Keita Sakurai1, Aya M Tokumaru2, Keigo Shimoji2, Shigeo Murayama3, Kazutomi Kanemaru3, Satoru Morimoto3, Ikuko Aiba4, Motoo Nakagawa5, Yoshiyuki Ozawa5, Masashi Shimohira5, Noriyuki Matsukawa6, Yoshio Hashizume7, Yuta Shibamoto5. 1. Department of Diagnostic Radiology, Tokyo Metropolitan Medical Center of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan. ksak666@yahoo.co.jp. 2. Department of Diagnostic Radiology, Tokyo Metropolitan Medical Center of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan. 3. Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan. 4. Department of Neurology, National Hospital Organization Higashi Nagoya National Hospital, Nagoya, Japan. 5. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 6. Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 7. Choju Medical Institute, Fukushimura Hospital, Toyohashi, Japan.
Abstract
PURPOSE: Recently, it has been recognized that pathologically proven progressive supranuclear palsy (PSP) cases are classified into various clinical subtypes with non-uniform symptoms and imaging findings. This article reviews essential imaging findings, general information, and advanced magnetic resonance imaging (MRI) techniques for PSP and presents these MRI findings of pathologically proven typical and atypical PSP cases for educational purposes. METHODS: With the review of literatures, notably including atypical pathologically proven PSP cases, MRI and clinical information of 15 pathologically proven typical and atypical PSP cases were retrospectively evaluated. RESULTS: In addition to typical symptoms, PSP patients can exhibit atypical symptoms including levodopa-responsive parkinsonism, pure akinesia, non-fluent aphasia, corticobasal syndrome, and predominant cerebellar ataxia. As well as clinical symptoms, the degree of midbrain atrophy, a well-known imaging hallmark, is not consistent in atypical PSP cases. This fact has important implications for the limitation of midbrain atrophy as a diagnostic imaging biomarker of PSP pathology. Additional evaluation of other imaging findings including various regional atrophies of the globus pallidus, frontal lobe, cerebral peduncle, and superior cerebellar peduncle is essential for the diagnosis of atypical PSP cases. CONCLUSION: It is necessary for radiologists to recognize the wide clinical and radiological spectra of typical and atypical PSP cases.
PURPOSE: Recently, it has been recognized that pathologically proven progressive supranuclear palsy (PSP) cases are classified into various clinical subtypes with non-uniform symptoms and imaging findings. This article reviews essential imaging findings, general information, and advanced magnetic resonance imaging (MRI) techniques for PSP and presents these MRI findings of pathologically proven typical and atypical PSP cases for educational purposes. METHODS: With the review of literatures, notably including atypical pathologically proven PSP cases, MRI and clinical information of 15 pathologically proven typical and atypical PSP cases were retrospectively evaluated. RESULTS: In addition to typical symptoms, PSPpatients can exhibit atypical symptoms including levodopa-responsive parkinsonism, pure akinesia, non-fluent aphasia, corticobasal syndrome, and predominant cerebellar ataxia. As well as clinical symptoms, the degree of midbrain atrophy, a well-known imaging hallmark, is not consistent in atypical PSP cases. This fact has important implications for the limitation of midbrain atrophy as a diagnostic imaging biomarker of PSP pathology. Additional evaluation of other imaging findings including various regional atrophies of the globus pallidus, frontal lobe, cerebral peduncle, and superior cerebellar peduncle is essential for the diagnosis of atypical PSP cases. CONCLUSION: It is necessary for radiologists to recognize the wide clinical and radiological spectra of typical and atypical PSP cases.
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