Accuracy of MR markers for differentiating Progressive Supranuclear Palsy from Parkinson's disease

• Main Authors: Stefano Zanigni, Giovanna Calandra-Buonaura, David Neil Manners, Claudia Testa, Dino Gibertoni, Stefania Evangelisti, Luisa Sambati, Maria Guarino, Patrizia De Massis, Laura Ludovica Gramegna, Claudio Bianchini, Paola Rucci, Pietro Cortelli, Raffaele Lodi, Caterina Tonon
• Format: Article
• Language: English
• Published: Elsevier 2016-01-01
• Series: NeuroImage: Clinical
• Subjects: Progressive Supranuclear Palsy; Parkinson's disease; MRI; Morphometry; DTI
• Online Access: http://www.sciencedirect.com/science/article/pii/S2213158216300924

Background: Advanced brain MR techniques are useful tools for differentiating Progressive Supranuclear Palsy from Parkinson's disease, although time-consuming and unlikely to be used all together in routine clinical work. We aimed to compare the diagnostic accuracy of quantitative morphometric, volumetric and DTI metrics for differentiating Progressive Supranuclear Palsy-Richardson's Syndrome from Parkinson's disease. Methods: 23 Progressive Supranuclear Palsy-Richardson's Syndrome and 42 Parkinson's disease patients underwent a standardized 1.5T brain MR protocol comprising high-resolution T1W1 and DTI sequences. Brainstem and cerebellar peduncles morphometry, automated volumetric analysis of brain deep gray matter and DTI metric analyses of specific brain structures were carried out. We determined diagnostic accuracy, sensitivity and specificity of MR-markers with respect to the clinical diagnosis by using univariate receiver operating characteristics curve analyses. Age-adjusted multivariate receiver operating characteristics analyses were then conducted including only MR-markers with a sensitivity and specificity exceeding 80%. Results: Morphometric markers (midbrain area, pons to midbrain area ratio and MR Parkinsonism Index), DTI parameters (infratentorial structures) and volumetric analysis (thalamus, putamen and pallidus nuclei) presented moderate to high diagnostic accuracy in discriminating Progressive Supranuclear Palsy-Richardson's Syndrome from Parkinson's disease, with midbrain area showing the highest diagnostic accuracy (99%) (mean ± standard deviation: 75.87 ± 16.95 mm2 vs 132.45 ± 20.94 mm2, respectively; p < 0.001). Conclusion: Although several quantitative brain MR markers provided high diagnostic accuracy in differentiating Progressive Supranuclear Palsy-Richardson's Syndrome from Parkinson's disease, the morphometric assessment of midbrain area is the best single diagnostic marker and should be routinely included in the neuroradiological work-up of parkinsonian patients.