Objective: To see if frontal atrophy is a frequent radiologic  feature of PSP on MRI imaging .

Background: Progressive supranuclear palsy[PSP]  is a  taupathy  that causes problems with walking, balance , frequent falls, behaviour issues, difficulty in swallowing and vertical eye movements. Due to common clinical features, it is often confused and misdiagnosed as Parkinson’s disease, especially in initial stages of the disease. PSP is most commonly diagnosed using a combination of clinical signs and  MRI(Magnetic Resonanace Imaging)

Method: We evaluated 12 patients of PSP on MRI; MRI scans were done on 1.5 Tesla and 3 Tesla MRI at two separate centres. High resolution 3D T1 weighted volumetric spoiled gradient echo images acquired in sagittal, axial and coronal planes were used. MRPI(Magnetic Resonance Parkinsonism Index) was calculated using equation: MRPI = (P/M) x (MCP/SCP) where P and M represent surface area of pons and midbrain and MCP and SCP represent width of middle cerebellar peduncle and superior cerebellar peduncle . MRPI values >13.55 suggest a diagnosis of PSP [Fig 1 shows Saggital sections and Fig 2 shows coronal sections  of MRI images of patients]. Diagnosis of PSP was made using  clinical and MRI criteria. In addition ,frontal lobe atrophy was qualitatively evaluated in these patients by two experienced neuroradiologists, each with >10 years of experience.

Results: 11 patients had MRPI values >13.55 , one patient’s value was 12.20 [91.66% patients had MRPI abnormality ] . Moderate to severe frontal atrophy was found on MRI in all 12 patients with PSP[100% patients had frontal atrophy].

Conclusion: Our study confirms the association between PSP and frontal atrophy [Ref 1] and emphasizes that in cases where brainstem measurements are inconclusive in differentiating PSP from Parkinson’s disease, frontal lobe atrophy can serve as a sensitive marker to differentiate the two.  Further research is needed to evaluate the usefulness of frontal atrophy in early diagnosis of PSP in addition to midbrain atrophy and to see if it predates midbrain atrophy.

Fig 1 – Panel showing MRI,Saggital Sequence.

Fig 2 – Panel showing MRI,Coronal Sequence

References: 1. Rowe JB, Holland N, Rittman T. Progressive supranuclear palsy: diagnosis and management. Pract Neurol. 2021 Oct;21(5):376-383. doi: 10.1136/practneurol-2020-002794. Epub 2021 Jul 2. PMID: 34215700; PMCID: PMC8461411.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/frontal-atrophy-in-progressive-supranuclear-palsypsp-an-universal-feature-along-with-midbrain-atrophy/