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Published online before print November 8, 2007, 10.1148/radiol.2453061703
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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).


Figure 1
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  		Figure 1: Flow diagram of our study. Eligible participants were patients suspected of having PSP, PD, or MSA-P or healthy control participants. Clinical evaluation was performed by using established consensus criteria for PSP as the reference standard. The MR parkinsonism index (MRPI) value was considered abnormal when the values were equal to or higher than the cutoff levels calculated for patients with PD, patients with MSA-P, and healthy control participants (patients with PSP vs patients with PD, ≥13.55; patients with PSP vs patients with MSA-P, ≥12.85; patients with PSP vs control participants, ≥13.58). The group of patients with PSP includes those with possible PSP and probable PSP.

 

Figure 2A
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  		Figure 2a: Sagittal and coronal T1-weighted volumetric spoiled gradient-echo MR images (15.2/6.8; section thickness, 0.6 mm; frequency- and phase-encoding matrix, 256 x 256; flip angle, 15°) show midbrain area (1), pons area (2), MCP width (3), and SCP width (4) in (a) a control participant and (b) a patient with PSP. Images show marked atrophy of both midbrain and SCP in the PSP patient in comparison with the healthy control participant. In the patient with PSP, values were as follows: midbrain area, 60 mm2; pons area, 502 mm2; MCP width, 8.15 mm; and SCP width, 1.70 mm. In the control participant, values were as follows: midbrain area, 108 mm2; pons area, 478 mm2; MCP width, 10.05 mm; and SCP width, 4.10 mm.

 

Figure 2B
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  		Figure 2b: Sagittal and coronal T1-weighted volumetric spoiled gradient-echo MR images (15.2/6.8; section thickness, 0.6 mm; frequency- and phase-encoding matrix, 256 x 256; flip angle, 15°) show midbrain area (1), pons area (2), MCP width (3), and SCP width (4) in (a) a control participant and (b) a patient with PSP. Images show marked atrophy of both midbrain and SCP in the PSP patient in comparison with the healthy control participant. In the patient with PSP, values were as follows: midbrain area, 60 mm2; pons area, 502 mm2; MCP width, 8.15 mm; and SCP width, 1.70 mm. In the control participant, values were as follows: midbrain area, 108 mm2; pons area, 478 mm2; MCP width, 10.05 mm; and SCP width, 4.10 mm.

 

Figure 3
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  		Figure 3: Box plots in patients with possible PSP, patients with probable PSP, patients with PD, and patients with MSA-P and in control participants. Vertical solid lines (whiskers) show lower and upper values. Box stretches from lower hinge (25th percentile) to upper hinge (75th percentile). Median is shown as line across each box. Left: P/M. Middle: MCP/SCP. Right: MR parkinsonism index (MRPI). None of the MR parkinsonism index measurements in both PSP groups overlapped with values in the other groups.

 




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