MR Imaging Index for Differentiation of Progressive Supranuclear Palsy from Parkinson Disease and the Parkinson Variant of Multiple System Atrophy

doi:10.1148/radiol.2453061703

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Neuroradiology

MR Imaging Index for Differentiation of Progressive Supranuclear Palsy from Parkinson Disease and the Parkinson Variant of Multiple System Atrophy¹

Aldo Quattrone, MD, Giuseppe Nicoletti, MD, Demetrio Messina, MD, Francesco Fera, MD, Francesca Condino, PhD, Pierfrancesco Pugliese, MD, Pierluigi Lanza, MD, Paolo Barone, MD, Letterio Morgante, MD, Mario Zappia, MD, Umberto Aguglia, MD, and Olivier Gallo, STc

¹ From the Institute of Neurology (A.Q., D.M., P.P.) and Neuroradiology (F.F.), Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy; Institute of Neurological Sciences, National Research Council, Piano Lago di Mangone, Cosenza, Calabria, Italy (A.Q., G.N., F.C., P.L., O.G.); Department of Neurological Sciences, University of Naples Federico II, Naples, Italy (P.B.); Department of Neuroscience, Psychiatry and Anesthesiology, University of Messina, Messina, Sicily (L.M.); Institute of Neurology, Department of Neurosciences, University of Catania, Catania, Sicily (M.Z.); and Regional Epilepsy Center, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio di Calabria, Calabria, Italy (U.A.). Received October 2, 2006; revision requested December 12; revision received January 17, 2007; accepted February 28; final version accepted April 16. Address correspondence to A.Q., Clinica Neurologica, Policlinico Mater Domini, Campus Universitario, Germaneto, 88100 Catanzaro, Italy (e-mail: a.quattrone{at}isn.cnr.it).

Purpose: To prospectively assess sensitivity and specificity of magneticresonance (MR) imaging measurements of midbrain, pons, middle cerebellarpeduncles (MCPs), and superior cerebellar peduncles (SCPs) for differentiatingprogressive supranuclear palsy (PSP) from Parkinson disease (PD)and Parkinson variant of multiple system atrophy (MSA-P), with establishedconsensus criteria as reference standard.

Materials and Methods:All study participants provided informed consent;study was approved by the institutional review board. Pons area,midbrain area, MCP width, and SCP width were measured in 33 consecutivepatients with PSP (16 possible, 17 probable), 108 consecutive patientswith PD, 19 consecutive patients with MSA-P, and 50 healthy controlparticipants on T1-weighted MR images. The pons area–midbrainarea ratio (P/M) and MCP width–SCP width ratio (MCP/SCP) werealso used, and an index termed MR parkinsonism index was calculated[(P/M)·(MCP/SCP)]. Differences in MR imaging measurementsamong groups were evaluated with Kruskal-Wallis test, Mann-WhitneyU test, and Bonferroni correction.

Results:Midbrain area and SCP width in patients with PSP (23 men,10 women; mean age, 69.3 years) were significantly (P < .001)smaller than in patients with PD (62 men, 46 women; mean age, 65.8years), patients with MSA-P (five men, 14 women; mean age, 64.0 years),and control participants (25 men, 25 women; mean age, 66.6 years).P/M and MCP/SCP were significantly larger in patients with PSP thanin patients in other groups and control participants. All measurementsshowed some overlap of values between patients with PSP and patientsfrom other groups and control participants. MR parkinsonism indexvalue was significantly larger in patients with PSP (median, 19.42)than in patients with PD (median, 9.40; P < .001), patients withMSA-P (median, 6.53; P < .001), and control participants (median,9.21; P < .001), without overlap of values among groups. No patientwith PSP received a misdiagnosis when the index was used (sensitivityand specificity, 100%).