“One line”: A method for differential diagnosis of parkinsonian syndromes

Abstract

Background: Neurological findings are important for the differential diagnosis of Parkinson's disease (PD), multiple system atrophy with predominant parkinsonian features (MSA-P), and progressive supranuclear palsy (PSP). There is currently no fast and reliable method to distinguish these patients. Objectives:To address this, we propose a novel approach to measure midbrain and pons size using a longitudinal "one line" method from the mid-sagittal view.Methods: Structural images were acquired from 101 subjects who underwent 3.0 T MRI (20 controls, 44 PD, 20 MSA, 12 PSP, and 5 corticobasal syndrome). We measured the middle cerebellar peduncle (MCP), superior cerebellar peduncle (SCP), midbrain, and pons. Brainstem size was measured by area or length of the longitudinal axis, which we named the "one line" method. We conducted intraclass correlation coefficients to assess the extent of agreement and consistency among raters, and receiver operating characteristic curves were used to determine diagnostic accuracy.Results: Intraclass correlation coefficients (ICC) of MCP width were excellent in sagittal and axial sections while those of SCP width were moderate. There were also excellent ICCs between raters for "one line" method of the midbrain and pons, while areas showed good ICCs. "One line" method and area of the midbrain were better than SCP width for the differential diagnosis of PSP from MSA-P and PD. In contrast, there was no clearly superior measurement for differentially diagnosing MSA-P. Conclusions:The "one line" method was comparable with area for inter-rater agreement and diagnostic accuracy even though this was a simple and fast way. K E Y W O R D Sbrainstem, magnetic resonance imaging, multiple system atrophy, Parkinson's disease, progressive supranuclear palsy S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section at the end of the article.How to cite this article: Sako W, Abe T, Haji S, et al. "One line": A method for differential diagnosis of parkinsonian syndromes.

Midbrain morphology in idiopathic normal pressure hydrocephalus: A progressive supranuclear palsy mimic

“…This is particularly important in an era of specific protein‐targeted therapies which are being developed in clinical trials. To this end, various quantitative MRI measurements and relevant indices, as well as qualitative signs, have been introduced as surrogate markers of Richardson's syndrome …”

“…To this end, various quantitative MRI measurements and relevant indices, as well as qualitative signs, have been introduced as surrogate markers of Richardson's syndrome. [2][3][4][5][6][7]19 These imaging markers have been extensively tested in cohorts of patients with atypical Parkinsonism and have provided high sensitivity and specificity. Thus, they can be applied in the differential diagnosis of PSP from other causes of Parkinsonism, such as Parkinson's disease, multiple system atrophy, and corticobasal degeneration.…”

Conventional Magnetic Resonance Imaging in the Diagnosis of Parkinsonian Disorders: AMeta‐Analysis

“…A total of 36 publications satisfied criteria for inclusion 10–45 (Table S1). Most studies were either retrospective or cross‐sectional in design with the gold standard of diagnosis being clinical according to consensus criteria 46–48 .…”

“…LR and DOR were calculated for 15 cMRI parameters, whereas Cohen's d was calculated for 12 (Table S2) with the weighted mean Cohen's d calculated for 6 (Table 2). cMRI parameters that were identified as useful in differentiating MSA from PD in more than 1 population of patients included reduced MCP sagittal diameter (MCP sag ) (weighted mean Cohen's d 2.24; DOR infinity 15,26,32,39 ), reduced superior cerebellar peduncle oblique coronal diameter (SCP cor ) (weight mean Cohen's d 1.96 15,26 ); hot cross bun sign (LR+ and DOR infinity 13,29,32,37 ), putaminal slit‐like hyperintensity (DOR 23–30 24,32,37 ), putaminal T2 hypointensity (DOR 23–infinity 13,32,37,42 ), putaminal atrophy (Cohen's d 2.09; DOR 32–infinity 13,18,24,37 ), MCP hyperintensity (LR+ and DOR infinity 13,24,29,37 ), pontine atrophy (LR+ and DOR infinity 13,37 ), and dilatation of fourth ventricle (DOR 22 and infinity 24,29 ). Other potentially useful parameters in differentiating MSA from PD examined in a single population of patients included reduced midbrain axial diameter (Cohen's d 4.42 45 ), midbrain and medullary atrophy, 13 and increased score on a composite scale quantifying putaminal characteristics and pontocerebellar structures 44 (DOR infinity).…”

“…LR and DOR were calculated for 14 cMRI parameters, whereas Cohen's d was calculated for 21 (Table S2) with the weighted mean Cohen's d calculated for 11 (Table 2). cMRI parameters that were identified as useful in differentiating PSP from PD in more than 1 population of patients included increased third ventricle/frontal horn width (weighted mean Cohen's d 2.39 36 ), widened third ventricular axial width (weighted mean Cohen's d 2.09; DOR infinity 12,36 ), reduced midbrain/pontine sagittal diameter ratio (weighted mean Cohen's d 2.42 14,26–28,35 ), reduced SCP cor (weighted mean Cohen's d 2.47; DOR infinity 14,15,20,25–27,29,30,33,34,37,39 ), reduced sagittal midbrain diameter (weighted mean Cohen's d 3.13 12,14,15,19,26–28,35,39,43 ), reduced midbrain axial diameter (weighted mean Cohen's d 8.69 14,45 ), hummingbird sign (DOR 177.56 and infinity 29,31 ), and morning glory flower sign (DOR infinity 10,29 ). The product and ratio of midbrain, pontine, MCP sag , and SCP cor diameters in various combinations (Cohen's d 2–6 14 ) along with increased interpeduncular fossa/midbrain sagittal length (Cohen's d 2.72 19 ), reduced quadrigeminal plate thickness (Cohen's d 3.07 12 ), and dilatation of fourth ventricle (DOR infinity 29 ) and a higher score on a composite scale examining the midbrain, cortical, putaminal, and pontocerebellar structures (DOR 23.58–infinity 44 ) also yielded large effect sizes in differentiating PSP from PD in a single population of patients.…”