R V Bakklund
- From the Department of Circulation and Medical Imaging (S.T.R., R.V.B., E.M.B.)
| | - A K Håberg
- Faculty of Medicine and Health Sciences, and Neuromedicine and Movement Sciences (A.K.H.), Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine (A.K.H., E.M.B.), St. Olavs University Hospital, Trondheim, Norway
| | - E M Berntsen
- From the Department of Circulation and Medical Imaging (S.T.R., R.V.B., E.M.B.) .,Department of Radiology and Nuclear Medicine (A.K.H., E.M.B.), St. Olavs University Hospital, Trondheim, Norway
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15
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Grijalva RM, Pham NTT, Huang Q, Martin PR, Ali F, Clark HM, Duffy JR, Utianski RL, Botha H, Machulda MM, Weigand SD, Ahlskog JE, Dickson DW, Josephs KA, Whitwell JL. Brainstem Biomarkers of Clinical Variant and Pathology in Progressive Supranuclear Palsy. Mov Disord 2021; 37:702-712. [PMID: 34970796 DOI: 10.1002/mds.28901] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Magnetic resonance brainstem measurements are useful structural biomarkers in the Richardson's syndrome variant of progressive supranuclear palsy (PSP). However, it is unclear how these biomarkers differ across the phenotypic spectrum of PSP and how they relate to underlying pathology. OBJECTIVE The aim of this study was to compare brainstem imaging measures across clinical variants of PSP and determine sensitivity and specificity based on pathologically diagnosed cases. METHODS A total of 153 patients with PSP who represented eight clinical variants were recruited at Mayo Clinic (Rochester, MN, USA) and underwent structural magnetic resonance imaging (MRI). Midbrain and pons area and superior and middle cerebellar peduncle width measurements were performed, and midbrain/pons ratio and Magnetic Resonance Parkinsonism Index (MRPI) were calculated. Among the 43 patients who later died, PSP pathology was confirmed in 29, whereas 14 had other pathology. RESULTS Brainstem measurements varied across PSP clinical variants and were most abnormal in PSP-Richardson's syndrome and frontal variants, followed by PSP-corticobasal, PSP-speech/language, and PSP-parkinsonism variants. All these variants showed abnormalities compared with controls. The PSP-gait freezing variant and patients with prominent corticospinal tract signs showed normal brainstem measures. Among cases with confirmed PSP pathology, the midbrain area, midbrain/pons ratio, and MRPI were all more abnormal compared to those with other pathologies, with best differentiation obtained with the MRPI (sensitivity = 83%; specificity = 85%). CONCLUSIONS MRI brainstem measures show utility as diagnostic biomarkers across PSP clinical variants and have the potential to be useful in predicting underlying pathology. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | | | - Qiao Huang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter R Martin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen D Weigand
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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16
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Diagnostic Performance of the Magnetic Resonance Parkinsonism Index in Differentiating Progressive Supranuclear Palsy from Parkinson's Disease: An Updated Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 12:diagnostics12010012. [PMID: 35054178 PMCID: PMC8774886 DOI: 10.3390/diagnostics12010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 12/17/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and Parkinson's disease (PD) are difficult to differentiate especially in the early stages. We aimed to investigate the diagnostic performance of the magnetic resonance parkinsonism index (MRPI) in differentiating PSP from PD. A systematic literature search of PubMed-MEDLINE and EMBASE was performed to identify original articles evaluating the diagnostic performance of the MRPI in differentiating PSP from PD published up to 20 February 2021. The pooled sensitivity, specificity, and 95% CI were calculated using the bivariate random-effects model. The area under the curve (AUC) was calculated using a hierarchical summary receiver operating characteristic (HSROC) model. Meta-regression was performed to explain the effects of heterogeneity. A total of 14 original articles involving 484 PSP patients and 1243 PD patients were included. In all studies, T1-weighted images were used to calculate the MRPI. Among the 14 studies, nine studies used 3D T1-weighted images. The pooled sensitivity and specificity for the diagnostic performance of the MRPI in differentiating PSP from PD were 96% (95% CI, 87-99%) and 98% (95% CI, 91-100%), respectively. The area under the HSROC curve was 0.99 (95% CI, 0.98-1.00). Heterogeneity was present (sensitivity: I2 = 97.29%; specificity: I2 = 98.82%). Meta-regression showed the association of the magnet field strength with heterogeneity. Studies using 3 T MRI showed significantly higher sensitivity (100%) and specificity (100%) than those of studies using 1.5 T MRI (sensitivity of 98% and specificity of 97%) (p < 0.01). Thus, the MRPI could accurately differentiate PSP from PD and support the implementation of appropriate management strategies for patients with PSP.
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17
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Che Mohd Nassir CMN, Damodaran T, Yusof SR, Norazit A, Chilla G, Huen I, K. N. BP, Mohamed Ibrahim N, Mustapha M. Aberrant Neurogliovascular Unit Dynamics in Cerebral Small Vessel Disease: A Rheological Clue to Vascular Parkinsonism. Pharmaceutics 2021; 13:1207. [PMID: 34452169 PMCID: PMC8398765 DOI: 10.3390/pharmaceutics13081207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 12/26/2022] Open
Abstract
The distinctive anatomical assemble and functionally discrete multicellular cerebrovasculature dynamics confer varying rheological and blood-brain barrier permeabilities to preserve the integrity of cerebral white matter and its neural microenvironment. This homeostasis intricately involves the glymphatic system that manages the flow of interstitial solutes, metabolic waste, and clearance through the venous circulation. As a physiologically integrated neurogliovascular unit (NGVU) serving a particularly vulnerable cerebral white matter (from hypoxia, metabolic insults, infection, and inflammation), a likely insidious process over a lifetime could inflict microenvironment damages that may lead to pathological conditions. Two such conditions, cerebral small vessel disease (CSVD) and vascular parkinsonism (VaP), with poorly understood pathomechanisms, are frequently linked to this brain-wide NGVU. VaP is widely regarded as an atypical parkinsonism, described by cardinal motor manifestations and the presence of cerebrovascular disease, particularly white matter hyperintensities (WMHs) in the basal ganglia and subcortical region. WMHs, in turn, are a recognised imaging spectrum of CSVD manifestations, and in relation to disrupted NGVU, also include enlarged perivascular spaces. Here, in this narrative review, we present and discuss on recent findings that argue for plausible clues between CSVD and VaP by focusing on aberrant multicellular dynamics of a unique integrated NGVU-a crossroad of the immune-vascular-nervous system-which may also extend fresher insights into the elusive interplay between cerebral microvasculature and neurodegeneration, and the potential therapeutic targets.
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Affiliation(s)
- Che Mohd Nasril Che Mohd Nassir
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Thenmoly Damodaran
- Centre for Drug Research, Universiti Sains Malaysia, Minden 11800, Penang, Malaysia; (T.D.); (S.R.Y.)
| | - Siti R. Yusof
- Centre for Drug Research, Universiti Sains Malaysia, Minden 11800, Penang, Malaysia; (T.D.); (S.R.Y.)
| | - Anwar Norazit
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Selangor, Malaysia;
| | - Geetha Chilla
- A*STAR Institute of Bioengineering and Bioimaging, Helios, 11 Biopolis Way, Singapore 138667, Singapore; (G.C.); (I.H.); (B.P.K.N.)
| | - Isaac Huen
- A*STAR Institute of Bioengineering and Bioimaging, Helios, 11 Biopolis Way, Singapore 138667, Singapore; (G.C.); (I.H.); (B.P.K.N.)
| | - Bhanu Prakash K. N.
- A*STAR Institute of Bioengineering and Bioimaging, Helios, 11 Biopolis Way, Singapore 138667, Singapore; (G.C.); (I.H.); (B.P.K.N.)
| | - Norlinah Mohamed Ibrahim
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Selangor, Malaysia;
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian 16150, Kelantan, Malaysia
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Sjöström H, Granberg T, Hashim F, Westman E, Svenningsson P. Automated brainstem volumetry can aid in the diagnostics of parkinsonian disorders. Parkinsonism Relat Disord 2020; 79:18-25. [DOI: 10.1016/j.parkreldis.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 06/30/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022]
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19
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Lee W. Conventional Magnetic Resonance Imaging in the Diagnosis of Parkinsonian Disorders: A Meta-Analysis. Mov Disord Clin Pract 2020; 8:217-223. [PMID: 33553491 DOI: 10.1002/mdc3.13070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/23/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background Numerous conventional magnetic resonance imaging (cMRI) parameters were previously found to differentiate parkinsonian disorders with statistical significance, but effect size has not been considered. Objectives To quantify effect size of previously identified cMRI parameters that differentiated parkinsonian disorders with statistical significance. Method A PubMed search limited to studies assessing cMRI parameters in at least 2 of Parkinson's disease, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration/syndrome were selected. Either Cohen's d or positive and negative likelihood (LR+/-) as well as diagnostic odds ratios (DORs) were calculated as appropriate. cMRI parameter was considered useful if Cohen's d > 1.94 (<20% overlap) or if LR+ > 10, LR- < 0.1, or DOR > 20. Results Literature search identified 8848 publications and 36 were included for analysis. Putaminal (Cohen's d 2.07; DOR 23-infinity), pontine (DOR 32-infinity), and middle cerebellar peduncle (Cohen's d 2.24; DOR infinity) abnormalities were most useful in differentiating multiple system atrophy while reduced midbrain (Cohen's d 2.33-8.69; DOR infinity) and superior cerebellar peduncle (Cohen's d 2.47; DOR 51-infinity) diameters separated progressive supranuclear palsy. Corticobasal degeneration/syndrome does not have any distinguishing cMRI features, but reduced midbrain diameter may help differentiate corticobasal degeneration/syndrome from Parkinson's disease (DOR infinity). When LR- was calculated, all of these features carried a value of <0.1. Conclusion A number of cMRI features consistently demonstrated large effect size in separating parkinsonian disorders. However, it is the presence and not absence of these cMRI features that is most useful in patients with low to moderate pretest probability.
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Affiliation(s)
- Will Lee
- Department of Neurosciences Box Hill Hospital Box Hill Victoria Australia.,Eastern Health Clinical School Monash University, Eastern Health Box Hill Victoria Australia
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20
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Archer DB, Mitchell T, Burciu RG, Yang J, Nigro S, Quattrone A, Quattrone A, Jeromin A, McFarland NR, Okun MS, Vaillancourt DE. Magnetic Resonance Imaging and Neurofilament Light in the Differentiation of Parkinsonism. Mov Disord 2020; 35:1388-1395. [PMID: 32357259 PMCID: PMC8316785 DOI: 10.1002/mds.28060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Accurate diagnosis is particularly challenging in Parkinson's disease (PD), multiple system atrophy (MSAp), and progressive supranuclear palsy (PSP). We compare the utility of 3 promising biomarkers to differentiate disease state and explain disease severity in parkinsonism: the Automated Imaging Differentiation in Parkinsonism (AID-P), the Magnetic Resonance Parkinsonism Index (MRPI), and plasma-based neurofilament light chain protein (NfL). METHODS For each biomarker, the area under the curve (AUC) of receiver operating characteristic curves were quantified for PD versus MSAp/PSP and MSAp versus PSP and statistically compared. Unique combinations of variables were also assessed. Furthermore, each measures association with disease severity was determined using stepwise multiple regression. RESULTS For PD versus MSAp/PSP, AID-P (AUC, 0.900) measures had higher AUC compared with NfL (AUC, 0.747) and MRPI (AUC, 0.669), P < 0.05. For MSAp versus PSP, AID-P (AUC, 0.889), and MRPI (AUC, 0.824) measures were greater than NfL (AUC, 0.537), P < 0.05. We then combined measures to determine if any unique combination provided enhanced accuracy and found that no combination performed better than the AID-P alone in differentiating parkinsonisms. Furthermore, we found that the AID-P demonstrated the highest association with the MDS-UPDRS (Radj2 -AID-P, 26.58%; NfL,15.12%; MRPI, 12.90%). CONCLUSIONS Compared with MRPI and NfL, AID-P provides the best overall differentiation of PD versus MSAp/PSP. Both AID-P and MRPI are effective in differentiating MSAp versus PSP. Furthermore, combining biomarkers did not improve classification of disease state compared with using AID-P alone. The findings demonstrate in the current sample that the AID-P and MRPI are robust biomarkers for PD, MSAp, and PSP. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Derek B. Archer
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Trina Mitchell
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Roxana G. Burciu
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Jing Yang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Salvatore Nigro
- Neuroscience Centre, Magna Graecia University, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Centre, Magna Graecia University, Catanzaro, Italy
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, Department of Medical Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Nikolaus R. McFarland
- Fixel Institute for Neurological Disease, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, McKnight Brain Institute, Gainesville, Florida, USA
| | - Michael S. Okun
- Fixel Institute for Neurological Disease, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, McKnight Brain Institute, Gainesville, Florida, USA
- Department of Neurosurgery, University of Florida, McKnight Brain Institute, Gainesville, Florida, USA
| | - David E. Vaillancourt
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
- Fixel Institute for Neurological Disease, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neurology, University of Florida, McKnight Brain Institute, Gainesville, Florida, USA
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
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21
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Scheffler M, Maréchal B, Boto J, Lövblad KO, Vargas MI. A method for fast automated assessment of the magnetic resonance parkinsonism index. Neuroradiology 2020; 62:747-751. [DOI: 10.1007/s00234-020-02380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/10/2020] [Indexed: 11/24/2022]
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22
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Constantinides VC, Paraskevas GP, Velonakis G, Toulas P, Stefanis L, Kapaki E. Midbrain morphology in idiopathic normal pressure hydrocephalus: A progressive supranuclear palsy mimic. Acta Neurol Scand 2020; 141:328-334. [PMID: 31856297 DOI: 10.1111/ane.13205] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/29/2019] [Accepted: 12/14/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Various MRI markers have been applied to support the diagnosis of progressive supranuclear palsy (PSP), such as midbrain diameter and surface, superior cerebellar peduncle (SCP) width, midbrain to pons (m/p) diameter and surface ratio and the Magnetic Resonance Parkinsonism Index (MRPI). These markers provide excellent diagnostic accuracy in discriminating Richardson's syndrome from other causes of Parkinsonism. Idiopathic normal pressure hydrocephalus (iNPH) may mimic Richardson's syndrome, particularly in cases of subtle opthalmokinetic abnormalities. The aim of this study was to compare these MRI markers in PSP and iNPH and examine their diagnostic accuracy. MATERIALS AND METHODS Forty-three patients with probable PSP, 17 patients with iNPH, and 29 controls were included. Midbrain diameter and surface, SCP width, m/p diameter and surface ratio and the MRPI were recorded. The "hummingbird sign," "morning glory sign" and "mickey mouse sign" were also evaluated. Analysis of covariance, chi-squared test, and ROC curve analysis were used as appropriate. RESULTS All MRI measurements differed significantly among the three study groups. Comparison of PSP and iNPH patients produced the following significant differences: midbrain diameter (P < .0001), m/p diameter ratio (P < .0001), SCP width (P = .050), and MRPI (P = .049). None of these markers produced combined high (>80%) specificity and sensitivity. Qualitative MRI signs were specific, but lacked sensitivity. DISCUSSION Midbrain morphology in iNPH may resemble that of PSP. Established MRI markers of midbrain and SCP atrophy cannot confidently differentiate PSP from iNPH. MRI markers do not provide combined high sensitivity and specificity for the differential diagnosis of PSP from iNPH.
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Affiliation(s)
- Vasilios C. Constantinides
- 1st Department of Neurology School of Medicine National and Kapodistrian University of Athens Eginition Hospital Athens Greece
| | - George P. Paraskevas
- 1st Department of Neurology School of Medicine National and Kapodistrian University of Athens Eginition Hospital Athens Greece
| | - Georgios Velonakis
- 2nd Department of Radiology Research Unit of Radiology Medical School National and Kapodistrian University of Athens Athens Greece
| | - Panagiotis Toulas
- 2nd Department of Radiology Research Unit of Radiology Medical School National and Kapodistrian University of Athens Athens Greece
| | - Leonidas Stefanis
- 1st Department of Neurology School of Medicine National and Kapodistrian University of Athens Eginition Hospital Athens Greece
| | - Elisabeth Kapaki
- 1st Department of Neurology School of Medicine National and Kapodistrian University of Athens Eginition Hospital Athens Greece
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23
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Quattrone A, Morelli M, Quattrone A, Vescio B, Nigro S, Arabia G, Nisticò R, Novellino F, Salsone M, Arcuri P, Luca A, Mazzuca A, Alessio C, Rocca F, Caracciolo M. Magnetic Resonance Parkinsonism Index for evaluating disease progression rate in progressive supranuclear palsy: A longitudinal 2-year study. Parkinsonism Relat Disord 2020; 72:1-6. [DOI: 10.1016/j.parkreldis.2020.01.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/14/2020] [Accepted: 01/31/2020] [Indexed: 12/27/2022]
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24
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Nigro S, Antonini A, Vaillancourt DE, Seppi K, Ceravolo R, Strafella AP, Augimeri A, Quattrone A, Morelli M, Weis L, Fiorenzato E, Biundo R, Burciu RG, Krismer F, McFarland NR, Mueller C, Gizewski ER, Cosottini M, Del Prete E, Mazzucchi S, Quattrone A. Automated MRI Classification in Progressive Supranuclear Palsy: A Large International Cohort Study. Mov Disord 2020; 35:976-983. [PMID: 32092195 DOI: 10.1002/mds.28007] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Magnetic Resonance Parkinsonism Index is listed as one of the most reliable imaging morphometric markers for diagnosis of progressive supranuclear palsy (PSP). However, the use of this index in diagnostic workup has been limited until now by the low generalizability of published results because of small monocentric patient cohorts, the lack of data validation in independent patient series, and manual measurements used for index calculation. The objectives of this study were to investigate the generalizability of Magnetic Resonance Parkinsonism Index performance validating previously established cutoff values in a large international cohort of PSP patients subclassified into PSP-Richardson's syndrome and PSP-parkinsonism and to standardize the use of the automated Magnetic Resonance Parkinsonism Index by providing a web-based platform to obtain homogenous measures around the world. METHODS In a retrospective international multicenter study, a total of 173 PSP patients and 483 non-PSP participants were enrolled. A web-based platform (https://mrpi.unicz.it) was used to calculate automated Magnetic Resonance Parkinsonism Index values. RESULTS Magnetic Resonance Parkinsonism Index values showed optimal performance in differentiating PSP-Richardson's syndrome and PSP-parkinsonism patients from non-PSP participants (93.6% and 86.5% of accuracy, respectively). The Magnetic Resonance Parkinsonism Index was also able to differentiate PSP-Richardson's syndrome and PSP-parkinsonism patients in an early stage of the disease from non-PSP participants (90.1% and 85.9%, respectively). The web-based platform provided the automated Magnetic Resonance Parkinsonism Index calculation in 94% of cases. CONCLUSIONS Our study provides the first evidence on the generalizability of automated Magnetic Resonance Parkinsonism Index measures in a large international cohort of PSP-Richardson's syndrome and PSP-parkinsonism patients. The web-based platform enables widespread applicability of the automated Magnetic Resonance Parkinsonism Index to different clinical and research settings. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Salvatore Nigro
- Neuroscience Centre, Magna Graecia University, Catanzaro, Italy
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - David E Vaillancourt
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA.,Department of Neurology and Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.,Neuroimaging Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Pisa, Pisa, Italy
| | - Antonio P Strafella
- Krembil Research Institute, UHN & Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrea Quattrone
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Maurizio Morelli
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Luca Weis
- IRCCS San Camillo Hospital, Venice, Italy
| | | | | | - Roxana G Burciu
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Nikolaus R McFarland
- Department of Neurology and Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Christoph Mueller
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Neuroimaging Core Facility, Medical University Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Mirco Cosottini
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Eleonora Del Prete
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Pisa, Pisa, Italy
| | - Aldo Quattrone
- Neuroscience Centre, Magna Graecia University, Catanzaro, Italy.,Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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25
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Picillo M, Tepedino MF, Abate F, Erro R, Ponticorvo S, Tartaglione S, Volpe G, Frosini D, Cecchi P, Cosottini M, Ceravolo R, Esposito F, Pellecchia MT, Barone P, Manara R. Midbrain MRI assessments in progressive supranuclear palsy subtypes. J Neurol Neurosurg Psychiatry 2020; 91:98-103. [PMID: 31527182 DOI: 10.1136/jnnp-2019-321354] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To explore the role of the available midbrain-based MRI morphometric assessments in (1) differentiating among progressive supranuclear palsy (PSP) subtypes (PSP Richardson's syndrome (PSP-RS), PSP with predominant parkinsonism (PSP-P) and the other variant syndromes of PSP (vPSP)), and (2) supporting the diagnosis of PSP subtypes compared with Parkinson's disease (PD) and healthy controls (HC). METHODS Seventy-eight patients with PSP (38 PSP-RS, 21 PSP-P and 19 vPSP), 35 PD and 38 HC were included in the present analysis. Available midbrain-based MRI morphometric assessments were calculated for all participants. RESULTS Current MRI midbrain-based assessments do not display an adequate sensitivity and specificity profile in differentiating PSP subtypes. On the other hand, we confirmed MR Parkinsonism Index (MRPI) and pons area to midbrain area ratio (P/M) have adequate diagnostic value to support PSP-RS clinical diagnosis compared with both PD and HC, but low sensitivity and specificity profile in differentiating PSP-P from PD as well as from HC. The same measures show acceptable sensitivity and specificity profile in supporting clinical diagnosis of vPSP versus HC but not versus PD. Similar findings were detected for the newer MRPI and P/M versions. CONCLUSIONS Further studies are warranted to identify neuroimaging biomarkers supporting the clinical phenotypic categorisation of patients with PSP. MRPI and P/M have diagnostic value in supporting the clinical diagnosis of PSP-RS. CLASSIFICATION OF EVIDENCE This study provides class III evidence that available MRI midbrain-based assessments do not have diagnostic value in differentiating the Movement Disorder Society PSP subtypes.
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Affiliation(s)
- Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Maria Francesca Tepedino
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Filomena Abate
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Sara Ponticorvo
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi (SA), Italy
| | - Salvatore Tartaglione
- Department of Diagnostic Imaging, University Hospital A.O.U. OO.RR. San Giovanni di Dio e Ruggi D'Aragona, Scuola Medica Salernitana, Salerno, Italy
| | - Giampiero Volpe
- Neurology, University Hospital A.O.U. OO.RR. San Giovanni di Dio e Ruggi D'Aragona, Scuola Medica Salernitana, Salerno, Italy
| | - Daniela Frosini
- Dipartimento di Medicina Clinica e Sperimentale Università di Pisa, Italy, Università di Pisa, Pisa, Italy
| | - Paolo Cecchi
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
| | - Mirco Cosottini
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
| | - Roberto Ceravolo
- Dipartimento di Medicina Clinica e Sperimentale Università di Pisa, Italy, Università di Pisa, Pisa, Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi (SA), Italy.,Department of Diagnostic Imaging, University Hospital A.O.U. OO.RR. San Giovanni di Dio e Ruggi D'Aragona, Scuola Medica Salernitana, Salerno, Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Renzo Manara
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi (SA), Italy
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Abstract
PURPOSE OF REVIEW Being a disease with heterogeneous presentations and unclear consensus on its diagnostic criteria, it is difficult to differentiate vascular parkinsonism (VaP) from other neurodegenerative parkinsonism variants. Ongoing research on structural and functional neuroimaging targeting dopaminergic pathway provides us more insight into the pathophysiology of VaP to improve diagnostic accuracy. The aim of this article is to review how the emerging imaging modalities help the diagnostic process and treatment decision in VaP. RECENT FINDINGS Dopamine transporter imaging is a promising tool in differentiating presynaptic parkinsonism and VaP. It also predicts the levodopa responders in VaP. Advanced MRI techniques including volumetry, diffusion tensor imaging and sequences visualising substantia nigra are under development, and they are complementary to each other in detecting structural and functional changes in VaP, which is crucial to ensure the quality of future therapeutic trials for VaP. Dopamine transporter imaging is recommended to patients with suspected VaP. Multimodal MRI in VaP would be an important area to be investigated in the near future.
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Affiliation(s)
- Karen K Y Ma
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shi Lin
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- BrainNow Research Institute, Guangdong Province, Shenzhen, China
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- BrainNow Research Institute, Guangdong Province, Shenzhen, China.
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27
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Zhang K, Liang Z, Wang C, Zhang X, Yu B, Liu X. Diagnostic validity of magnetic resonance parkinsonism index in differentiating patients with progressive supranuclear palsy from patients with Parkinson's disease. Parkinsonism Relat Disord 2019; 66:176-181. [PMID: 31420309 DOI: 10.1016/j.parkreldis.2019.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/30/2019] [Accepted: 08/09/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Progressive supranuclear palsy is a neuropathologically defined disease, and many studies worked on detecting the diagnostic use of Magnetic resonance imaging. This article purposed to detect the diagnostic performance of Magnetic resonance parkinsonism index (MRPI). METHODS We systematically searched electronic database PubMed for articles published since 1996 using the National Institute of Neurological Disorders and Stroke and Society for PSP (NINDS-SPSP) criteria as the diagnostic standard. Methodological quality was assessed by Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and software Review Manager 5.3, software STATA 14.0 and meta-disc were applied in statistics analysis. RESULTS Totally 14 articles were included in this article. MRPI is proved to have pooled sensitivity of 0.98, pooled specificity of 0.99 in differentiating patients with Progressive supranuclear palsy (PSP) from patients with Parkinson's disease (PD) and the area under the Receiver operating characteristic curve value was 1.00. CONCLUSION MRPI shows excellent performance in differentiating patients with PSP from patients with PD, the clinical usage of MRPI in auxiliary diagnosis of PSP is recommended.
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Affiliation(s)
- Kejia Zhang
- School of Clinical Medicine, Jilin University, Changchun, China
| | - Zhenzhen Liang
- NHC Key Lab of Radiobiology (Jilin University), Changchun, Jilin, 130021, China
| | - Chunpeng Wang
- School of Mathematics and Statistics, Northeast Normal University, Changchun, Jilin, 130000, China
| | - Xueyuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Binbin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Xin Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China.
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28
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Ahn JH, Kim M, Kim JS, Youn J, Jang W, Oh E, Lee PH, Koh SB, Ahn TB, Cho JW. Midbrain atrophy in patients with presymptomatic progressive supranuclear palsy-Richardson's syndrome. Parkinsonism Relat Disord 2019; 66:80-86. [PMID: 31307918 DOI: 10.1016/j.parkreldis.2019.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/27/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION In the present study, midbrain atrophy and the pons-to-midbrain area ratio (P/M ratio) were investigated as diagnostic markers for presymptomatic progressive supranuclear palsy-Richardson's syndrome (Pre-PSP-RS). METHODS The present study included 27 patients with probable PSP-RS who underwent brain MRI at least twice before and after the development of clinical symptoms, age- and sex-matched participants with Parkinson's disease (PD, n = 27), and healthy controls (n = 27). The midbrain area, pons area, and P/M ratio of the Pre-PSP-RS, PD, and control subjects were measured using midsagittal images from brain MRI, and the parameters were compared among the groups. RESULTS The midbrain area decreased and the P/M ratio increased significantly in the Pre-PSP-RS patients compared with both the PD and control subjects (midbrain, Pre-PSP-RS vs. PD = 1.01 cm2vs. 1.29 cm2, p < 0.001, Pre-PSP-RS vs. controls = 1.01 cm2vs. 1.29 cm2, p < 0.001; P/M ratio, Pre-PSP-RS vs. PD = 5.27 vs. 4.03, p < 0.001, Pre-PSP-RS vs. controls = 5.27 cm2vs. 4.06 cm2, p < 0.001). The P/M ratio had high sensitivity (vs. PD, 96.3%, vs. control, 88.9%) and specificity (vs. PD, 81.5%, vs. control, 96.3%) in differentiating Pre-PSP-RS patients from PD and control subjects. CONCLUSION Midbrain atrophy precedes the clinical symptoms of PSP-RS and could be a useful diagnostic imaging biomarker for Pre-PSP-RS. Furthermore, this information could play an important role in the development of future treatment strategies.
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Affiliation(s)
- Jong Hyeon Ahn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Minkyeong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Wooyoung Jang
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon, Gangneung, 25440, Republic of Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, College of Medicine, 282 Munhwa-ro, Jung-Gu, Daejun, 35015, Republic of Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seong-Beom Koh
- Departments of Neurology, Korea University College of Medicine, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Neuroscience Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Krismer F, Seppi K, Göbel G, Steiger R, Zucal I, Boesch S, Gizewski ER, Wenning GK, Poewe W, Scherfler C. Morphometric MRI profiles of multiple system atrophy variants and implications for differential diagnosis. Mov Disord 2019; 34:1041-1048. [PMID: 30919495 PMCID: PMC6767501 DOI: 10.1002/mds.27669] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 12/14/2022] Open
Abstract
Background Manual width measurements of the middle cerebellar peduncle on MRI were shown to improve the accuracy of an imaging‐guided diagnosis of multiple system atrophy (MSA). Recently, automated volume segmentation algorithms were able to reliably differentiate patients with Parkinson's disease (PD) and the parkinsonian variant of MSA. The objective of the current study was to integrate probabilistic information of the middle cerebellar peduncle into an existing MRI atlas for automated subcortical segmentation and to evaluate the diagnostic properties of the novel atlas for the differential diagnosis of MSA (parkinsonian and cerebellar variant) versus PD. Methods Three Tesla MRI scans of 48 healthy individuals were used to establish an automated whole‐brain segmentation procedure that includes the volumes of the putamen, cerebellar gray and white matter, and the middle cerebellar peduncles. Classification accuracy of segmented volumes were tested in early‐stage MSA patients (18 MSA‐parkinsonism, 13 MSA‐cerebellar) and 19 PD patients using a C4.5 classifier. Results Putaminal and infratentorial atrophy were present in 77.8% and 61.1% of MSA‐parkinsonian patients, respectively. Four of 18 MSA‐parkinsonian patients (22.2%) had infratentorial atrophy without evidence of putaminal atrophy. Infratentorial atrophy was present in all MSA‐cerebellar patients, with concomitant putaminal atrophy in 46.2% of these cases. The diagnostic algorithm using putaminal and infratentorial volumetric information correctly classified all PD patients and 96.8% of MSA patients. Conclusions The middle cerebellar peduncle was successfully integrated into a subcortical segmentation atlas, and its excellent diagnostic accuracy outperformed existing volumetric MRI processing strategies in differentiating MSA patients with variable atrophy patterns from PD patients. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Göbel
- Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Ruth Steiger
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Isabel Zucal
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Sylvia Boesch
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
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30
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Quattrone A, Morelli M, Vescio B, Nigro S, Le Piane E, Sabatini U, Caracciolo M, Vescio V, Quattrone A, Barbagallo G, Stanà C, Nicoletti G, Arabia G, Nisticò R, Novellino F, Salsone M. Refining initial diagnosis of Parkinson's disease after follow-up: A 4-year prospective clinical and magnetic resonance imaging study. Mov Disord 2019; 34:487-495. [PMID: 30759325 PMCID: PMC6593994 DOI: 10.1002/mds.27621] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/27/2018] [Accepted: 01/02/2019] [Indexed: 01/05/2023] Open
Abstract
Background No prospective study of patients with Parkinson's disease (PD) has investigated the appearance of vertical gaze abnormalities, a feature suggestive of progressive supranuclear palsy (PSP). Objective To identify, within a cohort of patients with an initial diagnosis of PD, those who developed vertical gaze abnormalities during a 4‐year follow‐up, and to investigate the performance of new imaging biomarkers in predicting vertical gaze abnormalities. Methods A total of 110 patients initially classified as PD and 74 controls were enrolled. All patients underwent clinical assessment at baseline and every year up to the end of the follow‐up. The pons/midbrain area ratio 2.0 and the Magnetic Resonance Parkinsonism Index 2.0 were calculated. Results After 4‐year follow‐up, 100 of 110 patients maintained the diagnosis of PD, whereas 10 PD patients (9.1%) developed vertical gaze abnormalities, suggesting an alternative diagnosis of PSP‐parkinsonism. At baseline, the Magnetic Resonance Parkinsonism Index 2.0 was the most accurate biomarker in differentiating PD patients who developed vertical gaze abnormalities from those who maintained an initial diagnosis of PD. At the end of follow‐up, both of these biomarkers accurately distinguished PSP‐parkinsonism from PD. Conclusions Our results demonstrate that a number of patients with an initial diagnosis of PD developed vertical gaze abnormalities during a 4‐year follow‐up, and the diagnosis was changed from PD to PSP‐parkinsonism. In PD patients, baseline Magnetic Resonance Parkinsonism Index 2.0 showed the best performance in predicting the clinical evolution toward a PSP‐parkinsonism phenotype, enabling PSP‐parkinsonism patients to be identified at the earliest stage of the disease for promising disease‐modifying therapies. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Aldo Quattrone
- Neuroscience Centre, Magna Graecia University, Catanzaro, Italy.,Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Maurizio Morelli
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.,Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Salvatore Nigro
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Emilio Le Piane
- Department of Neurology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Umberto Sabatini
- Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy
| | - Manuela Caracciolo
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Virginia Vescio
- Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Gaetano Barbagallo
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Carlo Stanà
- Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Nicoletti
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Gennarina Arabia
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.,Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Rita Nisticò
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Fabiana Novellino
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Maria Salsone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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31
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Eraslan C, Acarer A, Guneyli S, Akyuz E, Aydin E, Colakoglu Z, Kitis O, Calli MC. MRI evaluation of progressive supranuclear palsy: differentiation from Parkinson’s disease and multiple system atrophy. Neurol Res 2018; 41:110-117. [DOI: 10.1080/01616412.2018.1541115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cenk Eraslan
- Department of Radiology, Ege University Medical Faculty, Izmir, Turkey
| | - Ahmet Acarer
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
| | - Serkan Guneyli
- Department of Radiology, Bulent Ecevit University Medical Faculty, Zonguldak, Turkey
| | - Esra Akyuz
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
| | - Elcin Aydin
- Department of Radiology, Baskent University Medical Faculty, Izmir, Turkey
| | - Zafer Colakoglu
- Department of Neurology, Ege University Medical Faculty, Izmir, Turkey
| | - Omer Kitis
- Department of Radiology, Ege University Medical Faculty, Izmir, Turkey
| | - Mehmet Cem Calli
- Department of Radiology, Ege University Medical Faculty, Izmir, Turkey
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Abstract
Qualitative and quantitative structural magnetic resonance imaging offer objective measures of the underlying neurodegeneration in atypical parkinsonism. Regional changes in tissue volume, signal changes and increased deposition of iron as assessed with different structural MRI techniques are surrogate markers of underlying neurodegeneration and may reflect cell loss, microglial proliferation and astroglial activation. Structural MRI has been explored as a tool to enhance diagnostic accuracy in differentiating atypical parkinsonian disorders (APDs). Moreover, the longitudinal assessment of serial structural MRI-derived parameters offers the opportunity for robust inferences regarding the progression of APDs. This review summarizes recent research findings as (1) a diagnostic tool for APDs as well as (2) as a tool to assess longitudinal changes of serial MRI-derived parameters in the different APDs.
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33
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Quattrone A, Morelli M, Nigro S, Quattrone A, Vescio B, Arabia G, Nicoletti G, Nisticò R, Salsone M, Novellino F, Barbagallo G, Le Piane E, Pugliese P, Bosco D, Vaccaro MG, Chiriaco C, Sabatini U, Vescio V, Stanà C, Rocca F, Gullà D, Caracciolo M. A new MR imaging index for differentiation of progressive supranuclear palsy-parkinsonism from Parkinson's disease. Parkinsonism Relat Disord 2018; 54:3-8. [DOI: 10.1016/j.parkreldis.2018.07.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 12/22/2022]
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34
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Mostile G, Nicoletti A, Zappia M. Vascular Parkinsonism: Still Looking for a Diagnosis. Front Neurol 2018; 9:411. [PMID: 29962998 PMCID: PMC6013552 DOI: 10.3389/fneur.2018.00411] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/18/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giovanni Mostile
- Section of Neurosciences, Department "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Section of Neurosciences, Department "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Mario Zappia
- Section of Neurosciences, Department "G.F. Ingrassia", University of Catania, Catania, Italy
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35
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Constantinides VC, Paraskevas GP, Velonakis G, Toulas P, Stamboulis E, Kapaki E. MRI Planimetry and Magnetic Resonance Parkinsonism Index in the Differential Diagnosis of Patients with Parkinsonism. AJNR Am J Neuroradiol 2018; 39:1047-1051. [PMID: 29622555 DOI: 10.3174/ajnr.a5618] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/07/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differential diagnosis of multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration from Parkinson disease on clinical grounds is often difficult. MR imaging biomarkers could assist in a more accurate diagnosis. We examined the utility of MR imaging surface measurements (MR imaging planimetry) in the differential diagnosis of patients with parkinsonism. MATERIALS AND METHODS Fifty-two patients with Parkinson-plus (progressive supranuclear palsy, n = 24; corticobasal degeneration, n = 9; multiple system atrophy, n = 19), 18 patients with Parkinson disease, and 15 healthy controls were included. Corpus callosum, midbrain, and pons surfaces; relevant indices; and the Magnetic Resonance Parkinsonism Index were calculated. Corpus callosum subsection analysis was performed, and the corpus callosum posteroanterior gradient was introduced. RESULTS A Magnetic Resonance Parkinsonism Index value of >12.6 discriminated progressive supranuclear palsy from other causes of parkinsonism with a 91% sensitivity and 95% specificity. No planimetry measurement could accurately discriminate those with multiple system atrophy with parkinsonism from patients with Parkinson disease. A corpus callosum posteroanterior gradient value of ≤191 was highly specific (97%) and moderately sensitive (75%) for the diagnosis of corticobasal degeneration versus all other groups. A midbrain-to-corpus callosum posteroanterior gradient ratio of ≤0.45 was highly indicative of progressive supranuclear palsy over corticobasal degeneration (sensitivity 86%, specificity 88%). CONCLUSIONS MR imaging planimetry measurements are potent imaging markers of progressive supranuclear palsy and promising markers of corticobasal degeneration but do not seem to assist in the diagnosis of multiple system atrophy with parkinsonism.
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Affiliation(s)
- V C Constantinides
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - G P Paraskevas
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - G Velonakis
- Research Unit of Radiology (G.V., P.T.), 2nd Department of Radiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Toulas
- Research Unit of Radiology (G.V., P.T.), 2nd Department of Radiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Stamboulis
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - E Kapaki
- From the 1st Department of Neurology (V.C.C., G.P.P., E.S., E.K.), National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
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36
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Huppertz HJ, Möller L, Südmeyer M, Hilker R, Hattingen E, Egger K, Amtage F, Respondek G, Stamelou M, Schnitzler A, Pinkhardt EH, Oertel WH, Knake S, Kassubek J, Höglinger GU. Differentiation of neurodegenerative parkinsonian syndromes by volumetric magnetic resonance imaging analysis and support vector machine classification. Mov Disord 2017; 31:1506-1517. [PMID: 27452874 DOI: 10.1002/mds.26715] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/06/2016] [Accepted: 06/03/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Clinical differentiation of parkinsonian syndromes is still challenging. OBJECTIVES A fully automated method for quantitative MRI analysis using atlas-based volumetry combined with support vector machine classification was evaluated for differentiation of parkinsonian syndromes in a multicenter study. METHODS Atlas-based volumetry was performed on MRI data of healthy controls (n = 73) and patients with PD (204), PSP with Richardson's syndrome phenotype (106), MSA of the cerebellar type (21), and MSA of the Parkinsonian type (60), acquired on different scanners. Volumetric results were used as input for support vector machine classification of single subjects with leave-one-out cross-validation. RESULTS The largest atrophy compared to controls was found for PSP with Richardson's syndrome phenotype patients in midbrain (-15%), midsagittal midbrain tegmentum plane (-20%), and superior cerebellar peduncles (-13%), for MSA of the cerebellar type in pons (-33%), cerebellum (-23%), and middle cerebellar peduncles (-36%), and for MSA of the parkinsonian type in the putamen (-23%). The majority of binary support vector machine classifications between the groups resulted in balanced accuracies of >80%. With MSA of the cerebellar and parkinsonian type combined in one group, support vector machine classification of PD, PSP and MSA achieved sensitivities of 79% to 87% and specificities of 87% to 96%. Extraction of weighting factors confirmed that midbrain, basal ganglia, and cerebellar peduncles had the largest relevance for classification. CONCLUSIONS Brain volumetry combined with support vector machine classification allowed for reliable automated differentiation of parkinsonian syndromes on single-patient level even for MRI acquired on different scanners. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Leona Möller
- Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany
| | - Martin Südmeyer
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Rüdiger Hilker
- Department of Neurology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Karl Egger
- Department of Neuroradiology, Medical University Center Freiburg, Freiburg, Germany
| | - Florian Amtage
- Department of Neurology, Medical University Center Freiburg, Freiburg, Germany
| | - Gesine Respondek
- Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany.,Department of Neurology, Technische Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Maria Stamelou
- Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany
| | - Alfons Schnitzler
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Wolfgang H Oertel
- Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany
| | - Susanne Knake
- Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany.
| | - Günter U Höglinger
- Department of Neurology, University Hospital Gießen and Marburg, Marburg, Germany.,Department of Neurology, Technische Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
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37
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Constantinides VC, Paraskevas GP, Stamboulis E, Kapaki E. Simple linear brainstem MRI measurements in the differential diagnosis of progressive supranuclear palsy from the parkinsonian variant of multiple system atrophy. Neurol Sci 2017; 39:359-364. [DOI: 10.1007/s10072-017-3212-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
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38
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Nizamani WM, Mubarak F, Barakzai MD, Ahmed MS. Role of magnetic resonance planimetry and magnetic resonance parkinsonism index in discriminating Parkinson's disease and progressive supranuclear palsy: a retrospective study based on 1.5 and 3 T MRI. Int J Gen Med 2017; 10:375-384. [PMID: 29184432 PMCID: PMC5673040 DOI: 10.2147/ijgm.s134297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective The objective of the study was to assess magnetic resonance (MR) planimetric measurements and MR parkinsonism index (MRPI) in differentiating progressive supranuclear palsy (PSP) from Parkinson’s disease (PD) using 1.5 and 3 T MRI scanner. Subjects and methods After ethical approval was obtained, analysis of 34 consecutive patients with PSP, 34 patients with PD and 34 healthy controls (HCs) was performed. HCs were age-matched adults without any history of neurodegenerative disease or movement disorders. Retrospective data from the past 10 years (from January 2006 to December 2015) were obtained from the Hospital Information Management System, and informed consent was obtained from all participants. The measurements of pons area–midbrain area ratio (P/M) and MCP width–superior cerebellar peduncle (SCP) width ratio (MCP/SCP) were used, and MRPI was calculated by the formula ([P/M]×[MCP/SCP]). Results Midbrain area and SCP width in patients with PSP (19 males, 15 females; mean age =66.7 years) were significantly (P<0.001) smaller than in patients with PD (20 males, 14 females; mean age =66.7 years) and control participants (17 males, 17 females; mean age =66.1 years). P/M and MCP/SCP were significantly higher in patients with PSP than in patients with PD and control participants. All measurements showed some overlap of values between patients with PSP and patients from PD group and control participants. MRPI value was significantly higher in patients with PSP (mean 21.00) than in patients with PD (mean 9.50; P<0.001) and control participants (mean 9.6; P<0.001), without any overlap of values among groups. No correlation was found between the duration of disease, PSP rating scale, PSP staging system and MRPI in this study. No patient with PSP received a misdiagnosis when the index was used (sensitivity and specificity, 100%). Conclusion MRPI should be made an essential part of all MRI brain reporting whenever differentiation between PD and PSP is sought for.
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Affiliation(s)
| | - Fatima Mubarak
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
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39
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Heim B, Krismer F, De Marzi R, Seppi K. Magnetic resonance imaging for the diagnosis of Parkinson's disease. J Neural Transm (Vienna) 2017; 124:915-964. [PMID: 28378231 PMCID: PMC5514207 DOI: 10.1007/s00702-017-1717-8] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/22/2017] [Indexed: 12/11/2022]
Abstract
The differential diagnosis of parkinsonian syndromes is considered one of the most challenging in neurology and error rates in the clinical diagnosis can be high even at specialized centres. Despite several limitations, magnetic resonance imaging (MRI) has undoubtedly enhanced the diagnostic accuracy in the differential diagnosis of neurodegenerative parkinsonism over the last three decades. This review aims to summarize research findings regarding the value of the different MRI techniques, including advanced sequences at high- and ultra-high-field MRI and modern image analysis algorithms, in the diagnostic work-up of Parkinson's disease. This includes not only the exclusion of alternative diagnoses for Parkinson's disease such as symptomatic parkinsonism and atypical parkinsonism, but also the diagnosis of early, new onset, and even prodromal Parkinson's disease.
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Affiliation(s)
- Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Roberto De Marzi
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria.
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40
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Lee SH, Lyoo CH, Cho H, Rinne JO, Lee MS. Parkinsonian Patients with Striatal Cribriform State Present Rapidly Progressive Axial Parkinsonism. Eur Neurol 2017; 78:119-124. [PMID: 28746923 DOI: 10.1159/000479227] [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: 02/07/2017] [Accepted: 07/05/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To define the significance of striatal cribriform state (SCS) observed in patients with primary progressive parkinsonism. METHODS We reviewed medical records and brain magnetic resonance imaging studies of 1,260 patients with primary progressive parkinsonism. We identified 23 patients with SCS and analyzed their clinical features. RESULTS All 23 patients had rapidly progressive parkinsonism predominated by postural instability and gait disturbance. Clinical features of 18 of the 23 patients were compatible with progressive supranuclear palsy (PSP); 2 patients were compatible with parkinsonian type multiple system atrophy; 2 patients were compatible with mixed clinical features of both; and 1 patient had PSP-like clinical features. CONCLUSIONS Most parkinsonian patients with SCS present rapidly progressive parkinsonism predominated by postural instability and gait disturbance. SCS observed in patients with parkinsonism does not seem to be a coincidental finding associated with the generalized cerebrovascular process.
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Affiliation(s)
- Seung Ha Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Juha O Rinne
- Turku PET Centre, University of Turku, Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Myung Sik Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Whitwell JL, Höglinger GU, Antonini A, Bordelon Y, Boxer AL, Colosimo C, van Eimeren T, Golbe LI, Kassubek J, Kurz C, Litvan I, Pantelyat A, Rabinovici G, Respondek G, Rominger A, Rowe JB, Stamelou M, Josephs KA. Radiological biomarkers for diagnosis in PSP: Where are we and where do we need to be? Mov Disord 2017; 32:955-971. [PMID: 28500751 PMCID: PMC5511762 DOI: 10.1002/mds.27038] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/11/2022] Open
Abstract
PSP is a pathologically defined neurodegenerative tauopathy with a variety of clinical presentations including typical Richardson's syndrome and other variant PSP syndromes. A large body of neuroimaging research has been conducted over the past two decades, with many studies proposing different structural MRI and molecular PET/SPECT biomarkers for PSP. These include measures of brainstem, cortical and striatal atrophy, diffusion weighted and diffusion tensor imaging abnormalities, [18F] fluorodeoxyglucose PET hypometabolism, reductions in striatal dopamine imaging and, most recently, PET imaging with ligands that bind to tau. Our aim was to critically evaluate the degree to which structural and molecular neuroimaging metrics fulfill criteria for diagnostic biomarkers of PSP. We queried the PubMed, Cochrane, Medline, and PSYCInfo databases for original research articles published in English over the past 20 years using postmortem diagnosis or the NINDS-SPSP criteria as the diagnostic standard from 1996 to 2016. We define a five-level theoretical construct for the utility of neuroimaging biomarkers in PSP, with level 1 representing group-level findings, level 2 representing biomarkers with demonstrable individual-level diagnostic utility, level 3 representing biomarkers for early disease, level 4 representing surrogate biomarkers of PSP pathology, and level 5 representing definitive PSP biomarkers of PSP pathology. We discuss the degree to which each of the currently available biomarkers fit into this theoretical construct, consider the role of biomarkers in the diagnosis of Richardson's syndrome, variant PSP syndromes and autopsy confirmed PSP, and emphasize current shortfalls in the field. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Günter U. Höglinger
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, IRCCS Hospital San Camillo, Venice and Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, CA, USA
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
| | - Thilo van Eimeren
- German Center for Neurodegenerative Diseases (DZNE), Germany
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Lawrence I. Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Carolin Kurz
- Psychiatrische Klinik, Ludwigs-Maximilians-Universität, München, Germany
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, CA, USA
| | | | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Gesine Respondek
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Axel Rominger
- Deptartment of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - James B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Maria Stamelou
- Second Department of Neurology, Attikon University Hospital, University of Athens, Greece; Philipps University, Marburg, Germany; Movement Disorders Dept., HYGEIA Hospital, Athens, Greece
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Sako W, Murakami N, Izumi Y, Kaji R. Usefulness of the superior cerebellar peduncle for differential diagnosis of progressive supranuclear palsy: A meta-analysis. J Neurol Sci 2017; 378:153-157. [PMID: 28566154 DOI: 10.1016/j.jns.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
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Nigro S, Arabia G, Antonini A, Weis L, Marcante A, Tessitore A, Cirillo M, Tedeschi G, Zanigni S, Calandra-Buonaura G, Tonon C, Pezzoli G, Cilia R, Zappia M, Nicoletti A, Cicero CE, Tinazzi M, Tocco P, Cardobi N, Quattrone A. Magnetic Resonance Parkinsonism Index: diagnostic accuracy of a fully automated algorithm in comparison with the manual measurement in a large Italian multicentre study in patients with progressive supranuclear palsy. Eur Radiol 2017; 27:2665-2675. [PMID: 27761709 DOI: 10.1007/s00330-016-4622-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/26/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate the reliability of a new in-house automatic algorithm for calculating the Magnetic Resonance Parkinsonism Index (MRPI), in a large multicentre study population of patients affected by progressive supranuclear palsy (PSP) or Parkinson's disease (PD), and healthy controls (HC), and to compare the diagnostic accuracy of the automatic and manual MRPI values. METHODS The study included 88 PSP patients, 234 PD patients and 117 controls. MRI was performed using both 3T and 1.5T scanners. Automatic and manual MRPI values were evaluated, and accuracy of both methods in distinguishing PSP from PD and controls was calculated. RESULTS No statistical differences were found between automated and manual MRPI values in all groups. The automatic MRPI values differentiated PSP from PD with an accuracy of 95 % (manual MRPI accuracy 96 %) and 97 % (manual MRPI accuracy 100 %) for 1.5T and 3T scanners, respectively. CONCLUSION Our study showed that the new in-house automated method for MRPI calculation was highly accurate in distinguishing PSP from PD. Our automatic approach allows a widespread use of MRPI in clinical practice and in longitudinal research studies. KEY POINTS • A new automatic method for calculating the MRPI is presented. • Automatic MRPI values are in good agreement with manual values. • Automatic MRPI can distinguish patients with PSP from patients with PD. • The automatic method overcomes MRPI application limitations in routine practice. • The automatic method may allow a more widespread use of MRPI.
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Affiliation(s)
- Salvatore Nigro
- Institute of Bioimaging and Molecular Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Gennarina Arabia
- Institute of Neurology, Department of Medical and Surgical Sciences, University 'Magna Graecia', 88100, Catanzaro, Italy
| | - Angelo Antonini
- Parkinson's Disease and Movement Disorders Unit, 'Fondazione Ospedale San Camillo' - I.R.C.C.S, Venice-Lido, Italy
| | - Luca Weis
- Parkinson's Disease and Movement Disorders Unit, 'Fondazione Ospedale San Camillo' - I.R.C.C.S, Venice-Lido, Italy
| | - Andrea Marcante
- Parkinson's Disease and Movement Disorders Unit, 'Fondazione Ospedale San Camillo' - I.R.C.C.S, Venice-Lido, Italy
| | - Alessandro Tessitore
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, 80138, Italy
- MRI Research Center SUN-FISM, Second University of Naples, Naples, Italy
| | - Mario Cirillo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, 80138, Italy
- MRI Research Center SUN-FISM, Second University of Naples, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, 80138, Italy
- MRI Research Center SUN-FISM, Second University of Naples, Naples, Italy
| | - Stefano Zanigni
- Functional MR Unit, Policlinico S. Orsola - Malpighi, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Caterina Tonon
- Functional MR Unit, Policlinico S. Orsola - Malpighi, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gianni Pezzoli
- Parkinson Institute, ASST G.Pini - CTO, ex ICP, Milano, Italy
| | - Roberto Cilia
- Parkinson Institute, ASST G.Pini - CTO, ex ICP, Milano, Italy
| | - Mario Zappia
- Department 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Department 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Michele Tinazzi
- Department of Neurological and Movement Sciences, University Hospital of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Pierluigi Tocco
- Department of Neurological and Movement Sciences, University Hospital of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Nicolò Cardobi
- Institute of Radiology, University Hospital of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Aldo Quattrone
- Institute of Bioimaging and Molecular Physiology, National Research Council, 88100, Catanzaro, Italy.
- Institute of Neurology, Department of Medical and Surgical Sciences, University 'Magna Graecia', 88100, Catanzaro, Italy.
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Nigro S, Morelli M, Arabia G, Nisticò R, Novellino F, Salsone M, Rocca F, Quattrone A. Magnetic Resonance Parkinsonism Index and midbrain to pons ratio: Which index better distinguishes Progressive Supranuclear Palsy patients with a low degree of diagnostic certainty from patients with Parkinson Disease? Parkinsonism Relat Disord 2017; 41:31-36. [PMID: 28487107 DOI: 10.1016/j.parkreldis.2017.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/13/2017] [Accepted: 05/02/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Several studies have compared the performances of midbrain to pons area ratio (M/P) and the Magnetic Resonance Parkinsonism Index (MRPI) in distinguishing patients with Progressive Supranuclear Palsy (PSP) from those with Parkinson's disease (PD) with conflicting results. The current study aimed to compare the performance of these indexes in a well-characterized sample of PSP patients using either a manual or a fully automated approach to measure the brainstem structures involved in M/P and MRPI calculation. METHODS This study involved 179 patients affected by idiopathic PD, 35 patients affected by PSP (15 probable and 20 possible) and 87 healthy controls. Sensitivity, specificity, positive predictive value (PPV) and area under the curve (AUC) of MRPI and M/P in distinguishing possible and probable PSP from PD and controls were calculated. RESULTS No significant difference was found between manual and automated values for both MRPI and M/P. MRPI and M/P differentiated probable PSP from PD with similar performance. By contrast, MRPI showed higher sensitivity and specificity than M/P when patients with possible PSP were compared with PD (MRPI, sensitivity 100%, specificity 98.88%; M/P, sensitivity 85%, specificity 93.85%). A significant difference was also observed in AUC between MRPI and M/P in distinguishing possible PSP from PD. CONCLUSION Our study demonstrates that MRPI was more accurate than M/P, in differentiating patients with possible PSP from those with PD. In patients suspected of having PSP with a low level of clinic diagnostic accuracy, MRPI should be preferred to M/P for distinguishing these patients from PD.
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Affiliation(s)
- Salvatore Nigro
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Maurizio Morelli
- Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Graecia", 88100, Catanzaro, Italy
| | - Gennarina Arabia
- Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Graecia", 88100, Catanzaro, Italy
| | - Rita Nisticò
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Fabiana Novellino
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Maria Salsone
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Federico Rocca
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy
| | - Aldo Quattrone
- Institute of Molecular Bioimaging and Physiology, National Research Council, 88100, Catanzaro, Italy; Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Graecia", 88100, Catanzaro, Italy.
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Bacchi S, Chim I, Patel S. Specificity and sensitivity of magnetic resonance imaging findings in the diagnosis of progressive supranuclear palsy. J Med Imaging Radiat Oncol 2017; 62:21-31. [DOI: 10.1111/1754-9485.12613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 03/11/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Stephen Bacchi
- University of Adelaide; Adelaide South Australia Australia
| | - Ivana Chim
- University of Adelaide; Adelaide South Australia Australia
| | - Sandy Patel
- Royal Adelaide Hospital; Adelaide South Australia Australia
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Sakurai K, Tokumaru AM, Shimoji K, Murayama S, Kanemaru K, Morimoto S, Aiba I, Nakagawa M, Ozawa Y, Shimohira M, Matsukawa N, Hashizume Y, Shibamoto Y. Beyond the midbrain atrophy: wide spectrum of structural MRI finding in cases of pathologically proven progressive supranuclear palsy. Neuroradiology 2017; 59:431-443. [DOI: 10.1007/s00234-017-1812-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/19/2017] [Indexed: 01/29/2023]
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47
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Advanced structural neuroimaging in progressive supranuclear palsy: Where do we stand? Parkinsonism Relat Disord 2017; 36:19-32. [DOI: 10.1016/j.parkreldis.2016.12.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/01/2016] [Accepted: 12/23/2016] [Indexed: 12/11/2022]
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Möller L, Kassubek J, Südmeyer M, Hilker R, Hattingen E, Egger K, Amtage F, Pinkhardt EH, Respondek G, Stamelou M, Möller F, Schnitzler A, Oertel WH, Knake S, Huppertz HJ, Höglinger GU. Manual MRI morphometry in Parkinsonian syndromes. Mov Disord 2017; 32:778-782. [PMID: 28150443 DOI: 10.1002/mds.26921] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/01/2016] [Accepted: 12/20/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Several morphometric magnetic resonance imaging parameters may serve for differential diagnosis of parkinsonism. The objective of this study was to identify which performs best in clinical routine. METHODS We acquired multicentric magnetization-prepared rapid gradient echo sequences in patients with Parkinson's disease (n=204), progressive supranuclear palsy (n=106), multiple system atrophy-cerebellar, (n = 21); multiple system atrophy-parkinsonian (n = 60), and healthy controls (n = 73), performed manual planimetric measurements, and calculated receiver operator characteristics with leave-one-out cross-validation to propose cutoff values. RESULTS The midsagittal midbrain area was reduced in PSP versus all other groups (P < 0.001). The midsagittal pons area was reduced in MSA-cerebellar, MSA-parkinsonian, and PSP versus PD patients and healthy controls (P < 0.001). The midbrain/pons area ratio was lower in PSP (P < 0.001) and higher in MSA-cerebellar and MSA-parkinsonian versus PD and PSP (P < 0.001). CONCLUSIONS The midsagittal midbrain area most reliably identified PSP, the midsagittal pons area MSA-cerebellar. The midbrain/pons area ratio differentiated MSA-cerebellar and PSP better than the magnetic resonance-Parkinson index. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Leona Möller
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Martin Südmeyer
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Rüdiger Hilker
- Departement of Neurology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Karl Egger
- Department of Neuroradiology, Medical University Center Freiburg, Freiburg, Germany
| | - Florian Amtage
- Department of Neurology, Medical University Center Freiburg, Freiburg, Germany
| | | | - Gesine Respondek
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Department of Neurology, Technische Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Maria Stamelou
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Parkinson's Disease and Movement Disorders Department, HYGEIA Hospital, Athens, Greece and Second Dept. of Neurology, Attikon Hospital, University of Athens Greece
| | - Franz Möller
- Department of Children and Youth Medicine, Philipps University Marburg, Marburg, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang H Oertel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Susanne Knake
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | | | - Günter U Höglinger
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Department of Neurology, Medical University Center Freiburg, Freiburg, Germany.,Department of Neurology, Technische Universität München, Munich, Germany
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MRI measurements of brainstem structures in patients with vascular parkinsonism, progressive supranuclear palsy, and Parkinson's disease. Neurol Sci 2017; 38:627-633. [PMID: 28078564 DOI: 10.1007/s10072-017-2812-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
Magnetic resonance (MR) measurements of brainstem structures have been reported to be useful in differentiating patients with progressive supranuclear palsy (PSP) from those with Parkinson's disease (PD). The aim of this study was to determine whether quantitative measurements of brainstem structures on MR images can help differentiate vascular parkinsonism (VaP) from degenerative parkinsonism (PD and PSP). Areas of the midbrain and pons, and widths of the superior cerebellar peduncle (SCP) and middle cerebellar peduncle (MCP) were measured in 62 patients with PD, 25 patients with PSP (11 probable and 14 possible), and 24 patients with VaP on T 1-weighted MR images. The midbrain-to-pons area ratio (M/P ratio), MCP-to-SCP width ratio (MCP/SCP ratio), and MR parkinsonism index (MRPI; P/M × MCP/SCP) were calculated. The midbrain area and M/P ratio of patients with VaP (104 and 0.22 mm2, respectively) were smaller than those in patients with PD (121 and 0.24 mm2, respectively) and larger than those in patients with PSP (90 and 0.19 mm2, respectively). The MRPI was significantly larger in patients with PSP (13.6) in comparison with those with PD (10.1) and VaP (10.7). However, the MRPI of patients with VaP was not significantly different from patients with PD. Our study showed that MRPI was useful in differentiating PSP from VaP or PD. Thus, MR imaging measurements of brainstem structures may help differentiate patients with VaP from those with PD and PSP.
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Wang Z, Luo XG, Gao C. Utility of susceptibility-weighted imaging in Parkinson's disease and atypical Parkinsonian disorders. Transl Neurodegener 2016; 5:17. [PMID: 27761236 PMCID: PMC5054585 DOI: 10.1186/s40035-016-0064-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/29/2016] [Indexed: 01/14/2023] Open
Abstract
In the clinic, the diagnosis of Parkinson's disease (PD) largely depends on clinicians' experience. When the diagnosis is made, approximately 80% of dopaminergic cells in the substantia nigra (SN) have been lost. Additionally, it is rather challenging to differentiate PD from atypical parkinsonian disorders (APD). Clinially-available 3T conventional MRI contributes little to solve these problems. The pathologic alterations of parkinsonism show abnormal brain iron deposition, and therefore susceptibility-weighted imaging (SWI), which is sensitive to iron concentration, has been applied to find iron-related lesions for the diagnosis and differentiation of PD in recent decades. Until now, the majority of research has revealed that in SWI the signal intensity changes in deep brain nuclei, such as the SN, the putamen (PUT), the globus pallidus (GP), the thalamus (TH), the red nucleus (RN) and the caudate nucleus (CN), thereby raising the possibility of early diagnosis and differentiation. Furthermore, the signal changes in SN, PUT and TH sub-regions may settle the issues with higher accuracy. In this article, we review the brain iron deposition of PD, MSA-P and PSP in SWI in the hope of exhibiting a profile of SWI features in PD, MSA and PSP and its clinical values.
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Affiliation(s)
- Zhibin Wang
- Neurology Department, The First Affiliated Hospital of China Medical University, 155# Nanjing Bei Street Heping District, Shenyang, 110001 People's Republic of China
| | - Xiao-Guang Luo
- Neurology Department, The First Affiliated Hospital of China Medical University, 155# Nanjing Bei Street Heping District, Shenyang, 110001 People's Republic of China
| | - Chao Gao
- Neurology Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin 2nd Road 197, Shanghai, 200025 People's Republic of China
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