Date: Sunday, October 7, 2018
Session Title: Parkinsonism, MSA, PSP (Secondary and Parkinsonism-Plus)
Session Time: 1:45pm-3:15pm
Location: Hall 3FG
Objective: To evaluate the effectiveness of quantitative midbrain measurements in differentiating vPSP from multiple system atrophy (MSA) and Parkinson’s disease (PD).
Background: Newly published criteria of progressive supranuclear palsy (PSP) by MDS suggests that the clinical variant phenotype of PSP (vPSP) is complex. The midbrain atrophy identified in MRI may support the diagnosis of PSP-Richadson syndrome (PSP-RS). However, little is known about the value of midbrain atrophy in diagnosing the vPSPs.
Methods: Quantitative midbrain measurements, including midbrain width (MW), midbrain to pons ratio (M/P) and magnetic resonance parkinsonism index (MRPI) were performed in patients with PSP (n=39), MSA (n=15) and PD (n=48). Patients with PSP were further sub-grouped according to variants (Class 1: 10 PSP-RS, 21 PSP-P, 8 PSP-PGF) and diagnostic level (Class 2: 24 probable PSP, 9 possible PSP, 6 suggestive of PSP) based on the MDS-PSP criteria (2017). A cross-sectional study was conducted in the series to evaluate the effectiveness of these quantitative measurements. Cutoff values were applied to this cohort using receiver operating characteristic curve analysis.
Results: The mean value of MW, M/P and MRPI in PSP group was 9.09mm, 0.52 and 13.02, correspondingly. Significant statistical difference could be obtained comparing to MSA (10.24mm, 0.65, 7.75) and PD (10.53, 0.62, 9.86) (p<0.0001). The medium value of MW, M/P and MRPI in PSP-RS (8.21mm, 0.49, 15.26) and PSP-P (9.31, 0.53, 12.13) were also statistically different from MSA and PD (p<0.0001). In PSP-PGF, difference could also be observed (9.61, 0.56, 12.55, p=0.238, p=0.0133, p=0.0003). Smaller MW and M/P, larger MRPI were revealed in PSP-RS than in PSP-P and PSP-PGF. No statistical difference for each variable was observed in Class 2. MW9.3mm, M/P0.52 and MRPI10.77 correspond ideal sensitivity and specificity (90%vs92.1%, 80%vs93.7%, 100%vs82.5%) in differentiating PSP-RS from MSA and PD.
Conclusions: Quantitative measurement of midbrain atrophy is useful in differentiating either PSP-RS or vPSP from MSA and PD, regardless of the diagnostic level.
To cite this abstract in AMA style:H. Wang, YW. Zhang, J. Yuan, D. Xu, H. You, ML. Li, F. Feng. Quantitative Midbrain Measurement in Diagnosing Variants of Progressive Supranuclear Palsy [abstract]. Mov Disord. 2018; 33 (suppl 2). https://www.mdsabstracts.org/abstract/quantitative-midbrain-measurement-in-diagnosing-variants-of-progressive-supranuclear-palsy/. Accessed December 9, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/quantitative-midbrain-measurement-in-diagnosing-variants-of-progressive-supranuclear-palsy/