Objective: In the present study, midbrain atrophy and the pons-to-midbrain area ratio (P/M ratio) were investigated as diagnostic markers for preclinical progressive supranuclear palsy (Pre-PSP).

Background: Midbrain atrophy is a characteristic feature of PSP and conventional brain MRI is a useful tool to determine midbrain atrophy. The midbrain area and the pons-to-midbrain area ratio (P/M ratio), measured based on the midsagittal plane of brain MRI, are considered neuroimaging diagnostic and progression biomarkers for PSP.

Method: The present study included 22 patients with probable PSP who underwent brain MRI at least twice before and after development of clinical symptoms, age- and sex-matched participants with Parkinson’s disease (PD, n = 22), and healthy controls (n = 22). The midbrain area, pons area, and P/M ratio of Pre-PSP, PD and controls were measured based on the midsagittal image of brain MRI and the parameters compared among the groups.

Results: The midbrain area and P/M ratio increased more in the Pre-PSP patients than PD or controls (midbrain, Pre-PSP vs. PD = 0.98 cm2 vs. 1.29 cm2, p < 0.001, Pre-PSP vs. controls = 0.98 cm2 vs. 1.30 cm2, p < 0.001; P/M ratio, Pre-PSP vs. PD = 5.42 vs. 4.10, p < 0.001, Pre-PSP vs. controls = 5.42 cm2 vs. 4.10 cm2, p < 0.001). P/M ratio had high sensitivity (vs. PD, 95.5%, vs. control 72.7%) and specificity (vs. PD, 95.5%, vs. control 100%) to differentiate Pre-PSP from PD or control.

Conclusion: Midbrain atrophy precedes the clinical symptoms of PSP and could be useful as a diagnostic imaging biomarker for Pre-PSP and may play an important role in the development of future treatment strategies as well as early diagnosis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/midbrain-atrophy-in-patients-with-preclinical-progressive-supranuclear-palsy/