Midbrain MRI assessments in progressive supranuclear palsy subtypes

Picillo, Marina; Tepedino, Maria Francesca; Abate, Filomena; Erro, Roberto; Ponticorvo, Sara; Tartaglione, Salvatore; Volpe, Giovanni; Frosini, Daniela; Cecchi, Paolo; Cosottini, Mirco; Ceravolo, Roberto; Esposito, Fabrizio; Pellecchia, Maria Teresa; Barone, Paolo; Manara, Renzo

doi:10.1136/jnnp-2019-321354

Cited by 46 publications

(79 citation statements)

References 21 publications

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“…with more than 15 years of experience in neurodegenerative diseases (7). Acceptable inter-rater agreement for manually computed measures between two different neuroradiologists as well as excellent agreement between manual and computerized MRPI have been already demonstrated elsewhere for the data considered in the present analysis (7).…”

Section: Morphometric Measurementssupporting

confidence: 64%

“…First, we recognize the lack of pathological confirmation of both diagnosis and phenotypic categorization, still the gold standard for PSP diagnosis. Although our data are based only on clinical judgment, both the MDS diagnostic flow chart and phenotypic attribution have been applied independently by two experts in movement disorders as detailed elsewhere (7). In addition, evaluation of clinical features was conducted by movement disorders specialists with more than 10 years of experience in movement disorders (MP, RC and DF).…”

Section: Discussionmentioning

confidence: 99%

“…Sixty-seven patients with probable or possible PSP according to the Movement Disorder Society (MDS) criteria were included in the present analysis. Detailed information on enrollment and application of the PSP diagnostic criteria to determine disease phenotype is available elsewhere (7,11,12). Briefly, 78 PSP outpatients were enrolled from the Movement Disorders Centers of the University of Salerno and the University of Pisa between November 2015 and December 2018.…”

Section: Patients and Clinical Evaluationmentioning

confidence: 99%

“…Midbrain-based measures were retrospectively calculated for all included patients and included midsagittal midbrain area, length of midbrain tegmentum, midbrain diameter, ponsto-midbrain diameter ratio, cerebral interpeduncolar angle, middle cerebellar peduncles to superior cerebellar peduncles ratio (MCP/SCP), pons-to midbrain area ratio (P/M), and MRPI as well as P/M 2.0 and MRPI 2.0 (MRPI and P/M multiplied by third ventricle width/frontal horns width ratio) ( Figure 1) (3,4,7,(16)(17)(18). Given its relevance in PSP, both the latter include a surrogate measure of the frontal lobe volume (4,10).…”

Section: Morphometric Measurementsmentioning

confidence: 99%

“…To date, research studies on magnetic resonance imaging (MRI) measures in PSP have focused on supporting the clinical diagnosis of disease. Given the key role of midbrain in PSP-related pathological process, a number of midbrain-based MRI morphometric measures have shown adequate diagnostic accuracy in differentiating PSP-RS from healthy subjects and other parkinsonian disorders (2)(3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

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Association of MRI Measures With Disease Severity and Progression in Progressive Supranuclear Palsy

et al. 2020

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Objective: To verify the association of midbrain-based MRI measures as well as cortical volumes with disease core features and progression in patients with Progressive Supranuclear Palsy (PSP). Methods: Sixty-seven patients (52.2% with Richardson's syndrome) were included in the present analysis. Available midbrain-based MRI morphometric assessments as well as cortical lobar volumes were computed. Ocular, gait and postural involvement at the time of MRI was evaluated with the PSP rating scale. Specific milestones or death were used to estimate disease progression up to 72 months follow up. Hierarchical regression models and survival analysis were used for analyzing cross-sectional and longitudinal data, respectively. Results: Multivariate models showed vertical supranuclear gaze palsy was associated with smaller midbrain area (OR: 0.02, 95% CI 0.00–0.175, p = 0.006). Cox regression adjusted for age, disease duration, and phenotype demonstrated that lower midbrain area (HR: 0.122, 95% CI 0.030–0.493, p = 0.003) and diameter (HR: 0.313, 95% CI 0.112–0.878, p = 0.027), higher MR Parkinsonism Index (HR: 6.162, 95% CI 1.790–21.209, p = 0.004) and larger third ventricle width (HR: 2.755, 95% CI 1.068–7.108, p = 0.036) were associated with higher risk of dependency on wheelchair. Conclusions: Irrespective of disease features and other MRI parameters, reduced midbrain size is significantly associated with greater ocular motor dysfunction at the time of MRI and more rapid disease progression over follow up. This is the first comprehensive study to systematically assess the association of available midbrain-based MRI measures and cortical volumes with disease severity and progression in a large cohort of patients with PSP in a real-world setting.

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Section: Morphometric Measurementssupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Patients and Clinical Evaluationmentioning

confidence: 99%

Section: Morphometric Measurementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of MRI Measures With Disease Severity and Progression in Progressive Supranuclear Palsy

et al. 2020

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Psychometric properties of the Beck Depression Inventory‐II in progressive supranuclear palsy

et al. 2021

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Objectives: Depression is one of the most common neuropsychiatric symptoms in progressive supranuclear palsy (PSP). Yet, few studies have examined the ability of available instruments to detect depressive symptoms in PSP. Aims of the present study were to (I) report psychometric properties of the Beck Depression Inventory Second Edition (BDI-II) in PSP, (II) establish the BDI-II cut-off indicating the presence of depression in PSP and (III) describe clinical correlates as well as correlation with quality of life of depressive symptoms in PSP. Design, setting and participants: : At the Center for Neurodegenerative Diseases of the University of Salerno, Italy, the BDI-II was validated in 62 PSP patients diagnosed according to the Movement Disorder Society criteria. Patients underwent a clinical interview, a motor evaluation, extensive cognitive and behavioral testing. Results:The mean BDI-II total score was 15.92 ± 10.31. The internal consistency was high (Cronbach's alpha = 0.868); corrected item-total correlation was >0.40 for the majority of items. The significant and moderate correlation of the BDI-II with other tools evaluating depressive symptoms indicated adequate convergent validity of the scale. The satisfactory cut-off to identify patients with clinically significant depression was >14.5. We also showed a correlation between higher scores on BDI-II and lower quality of life, irrespective of motor and cognitive burden. Conclusion:In conclusion, the BDI-II is a reliable and valid tool for the assessment of depression symptoms in PSP. Such data are useful to standardize studies of depression in PSP and to quantify the effectiveness of any interventions on this disabling symptom.

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Brainstem Biomarkers of Clinical Variant and Pathology in Progressive Supranuclear Palsy

et al. 2021

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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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Midbrain MRI assessments in progressive supranuclear palsy subtypes

Cited by 46 publications

References 21 publications

Association of MRI Measures With Disease Severity and Progression in Progressive Supranuclear Palsy

Association of MRI Measures With Disease Severity and Progression in Progressive Supranuclear Palsy

Psychometric properties of the Beck Depression Inventory‐II in progressive supranuclear palsy

Brainstem Biomarkers of Clinical Variant and Pathology in Progressive Supranuclear Palsy

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