A New MRI Measure to Early Differentiate Progressive Supranuclear Palsy From De Novo Parkinson's Disease in Clinical Practice: An International Study

Abstract

A BS TRACT: Background: Enlargement of the third ventricle has been reported in atypical parkinsonism. We investigated whether the measurement of third ventricle width could distinguish Parkinson's disease (PD) from progressive supranuclear palsy (PSP). Methods: We assessed a new MR T1-weighted measurement (third ventricle width/internal skull diameter) in a training cohort of 268 participants (98 PD, 73 PSP, 98 controls from our center) and in a testing cohort of 291 participants (82 de novo PD patients and 133 controls from the Parkinson's Progression Markers Initiative, 76 early-stage PSP from an international research group). PD diagnosis was confirmed after a 4-year follow-up. Diagnostic performance of the third ventricle/internal skull diameter was assessed using receiver operating characteristic curve with bootstrapping; the area under the curve of the training cohort was compared with the area under the curve of the testing cohort using the De Long test. Results: In both cohorts, third ventricle/internal skull diameter values did not differ between PD and controls but were significantly lower in PD than in PSP patients (P < 0.0001). In PD, third ventricle/internal skull diameter values did not change significantly between baseline and follow-up evaluation. Receiver operating characteristic analysis accurately differentiated PD from PSP in the training cohort (area under the curve, 0.94; 95% CI, 91.1-97.6; cutoff, 5.72) and

Experience with a New Index to Differentiate Parkinson's Disease and Progressive Supranuclear Palsy

“…We thank Rau and colleagues for their interest in our simple magnetic resonance imaging (MRI) biomarker (third ventricle width/internal skull diameter, 3 rd V/ID) for the early discrimination of progressive supranuclear palsy (PSP) and Parkinson's disease (PD) in clinical practice. 1 We are pleased to see that PSP patients enrolled by Rau and colleagues showed 3 rd V/ID values similar to those reported in our study, confirming the marked 3 rd V enlargement in PSP. Conversely, their PD patients had higher 3 rd V/ID values than those found in our study.…”

“…We congratulate Quattrone and colleagues for providing a simple MRI-based measure to separate patients with progressive supranuclear palsy (PSP) and Parkinson's disease (PD). 1 By relating the lateral diameter of the third ventricle to the inner skull diameter, they were able to separate PSP and PD patients with high diagnostic accuracy.…”

Human wildtype tau expression in cholinergic pedunculopontine tegmental neurons is sufficient to produce PSP‐like behavioural deficits and neuropathology

“…Moreover, when rats with these lesions were aged to 14 months post-lesion, postmortem analysis revealed a loss of SN dopaminergic neurons and enlargement of lateral ventricles (MacLaren et al, 2018). With the latter observation mirroring clinical MRI reports describing a significant increase in the lateral ventricles of PSP patients as compared to those with PD and healthy controls (Messina et al, 2011;Paviour et al, 2006;Quattrone et al, 2018Quattrone et al, , 2021Yekhlef et al, 2003), the accumulated evidence suggests that the cholinergic PPT may play an important role in the development of the symptomology of PSP.…”

The Strengths and Obstacles in the Differential Diagnosis of Progressive Supranuclear Palsy—Parkinsonism Predominant (PSP-P) and Multiple System Atrophy (MSA) Using Magnetic Resonance Imaging (MRI) and Perfusion Single Photon Emission Computed Tomography (SPECT)

“…All measurements were performed manually by physicians with at least 5-years’ experience in diagnostic imaging. The width of the 3rd ventricle was measured as the maximum width of the 3rd ventricle in the axial plane [ 23 , 24 ]. The areas of the midbrain and the pons were measured, as proposed by Oba et al, on the mid-sagittal MRI using the display tools of a Siemens workstation [ 21 , 22 , 24 ].…”