Assessment of midbrain atrophy in patients with progressive supranuclear palsy with routine magnetic resonance imaging

Cosottini, Mirco; Ceravolo, Roberto; Faggioni, Lorenzo; Lazzarotti, G; Michelassi, Mc; Bonuccelli, Ubaldo; Murri, Luigi; Bartolozzi, Carlo

doi:10.1111/j.1600-0404.2006.00767.x

Cited by 82 publications

(90 citation statements)

References 26 publications

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“…using Analyze software (Biomedical Imaging Resource; Mayo Clinic, Rochester, MN), based on previously published criteria. 4,18 PiB-PET scans were classified as positive or negative according to previously published criteria. 4 Global PiB ratios were calculated.…”

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confidence: 99%

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Syndromes dominated by apraxia of speech show distinct characteristics from agrammatic PPA

et al. 2013

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Objective: We assessed whether clinical and imaging features of subjects with apraxia of speech (AOS) more severe than aphasia (dominant AOS) are more similar to agrammatic primary progressive aphasia (agPPA) or to primary progressive AOS (PPAOS).Methods: Sixty-seven subjects (PPAOS 5 18, dominant AOS 5 10, agPPA 5 9, age-matched controls 5 30) who all had volumetric MRI, diffusion tensor imaging, F18-fluorodeoxyglucose and C11-labeled Pittsburgh compound B (PiB)-PET scanning, as well as neurologic and speech and language assessments, were included in this case-control study. AOS was classified as either type 1, predominated by sound distortions and distorted sound substitutions, or type 2, predominated by syllabically segmented prosodic speech patterns. Results:The dominant AOS subjects most often had AOS type 2, similar to PPAOS. In contrast, agPPA subjects most often had type 1 (p 5 0.01). Both dominant AOS and PPAOS showed focal imaging abnormalities in premotor cortex, whereas agPPA showed widespread involvement affecting premotor, prefrontal, temporal and parietal lobes, caudate, and insula. Only the dominant AOS and PPAOS groups showed midbrain atrophy compared with controls. No differences were observed in PiB binding across all 3 groups, with the majority being PiB negative. Conclusion:These results suggest that dominant AOS is more similar to PPAOS than agPPA, with dominant AOS and PPAOS exhibiting a clinically distinguishable subtype of progressive AOS compared with agPPA. Neurology â 2013;81:337-345 GLOSSARY agPPA 5 agrammatic primary progressive aphasia; AOS 5 apraxia of speech; ASRS 5 Apraxia of Speech Rating Scale; DTI 5 diffusion tensor imaging; FA 5 fractional anisotropy; FDG 5 F18-fluorodeoxyglucose; MD 5 mean diffusivity; NOS 5 not otherwise specified; PiB 5 Pittsburgh compound B; PPA 5 primary progressive aphasia; PPAOS 5 primary progressive apraxia of speech; PSPS 5 progressive supranuclear palsy syndrome; TDP-43 5 TAR DNA binding protein of 43 kDa; WAB 5 Western Aphasia Battery.The term apraxia of speech (AOS) is used to denote a motor speech disorder in which abnormalities reflect deficits in the programming of movements for speech production.1,2 Although usually caused by left hemisphere stroke, AOS can also be associated with neurodegenerative disease, and when it is the only sign or symptom, it is labeled primary progressive AOS (PPAOS).3,4 Unlike PPAOS, the term primary progressive aphasia (PPA) is reserved for a neurodegenerative disorder in which the most salient feature is language dysfunction. 5-7 Agrammatic PPA (agPPA) is one subtype of PPA, characterized by specific abnormalities that affect grammar and syntax in verbal or written expression. 8,9 Although it is recognized that many subjects with agPPA may have AOS, the most salient feature of agPPA is aphasia. In fact, to be diagnosed with any variant of PPA, 8 language difficulty must be the most prominent clinical feature at symptom onset and for the initial phases of the disease; deficits cannot be due to "disruption o...

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“…Measurements of midbrain area were performed on volumetric MRI because midbrain atrophy is a feature of PSPS, [18][19][20] a tauopathy associated with AOS. 21,22 Measurements were performed manually by one rater (J.L.W.)…”

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Syndromes dominated by apraxia of speech show distinct characteristics from agrammatic PPA

et al. 2013

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“…Previously, conventional magnetic resonance imaging (MRI) revealed important characteristic findings that can be used in clinical practice to differentiate among parkinsonian syndromes 5 . Objective quantifications of midbrain and pons using linear, surface and volumetric measurements have been reported before [6][7][8][9][10] . In these studies, two-point comparisons were made correlating each parkinsonian syndrome and PD.…”

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Morphometry MRI in the differential diagnosis of parkinsonian syndromes

Gama

Távora

Bomfim

et al. 2010

Arq. Neuro-Psiquiatr.

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This study evaluates the diagnostic value of morphometric magnetic resonance imaging (MRI) in the differential diagnosis among Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). We studied 21 PD cases, 11 MSA-c, 8 MSA-p and 20 PSP cases. Midbrain area (Ams), pons area (Apn), middle cerebellar peduncle (MCP) and superior cerebellar peduncle (SCP) were measured using MRI. Comparisons were made between PD, MSA-p, MSA-c and PSP. Apn , MCP and SCP morphometry dimensions presented differences among groups. Ams below 105 mm 2 and SCP smaller than 3 mm were the most predictive measures of PSP (sensitivity 95.0 and 80.0%, respectively). For the group of MSA-c patients, Apn area below 315 mm 2 showed good specificity and positive predictive value (93.8% and 72.7%, respectively). In conclusion, dimensions and cut off values obtained from routine MRI can differentiate between PD, PSP and MSA-c with good sensitivity, specificity and accuracy. Key words: Parkinson, multiple system atrophy, progressive supranuclear palsy, magnetic resonance imaging, pons, midbrain. Morfometria por ressonância magnética no diagnóstico diferencial das síndromes parkinsonianas rEsUMOMorfometria pela ressonância magnética (RM) no diagnóstico diferencial entre doença de Parkinson (DP), paralisia supranuclear progressiva (PSP) e atrofia de múltiplos sistemas (AMS). Este estudo avaliou a RM no diagnóstico diferencial de 21 casos com DP, 11 AMS-c, 8 AMS-p e 20 com PSP. A área sagital do mesencéfalo (Ams), área sagital da ponte (Apn), largura do pedúnculo cerebelar médio (PCM) e pedúnculo cerebelar superior (PCS) foram medidas pela RM e realizadas comparações entre destes pacientes. A Ams <105 mm 2 e a largura média do PCS <3 mm foram preditivas para PSP (sensibilidade de 95,0 e 80,0%, respectivamente). Nos casos de AMS-c a área pontina <315 mm 2 apresentou boa especificidade e valor preditivo positivo para o diagnóstico (93,8% e 72,7%). Em conclusão, as dimensões e valores de cortes obtidos a partir da RM podem diferenciar PD, PSP e

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“…However, clinical differentiation of PSP from PD and multiplesystem atrophy of Parkinson can be difficult, particularly in early stages of the disease. MRI studies on PSP have shown atrophy of the midbrain and pons in mid-sagittal sections, hence aiding in its diagnosis [6]. The goal of this case report is to highlight the usefulness of MRI brain in diagnosing PSP, especially in its early stages, and preventing its misdiagnosis as PD.…”

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confidence: 99%

Parkinson's Disease and Early Stages of Progressive Supranuclear Palsy: A Neurological Mimicry

R¹,

Krishnan²,

Mohan³

et al. 2015

JCR

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Abstract:Progressive supranuclear palsy (PSP) is not a rare condition, but because of its increasingly recognized clinical diversity, it may be difficult to diagnose, especially in a resource poor setting where imaging modalities may not be available. As a result, progressive supranuclear palsy is often misdiagnosed as Parkinson's disease (PD). In this case report, we would like to highlight the importance of brain Magnetic Resonance Imaging (MRI) in diagnosing early stage of progressive supranuclear palsy in a patient who was being treated as Parkinson's disease.

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Assessment of midbrain atrophy in patients with progressive supranuclear palsy with routine magnetic resonance imaging

Abstract: Morphological indexes indicate midbrain atrophy in PSP patients The combination of the A(ms) and A(ms)/A(pn) ratio measurements allows to discriminate between PSP and other conditions.

Cited by 82 publications

References 26 publications

Syndromes dominated by apraxia of speech show distinct characteristics from agrammatic PPA

Syndromes dominated by apraxia of speech show distinct characteristics from agrammatic PPA

Morphometry MRI in the differential diagnosis of parkinsonian syndromes

Parkinson's Disease and Early Stages of Progressive Supranuclear Palsy: A Neurological Mimicry

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