J Clin Neurol.  2015 Jul;11(3):268-274. 10.3988/jcn.2015.11.3.268.

Utility of the Midbrain Tegmentum Diameter in the Differential Diagnosis of Progressive Supranuclear Palsy from Idiopathic Parkinson's Disease

• Kim YH
• Ma HI
• Kim YJ

• KMID: 1894566
• DOI: http://doi.org/10.3988/jcn.2015.11.3.268

Abstract

BACKGROUND AND PURPOSE
Various magnetic resonance (MR) measurements have been proposed to aid in differentiating between progressive supranuclear palsy (PSP) and idiopathic Parkinson's disease (IPD); however, these methods have not been compared directly. The aim of this study was to determine which measurement method exhibits the highest power to differentiate between PSP and IPD.
METHODS
Brain MR images from 82 IPD and 29 PSP patients were analyzed retrospectively. T1-weighted 3D volumetric axial images, or sagittal images reconstructed from those axial images were examined. MR measurements included the length from the interpeduncular fossa to the center of the cerebral aqueduct at the mid-mammillary-body level, adjusted according to the anterior commissure-posterior commissure length (MB(Tegm)), the ratio of the midbrain area to the pons area (M/P ratio) as measured by both Oba's method (Oba M/P) and Cosottini's method (Cosottini M/P), and a modified MR parkinsonism index (mMRPI).
RESULTS
Receiver operating characteristic (ROC) analysis indicated that the areas under the ROC curves (AUCs) exceeded 0.70, with a high intrarater reliability for all MR measurement methods. ROC analyses of four MR measurements yielded AUCs of 0.69-0.76. At the cutoff value with the highest Youden index, mMRPI had the highest sensitivity, while Oba M/P offered the highest specificity. A comparison of the ROC analyses revealed that MB(Tegm) was superior to mMRPI in differentiating PSP from IPD (p=0.049). There was no difference in discriminating power among Oba M/P, Cosottini M/P, and MB(Tegm).
CONCLUSIONS
Simple measurements of MB(Tegm) on axial MR images at the mid-mammillary-body level are comparable to measurements of the M/P ratio with regard to their ability to discriminate PSP from IPD.

Keyword

progressive supranuclear palsy; idiopathic Parkinson's disease; MRI; neuroimaging

MeSH Terms

Area Under Curve
Brain
Cerebral Aqueduct
Diagnosis, Differential*
Humans
Magnetic Resonance Imaging
Mesencephalon*
Neuroimaging
Parkinson Disease*
Parkinsonian Disorders
Pons
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Supranuclear Palsy, Progressive*

Figure

• 

  Fig. 1 Schematic diagrams of midsagittal (A and B) and axial (D) images of the brain and parasagittal and coronal (C) T1-weighted volumetric magnetic resonance (MR) images. A: The midbrain area (Oba M) and the pons area (Oba P) were measured using a standard line as described by Oba et al.6 B: The midbrain area (Cosottini M) and the pons area (Cosottini P) were measured using a standard line as described by Cosottini et al.7 C: The MR parkinsonism index (MRPI) was measured using a modified version of Quattrone's method (mMRPI). The middle cerebellar peduncle length measured in a parasagittal image is marked with an asterisk (*). Bilateral superior cerebellar peduncle lengths are marked by arrows (↓). D: The axial length of the midbrain tegmentum, adjusted according to the anterior commissure-posterior commissure length (MBTegm), was measured from the anterior interpeduncular fossa to the center of the cerebral aqueduct at the plane of the mid-mammillary body. Lines between the midbrain and the pons and between the pons and medulla oblongata represent the lower borders of the midbrain and pons areas, respectively.

• 

  Fig. 2 Receiver operating curve analyses of the brain structure measurements for differentiating progressive supranuclear palsy (PSP) from idiopathic Parkinson's disease (IPD). A: PSP vs. IPD, not age matched (n=111). B: PSP vs. IPD, age-matched. C: Probable PSP vs. IPD. Cosottini M/P: ratio of the midbrain area to the pons area in the midsagittal plane, measured by Cosottini's method, Oba M/P: ratio of the midbrain area to the pons area in the midsagittal plane, measured by Oba's method.

Reference

1. Litvan I, Bhatia KP, Burn DJ, Goetz CG, Lang AE, McKeith I, et al. Movement Disorders Society Scientific Issues Committee report: SIC Task Force appraisal of clinical diagnostic criteria for Parkinsonian disorders. Mov Disord. 2003; 18:467–486.

2. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992; 55:181–184.

3. Warmuth-Metz M, Naumann M, Csoti I, Solymosi L. Measurement of the midbrain diameter on routine magnetic resonance imaging: a simple and accurate method of differentiating between Parkinson disease and progressive supranuclear palsy. Arch Neurol. 2001; 58:1076–1079.

4. Righini A, Antonini A, Ferrarini M, de Notaris R, Canesi M, Triulzi F, et al. Thin section MR study of the basal ganglia in the differential diagnosis between striatonigral degeneration and Parkinson disease. J Comput Assist Tomogr. 2002; 26:266–271.

5. Kato N, Arai K, Hattori T. Study of the rostral midbrain atrophy in progressive supranuclear palsy. J Neurol Sci. 2003; 210:57–60.

6. Oba H, Yagishita A, Terada H, Barkovich AJ, Kutomi K, Yamauchi T, et al. New and reliable MRI diagnosis for progressive supranuclear palsy. Neurology. 2005; 64:2050–2055.

7. Cosottini M, Ceravolo R, Faggioni L, Lazzarotti G, Michelassi MC, Bonuccelli U, et al. Assessment of midbrain atrophy in patients with progressive supranuclear palsy with routine magnetic resonance imaging. Acta Neurol Scand. 2007; 116:37–42.

8. Quattrone A, Nicoletti G, Messina D, Fera F, Condino F, Pugliese P, et al. MR imaging index for differentiation of progressive supranuclear palsy from Parkinson disease and the Parkinson variant of multiple system atrophy. Radiology. 2008; 246:214–221.

9. Sung YH, Park KH, Lee YB, Park HM, Shin DJ, Park JS, et al. Midbrain atrophy in subcortical ischemic vascular dementia. J Neurol. 2009; 256:1997–2002.

10. Longoni G, Agosta F, Kostić VS, Stojković T, Pagani E, Stošić-Opinćal T, et al. MRI measurements of brainstem structures in patients with Richardson's syndrome, progressive supranuclear palsy-parkinsonism, and Parkinson's disease. Mov Disord. 2011; 26:247–255.

11. Morelli M, Arabia G, Salsone M, Novellino F, Giofrè L, Paletta R, et al. Accuracy of magnetic resonance parkinsonism index for differentiation of progressive supranuclear palsy from probable or possible Parkinson disease. Mov Disord. 2011; 3:527–533.

12. Morelli M, Arabia G, Messina D, Vescio B, Salsone M, Chiriaco C, et al. Effect of aging on magnetic resonance measures differentiating progressive supranuclear palsy from Parkinson's disease. Mov Disord. 2014; 29:488–495.

13. Righini A, Antonini A, De Notaris R, Bianchini E, Meucci N, Sacilotto G, et al. MR imaging of the superior profile of the midbrain: differential diagnosis between progressive supranuclear palsy and Parkinson disease. AJNR Am J Neuroradiol. 2004; 25:927–932.

14. Massey LA, Jäger HR, Paviour DC, O'Sullivan SS, Ling H, Williams DR, et al. The midbrain to pons ratio: a simple and specific MRI sign of progressive supranuclear palsy. Neurology. 2013; 80:1856–1861.

15. Whitwell JL, Jack CR Jr, Parisi JE, Gunter JL, Weigand SD, Boeve BF, et al. Midbrain atrophy is not a biomarker of progressive supranuclear palsy pathology. Eur J Neurol. 2013; 20:1417–1422.