J Korean Neurol Assoc.  2004 Oct;22(5):478-484.

Measurements of Brain Stem and Cerebellum on Brain MRI: for the Differential Diagnosis Between Multiple System Atrophy and Idiopathic Parkinson's Disease

• Na SJ
• Park JH
• Kim HS
• Hong JM
• Lee KO
• Lee MS

Abstract

BACKGROUND
Multiple system atrophy (MSA) and idiopathic Parkinson's disease (IPD) are two common neurodegenerative disorders presenting with parkinsonism. Since a brain MRI study is an available method for differentiating MSA from IPD, we tried to find further values of brain MRI studies in differentiating MSA from IPD. METHODS: We measured anteroposterior and transverse diameters (AD and TD, respectively) of the brain stem of T2-weighted axial images. We graded the severity of atrophy (grade 0: none; grade 1: mild; grade 2: moderate; and grade 3: severe) of cerebellar vermis and hemispheres on the midsagittal and parasagittal planes. RESULTS: There were 36 patients with probable MSA and 40 patients with IPD. We calculated a parameter multiplying AD of the midbrain by TD of the midbrain. The mean of the AD x TD of the midbrain was 1007.5 +/- 161.8 mm2 in patients with MSA, and it was significantly smaller than that of those with IPD (1113.3 +/- 118.7 mm2). When the cut off value was decided as 1050 mm2, the sensitivity of the parameter for the diagnosis of MSA was 83.3% and specificity was 80%. The frequency of cerebellar atrophy was 72.2% in patients with MSA, and it was significantly higher than that of those with IPD (37.5%). CONCLUSIONS: Measurements of the brain stem, particularly the midbrain, and cerebellum areas on brain MRI are helpful methods for the differential diagnosis of patients with MSA from those with IPD.

Keyword

Multiple system atrophy; Idiopathic Parkinson's disease; Brain magnetic resonance imaging

MeSH Terms

Atrophy
Brain Stem*
Brain*
Cerebellum*
Diagnosis
Diagnosis, Differential*
Humans
Magnetic Resonance Imaging*
Mesencephalon
Multiple System Atrophy*
Neurodegenerative Diseases
Parkinson Disease*
Parkinsonian Disorders
Sensitivity and Specificity