MRI evaluation of progressive supranuclear palsy: differentiation from Parkinson’s disease and multiple system atrophy

ABSTRACT

Objectives: To evaluate the magnetic resonance imaging (MRI)-derived parameters in differentiation of patients with progressive supranuclear palsy (PSP) from patients with Parkinson’s disease (PD), multiple system atrophy (MSA), and control subjects was aimed.

Methods: Thirty-three patients [mean age, 65.21 ± 4.75 years; PSP (n = 9), MSA (n = 8), PD (n = 6), and control subjects (n = 10)] who have undergone cranial MRI were included in this retrospective study. MRI-derived parameters including areas of midbrain and pons, midbrain area-to-pons area (M/P) ratio, widths of middle cerebellar peduncle (MCP) and superior cerebellar peduncle (SCP), MCP/SCP ratio, magnetic resonance parkinsonism index (MRPI), cerebral interpeduncular angle, and length of midbrain tegmentum were compared in patients with PSP, PD, MSA, and control subjects through the analysis of variance and Kruskal–Wallis tests with Bonferroni correction and Mann–Whitney U test.

Results: The length of midbrain tegmentum, midbrain area, SCP, and M/P ratio were found to be lower, while cerebral interpeduncular angle and MRPI were higher in patients with PSP. Pons area, MCP width, and MCP/SCP ratio were found to be lower in patients with MSA. For PSP, cerebral interpeduncular angle has a sensitivity of 100% and specifity of 90%, and MRPI had a sensitivity of 88.9% and specifity of 100% for PSP.

Discussion: Several MRI-derived parameters can be used in differentiation of patients with PSP from patients with PD, MSA and control subjects. The cerebral interpeduncular angle and MRPI, which demonstrated higher values in patients with PSP, were more significant for PSP than the other parameters.

KEYWORDS:

• MRI
• magnetic resonance parkinsonism index
• multiple system atrophy
• Parkinson’s disease
• progressive supranuclear palsy
• interpeduncular angle

Authors’ contributions

Cenk Eraslan, Ahmet Acarer and Cem Calli mainly contributed to the concept and the design of the study. Cenk Eraslan and Serkan Guneyli have been involved in drafting the manuscript. Omer Kitis and Zafer Colakoglu have analyzed and interpreted the data. Esra Akyuz and Elcin Aydin have contributed to obtaining the data and giving the consent to participants. All authors have read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical standard

The study was in compliance with the Decleration of Helsinki. All study participants provided informed consent.

Additional information

Notes on contributors

Cenk Eraslan

Cenk Eraslan graduated from Ege University School of Medicine in 2003. He performed his residency at the Department of Radiology in Adnan Menderes University between 2005 and 2010. After working as a general radiologist for two years, he has been working in Neuroradiology Unit at the Department of Radiology in Ege University Medical Faculty as a stuff radiologist since 2013. He had European Board Certification on Neuroradiology in 2017. His research focus is the field of movement disorders and neuro-oncology. He has several publications on these issues, which were presented as talks and posters at national and international meetings.