Objective: To explore the pattern of cerebellar atrophy if any, in patients with Progressive Supranuclear Palsy (PSP) using the SUIT (Spatially Unbiased atlas template for cerebellum and brainstem) based volumetric analysis.

Background: PSP is a chronic, progressive neurodegenerative disorder characterized by parkinsonism, supranuclear gaze palsy, postural instability, falls, and dementia. PSP has been categorized into two major subtypes; (i) Richardson-Steele-Olszewski variant (PSP-RS) and (ii) Parkinsonian variant (PSP-P). In addition to the aforementioned symptoms, patients with PSP may rarely have cerebellar signs. Previous autopsy based studies have also reported cerebellar atrophy in patients with PSP. However neuroimaging studies exploring degeneration of cerebellum in PSP are sparse and SUIT can be utilised to compare volumes of different regions of cerebellum between PSP patients and healthy controls.

Methods: This study included 25 patients with PSP (RS: 17, PSP-P: 8) satisfying the National Institute of Neurological Disorders and Stroke and Society for PSP (NINDS-SPSP) criteria for clinically probable PSP and 23 healthy controls. All recruited subjects underwent detailed neurological examination and 3-T MRI. SUIT based analysis was used to isolate cerebellum and brainstem structures from the surrounding tissues and voxel-based morphometry was utilized to determine patterns of cerebellar degeneration in PSP patients and controls.

Results: There was no significant difference in the age, gender distribution and Mini Mental Status Examination scores between PSP patients and controls. Significant atrophy was noted in the anterior lobe of cerebellum including bilateral culmen and areas of midbrain including left red nucleus and right substantia nigra in patients with PSP compared to healthy controls (p<0.01, FWE corrected). Figure-1represents the heat map of the volumetric analysis.

Conclusions: This SUIT based analysis confirms cerebellar degeneration in PSP, which has earlier been reported in neuropathological studies. It will be of importance to further characterize the different subtypes of PSP using this technique and correlate clinically.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/assessment-of-subclinical-cerebellar-involvement-in-progressive-supranuclear-palsy-using-suit-based-volumetric-analysis/