Aldo Quattrone1, Maurizio Morelli2, Salvatore Nigro3, Andrea Quattrone4, Basilio Vescio5, Gennarina Arabia2, Giuseppe Nicoletti3, Rita Nisticò3, Maria Salsone3, Fabiana Novellino3, Gaetano Barbagallo4, Emilio Le Piane6, Pierfrancesco Pugliese7, Domenico Bosco8, Maria Grazia Vaccaro3, Carmelina Chiriaco3, Umberto Sabatini9, Virginia Vescio9, Carlo Stanà9, Federico Rocca3, Domenico Gullà10, Manuela Caracciolo3. 1. Neuroscience Centre, Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy. Electronic address: quattrone@unicz.it. 2. Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy; Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. 3. Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy. 4. Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. 5. Biotecnomed, S.C.aR.L, Catanzaro, Italy. 6. Department of Neurology, Pugliese-Ciaccio Hospital, Catanzaro, Italy. 7. Neurology Unit, Annunziata Hospital, Cosenza, Italy. 8. San Giovanni di Dio Hospital, Crotone, Italy. 9. Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy. 10. Neuroscience Centre, Magna Graecia University, Catanzaro, Italy.
Abstract
INTRODUCTION: Differentiating clinically progressive supranuclear palsy-parkinsonism (PSP-P) from Parkinson's disease (PD) may be challenging, especially in the absence of vertical supranuclear gaze palsy (VSGP). The Magnetic Resonance Parkinsonism Index (MRPI) has been reported to accurately distinguish between PSP and PD, yet few data exist on the usefulness of this biomarker for the differentiation of PSP-P from PD. METHODS: Thirty-four patients with PSP-P, 46 with PSP-Richardson's syndrome (PSP-RS), 53 with PD, and 53 controls were enrolled. New consensus criteria for the clinical diagnosis of PSP were used as the reference standard. The MRPI, and a new index termed MRPI 2.0 including the measurement of the third ventricle width (MRPI multiplied by third ventricle width/frontal horns width ratio), were calculated on T1-weighted MR images. RESULTS: The MRPI differentiated patients with PSP-P from those with PD with sensitivity and specificity of 73.5% and 98.1%, respectively, while the MRPI 2.0 showed higher sensitivity (100%) and similar specificity (94.3%) in differentiating between these two groups. Both biomarkers showed excellent performance in differentiating PSP-P patients with VSGP from those with PD, but the MRPI 2.0 was much more accurate (95.8%) than MRPI in differentiating PSP-P patients with slowness of vertical saccades from PD patients. CONCLUSION: The MRPI 2.0 accurately differentiated PSP-P patients from those with PD. This new index was more powerful than MRPI in differentiating PSP patients in the early stage of the disease with slowness of vertical saccades from patients with PD, thus helping clinicians to consolidate the diagnosis based on clinical features, in vivo.
INTRODUCTION: Differentiating clinically progressive supranuclear palsy-parkinsonism (PSP-P) from Parkinson's disease (PD) may be challenging, especially in the absence of vertical supranuclear gaze palsy (VSGP). The Magnetic Resonance Parkinsonism Index (MRPI) has been reported to accurately distinguish between PSP and PD, yet few data exist on the usefulness of this biomarker for the differentiation of PSP-P from PD. METHODS: Thirty-four patients with PSP-P, 46 with PSP-Richardson's syndrome (PSP-RS), 53 with PD, and 53 controls were enrolled. New consensus criteria for the clinical diagnosis of PSP were used as the reference standard. The MRPI, and a new index termed MRPI 2.0 including the measurement of the third ventricle width (MRPI multiplied by third ventricle width/frontal horns width ratio), were calculated on T1-weighted MR images. RESULTS: The MRPI differentiated patients with PSP-P from those with PD with sensitivity and specificity of 73.5% and 98.1%, respectively, while the MRPI 2.0 showed higher sensitivity (100%) and similar specificity (94.3%) in differentiating between these two groups. Both biomarkers showed excellent performance in differentiating PSP-Ppatients with VSGP from those with PD, but the MRPI 2.0 was much more accurate (95.8%) than MRPI in differentiating PSP-Ppatients with slowness of vertical saccades from PDpatients. CONCLUSION: The MRPI 2.0 accurately differentiated PSP-Ppatients from those with PD. This new index was more powerful than MRPI in differentiating PSPpatients in the early stage of the disease with slowness of vertical saccades from patients with PD, thus helping clinicians to consolidate the diagnosis based on clinical features, in vivo.
Keywords:
Magnetic resonance parkinsonism index; Magnetic resonance parkinsonism index 2.0; Pons area-midbrain area ratio; Progressive supranuclear palsy-parkinsonism; Third ventricle
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