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Manual MRI morphometry in Parkinsonian syndromes

L. Möller, J. Kassubek, M. Südmeyer, R. Hilker, E. Hattingen, K. Egger, F. Amtage, G. Respondek, M. Stamelou, A. Schnitzler, W.H. Oertel, S. Knake, H.J. Huppertz, G.U. Höglinger (Marburg, Germany)

Meeting: 2016 International Congress

Abstract Number: 1179

Keywords: Magnetic resonance imaging(MRI), Multiple system atrophy(MSA): Clinical features, Progressive supranuclear palsy(PSP)

Session Information

Date: Wednesday, June 22, 2016

Session Title: Imaging and Neurophysiology

Session Time: 12:00pm-1:30pm

Objective: We investigated a large sample of Parkinsonian patients and healthy controls from five German academic medical centers with 3D MP-RAGE sequences on mainly 3T MR scanners, performed manual planimetric measures, and evaluated their diagnostic value against the clinically most probable diagnosis.

Background: MRI is of particular importance in clinical routine as supportive investigation for the differential diagnosis of neurodegenerative Parkinsonian syndromes. Several quantitative morphometric parameters have been proposed for this purpose, but their relative diagnostic value remains insufficiently validated. It remains unclear which of these parameters are most useful to support the differential diagnosis of Parkinsonian syndromes.

Methods: We investigated patients with PD (n=204), PSP (n=106), MSA-C (n=20) and MSA-P (n=60) together with healthy controls (n=73) in a multicentric setting (five German academic medical centers) with 3D MP-RAGE sequences on 1.5 or 3T MR scanners and performed manual planimetric measures of pre-defined structures.

Results: The midsagittal midbrain area was reduced in PSP compared to all other groups (P<0.001). The midsagittal pons area was reduced in MSA-C, MSA-P and PSP compared to both PD patients and healthy controls (P<0.001); it was also reduced in MSA-C (P<0.01) compared to PSP patients. The midbrain/pons area ratio was lower in PSP compared to all other groups (P<0.001), and higher in MSA-C and MSA-P compared to PD and PSP (P<0.001).

Conclusions: The midsagittal midbrain area was the most reliable single measure to identify PSP patients in our cohort. The midsagittal pons area was the most useful single measure for MSA-C, but it proved unreliable for MSA-P. The midbrain/pons area ratio performed slightly better than the MR-Parkinson index to differentiate MSA-C and PSP. Receiver operator characteristics were conducted to recommend cut-off values for clinical routine and research.

To cite this abstract in AMA style:

L. Möller, J. Kassubek, M. Südmeyer, R. Hilker, E. Hattingen, K. Egger, F. Amtage, G. Respondek, M. Stamelou, A. Schnitzler, W.H. Oertel, S. Knake, H.J. Huppertz, G.U. Höglinger. Manual MRI morphometry in Parkinsonian syndromes [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/manual-mri-morphometry-in-parkinsonian-syndromes/. Accessed June 14, 2025.
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