Diagnostic Performance of the Magnetic Resonance Parkinsonism Index in Differentiating Progressive Supranuclear Palsy from Parkinson’s Disease: An Updated Systematic Review and Meta-Analysis

Abstract

Progressive supranuclear palsy (PSP) and Parkinson’s disease (PD) are difficult to differentiate especially in the early stages. We aimed to investigate the diagnostic performance of the magnetic resonance parkinsonism index (MRPI) in differentiating PSP from PD. A systematic literature search of PubMed-MEDLINE and EMBASE was performed to identify original articles evaluating the diagnostic performance of the MRPI in differentiating PSP from PD published up to 20 February 2021. The pooled sensitivity, specificity, and 95% CI were calculated using the bivariate random-effects model. The area under the curve (AUC) was calculated using a hierarchical summary receiver operating characteristic (HSROC) model. Meta-regression was performed to explain the effects of heterogeneity. A total of 14 original articles involving 484 PSP patients and 1243 PD patients were included. In all studies, T1-weighted images were used to calculate the MRPI. Among the 14 studies, nine studies used 3D T1-weighted images. The pooled sensitivity and specificity for the diagnostic performance of the MRPI in differentiating PSP from PD were 96% (95% CI, 87–99%) and 98% (95% CI, 91–100%), respectively. The area under the HSROC curve was 0.99 (95% CI, 0.98–1.00). Heterogeneity was present (sensitivity: I2 = 97.29%; specificity: I2 = 98.82%). Meta-regression showed the association of the magnet field strength with heterogeneity. Studies using 3 T MRI showed significantly higher sensitivity (100%) and specificity (100%) than those of studies using 1.5 T MRI (sensitivity of 98% and specificity of 97%) (p < 0.01). Thus, the MRPI could accurately differentiate PSP from PD and support the implementation of appropriate management strategies for patients with PSP.

Magnetic Resonance Planimetry in the Differential Diagnosis between Parkinson’s Disease and Progressive Supranuclear Palsy

“…These metanalyses revealed excellent pooled sensitivity and specificity of MRPI (0.96 and 0.98, respectively, in one study [64], and 0.98 and 0.99, respectively, in another one [65]) and confirmed its superiority compared to the M/P area ratio in differentiating between these two diseases [65], thus recommending the use MRPI in PSP diagnosis. The MRPI was measured manually in 12 out of the 14 studies included in the meta-analysis [64].…”

“…The automated MRPI was recently validated in a multicenter international study [ 61 ], including 173 patients affected by PSP, 283 patients with PD, 52 patients with MSA, and 148 healthy controls from several research centers in different countries, and showed excellent diagnostic accuracy (AUC 0.95, confidence intervals [CI]: 0.93–0.97) in distinguishing PSP from non-PSP participants (PD, MSA, and controls). In the last few years, the role of MRPI in the differential diagnosis between PSP and PD was confirmed by many studies [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 , 54 , 55 , 61 , 62 , 63 ] and strengthened by two metanalyses [ 64 , 65 ] including studies from different research groups for a total of nearly 500 PSP patients and more than 1000 PD patients. These metanalyses revealed excellent pooled sensitivity and specificity of MRPI (0.96 and 0.98, respectively, in one study [ 64 ], and 0.98 and 0.99, respectively, in another one [ 65 ]) and confirmed its superiority compared to the M/P area ratio in differentiating between these two diseases [ 65 ], thus recommending the use MRPI in PSP diagnosis.…”

“…In the last few years, the role of MRPI in the differential diagnosis between PSP and PD was confirmed by many studies [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 , 54 , 55 , 61 , 62 , 63 ] and strengthened by two metanalyses [ 64 , 65 ] including studies from different research groups for a total of nearly 500 PSP patients and more than 1000 PD patients. These metanalyses revealed excellent pooled sensitivity and specificity of MRPI (0.96 and 0.98, respectively, in one study [ 64 ], and 0.98 and 0.99, respectively, in another one [ 65 ]) and confirmed its superiority compared to the M/P area ratio in differentiating between these two diseases [ 65 ], thus recommending the use MRPI in PSP diagnosis.…”

“…b Possible PSP patients according to NINDS-SPSP criteria [ 10 ]. c The MRPI was measured manually in 12 out of the 14 studies included in the meta-analysis [ 64 ].…”

[18F]FDG-PET zur Differenzialdiagnostik und Prognostik der neurodegenerativen Parkinson-Syndrome: Update 2022

“…von 98%/99% [45] bzw. 96%/99% [46], für die Differenzierung von MSA-P vs. IPS eine gepoolte Sens./Spez. von 90%/93% [47] bzw.…”