Morphometry MRI in the differential diagnosis of parkinsonian syndromes

Abstract

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

Plasticity of the Superior and Middle Cerebellar Peduncles in Musicians Revealed by Quantitative Analysis of Volume and Number of Streamlines Based on Diffusion Tensor Tractography

“…Atrophy of SCP and MCP on these patients was associated with variety of motor, sensory and cognitive dysfunctions. These studies also suggested that measurement of volume/area/width of SCP and MCP is a useful strategy to improve the accuracy of diagnosis and can even help in differentiating between these disorders [70]. In contrast to patients with these disorders, we proposed that musicians with their enhanced sensorimotor skill acquisition would show increased size of SCP and MCP which was revealed in our study.…”

“…Quantitative MRI studies reported decreased size of SCP and MCP in patients with neurodegenerative disorders such as progressive supranuclear palsy [69], multiple system atrophy [69], Parkinson's disease [70] and Friedreich's ataxia. Atrophy of SCP and MCP on these patients was associated with variety of motor, sensory and cognitive dysfunctions.…”

Magnetic resonance imaging for the diagnosis of Parkinson’s disease

“…In terms of infratentorial atrophy, several studies have demonstrated that MSA is associated with a relatively greater pontine and MCP atrophy compared to PSP and PD, whereas patients with PSP have a relatively greater midbrain and SCP atrophy compared to MSA and PD (Warmuth-Metz et al 2001; Righini et al 2004; Oba et al 2005; Paviour et al 2005; Nicoletti et al 2006a; Quattrone et al 2008; Hotter et al 2009; Gama et al 2010). …”

Stereological Evaluation of the Brains in Patients with Parkinson’s disease Compared to Controls

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