Magnetic resonance imaging distinguishes progressive supranuclear palsy from multiple system atrophy

Asato, Reinin; Akiguchi, Ichiro; Masunaga, Shin Ichiro; Hashimoto, Nobuo

doi:10.1007/s007020070006

Cited by 42 publications

(39 citation statements)

References 18 publications

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“…Recent MRÎ ndings of parkinsonian syndromes have indicated that a low midbrain diameter may be valuable in discriminating PSP from Parkinson's disease and MSA. 6,7 However, the values overlap with those of the latter disorders. 6,7 We retrospectively reviewed MRIˆndings obtained from patients with Parkinson's disease, PSP, and MSA in order to investigate the morphological characteristics of the midbrain in parkinsonian syndromes.…”

Section: Discussionmentioning

confidence: 88%

“…6,7 However, the values overlap with those of the latter disorders. 6,7 We retrospectively reviewed MRIˆndings obtained from patients with Parkinson's disease, PSP, and MSA in order to investigate the morphological characteristics of the midbrain in parkinsonian syndromes. A peculiar atrophy of the midbrain has been seen in patients with PSP and MSA who had progressive supranuclear gaze-palsy.…”

Section: Discussionmentioning

confidence: 88%

“…Recently, a measurement of the midbrain was reported to be a clue for discriminating PSP patients from Parkinson's disease and multiple system atrophy (MSA). [5][6][7] On the other hand, in our experience, we found a peculiar atrophy of the midbrain in some patients with parkinsonian syndromes, and those patients had vertical supranuclear gaze-palsy. This atrophy, characterized by a concavity of the lateral margin of the tegmentum of the midbrain, we have termed the morning glory sign, because the shape of the We retrospectively assessed the relationship between the morning glory sign and vertical supranuclear gaze-palsy in patients with parkinsonian syndromes in order to elucidate whether it is a reliable MRI (magnetic resonance imaging)ˆnding on which to base a diagnosis of PSP.…”

Section: Introductionmentioning

confidence: 93%

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Morning Glory Sign: A Particular MR Finding in Progressive Supranuclear Palsy

Adachi¹,

Kawanami

Ohshima³

et al. 2004

MRMS

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Background and Purpose: We have encountered a peculiar atrophic change in the midbrain in some patients with parkinsonian syndromes. We discovered these patients had vertical supranuclear gaze-palsy, an eye movement disorder. The purpose of this study was to elucidate whether this atrophic pattern of the midbrain (which we have termed morning glory sign) is related to the vertical eye movement disorder, in particular to progressive supranuclear palsy (PSP).Methods: We reviewed T 2 -weighted axial images obtained from 42 patients with parkinsonian syndromes, includingˆve patients with PSP, 23 patients with Parkinson's disease, and 14 patients with multiple system atrophy (MSA). We focused on a speciˆc atrophy of the midbrain, the morning glory sign, which is a concavity of the lateral margin of the tegmentum of the midbrain.Results: The morning glory sign was detected in four of theˆve patients with PSP and in one (striatonigral degeneration; SND) of the14 patients with MSA. All morning glory sign patients had vertical supranuclear gaze-palsy, as did the one PSP patient without the morning glory sign. Vertical supranuclear gaze-palsy was seen in no other patients (23 patients with Parkinson's disease and 13 patients with MSA) who lacked the morning glory sign.Conclusions: Morphologically, the morning glory sign is believed to be related to vertical supranuclear gaze-palsy. This sign should be considered a useful clue when diagnosing PSP.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 93%

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Morning Glory Sign: A Particular MR Finding in Progressive Supranuclear Palsy

Adachi¹,

Kawanami

Ohshima³

et al. 2004

MRMS

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“…For instance, in Parkinson's disease, diagnosis can frequently be assumed on clinical basis only and the overall ability for routine MRI to differentiate patients with PD from controls is modest. Thus, the major relevance of certain MRI findings is to discriminate among other parkinsonian disorders [14][15][16] . Other relevant consideration is the fact that the linear and morphometric measures employed here can be easily performed.…”

Section: Discussionmentioning

confidence: 99%

“…The mid-sagittal image of the T1-weighted SE sequence was used for measurements of the midbrain area (Ams) and pons area (Apn) [12][13][14] (Fig 1). These areas were obtained according to the following parameters: two straight lines were drawn.…”

Section: Methodsmentioning

confidence: 99%

Morphometry MRI in the differential diagnosis of parkinsonian syndromes

Gama

Távora

Bomfim

et al. 2010

Arq. Neuro-Psiquiatr.

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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

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

Lee

2020

Movement Disord Clin Pract

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Background Numerous conventional magnetic resonance imaging (cMRI) parameters were previously found to differentiate parkinsonian disorders with statistical significance, but effect size has not been considered. Objectives To quantify effect size of previously identified cMRI parameters that differentiated parkinsonian disorders with statistical significance. Method A PubMed search limited to studies assessing cMRI parameters in at least 2 of Parkinson's disease, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration/syndrome were selected. Either Cohen's d or positive and negative likelihood (LR+/−) as well as diagnostic odds ratios (DORs) were calculated as appropriate. cMRI parameter was considered useful if Cohen's d > 1.94 (<20% overlap) or if LR+ > 10, LR− < 0.1, or DOR > 20. Results Literature search identified 8848 publications and 36 were included for analysis. Putaminal (Cohen's d 2.07; DOR 23–infinity), pontine (DOR 32–infinity), and middle cerebellar peduncle (Cohen's d 2.24; DOR infinity) abnormalities were most useful in differentiating multiple system atrophy while reduced midbrain (Cohen's d 2.33–8.69; DOR infinity) and superior cerebellar peduncle (Cohen's d 2.47; DOR 51–infinity) diameters separated progressive supranuclear palsy. Corticobasal degeneration/syndrome does not have any distinguishing cMRI features, but reduced midbrain diameter may help differentiate corticobasal degeneration/syndrome from Parkinson's disease (DOR infinity). When LR− was calculated, all of these features carried a value of <0.1. Conclusion A number of cMRI features consistently demonstrated large effect size in separating parkinsonian disorders. However, it is the presence and not absence of these cMRI features that is most useful in patients with low to moderate pretest probability.

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Magnetic resonance imaging distinguishes progressive supranuclear palsy from multiple system atrophy

Cited by 42 publications

References 18 publications

Morning Glory Sign: A Particular MR Finding in Progressive Supranuclear Palsy

Morning Glory Sign: A Particular MR Finding in Progressive Supranuclear Palsy

Morphometry MRI in the differential diagnosis of parkinsonian syndromes

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

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