A new MR imaging index for differentiation of progressive supranuclear palsy-parkinsonism from Parkinson's disease

Highlights

• •Distinguishing PSP-P from PD is challenging in the early stages of the disease.
• •Few data exist on the usefulness of MRPI for diagnosing PSP-P patients.
• •MRPI 2.0 is a new version of MRPI which includes the 3rd ventricular width.
• •MRPI 2.0 accurately differentiated patients with PSP-P from those with PD.
• •MRPI 2.0 accurately diagnosed PSP-P in the absence of vertical ocular palsy.
• 
  

Abstract

Introduction

Differentiating clinically progressive supranuclear palsy-parkinsonism (PSP-P) from Parkinson's disease (PD) may be challenging, especially in the absence of vertical supranuclear gaze palsy (VSGP). The Magnetic Resonance Parkinsonism Index (MRPI) has been reported to accurately distinguish between PSP and PD, yet few data exist on the usefulness of this biomarker for the differentiation of PSP-P from PD.

Methods

Thirty-four patients with PSP-P, 46 with PSP-Richardson's syndrome (PSP-RS), 53 with PD, and 53 controls were enrolled. New consensus criteria for the clinical diagnosis of PSP were used as the reference standard. The MRPI, and a new index termed MRPI 2.0 including the measurement of the third ventricle width (MRPI multiplied by third ventricle width/frontal horns width ratio), were calculated on T1-weighted MR images.

Results

The MRPI differentiated patients with PSP-P from those with PD with sensitivity and specificity of 73.5% and 98.1%, respectively, while the MRPI 2.0 showed higher sensitivity (100%) and similar specificity (94.3%) in differentiating between these two groups. Both biomarkers showed excellent performance in differentiating PSP-P patients with VSGP from those with PD, but the MRPI 2.0 was much more accurate (95.8%) than MRPI in differentiating PSP-P patients with slowness of vertical saccades from PD patients.

Conclusion

The MRPI 2.0 accurately differentiated PSP-P patients from those with PD. This new index was more powerful than MRPI in differentiating PSP patients in the early stage of the disease with slowness of vertical saccades from patients with PD, thus helping clinicians to consolidate the diagnosis based on clinical features, in vivo.

DOI: https://doi.org/10.1016/j.parkreldis.2018.07.016

Parietal atrophy score on magnetic resonance imaging of the brain in normally aging people

Aim: Our intention was to create a simple visual evaluation of parietal atrophy on MRI of the brain useful in identifying neurodegenerative dementias, especially Alzheimer‘s disease. We assessed the changes of the parietal regions dur ing natural aging. Patients and methods: We created a new rat ing scale that we named the Parietal atrophy score. This method is based on semiquantitative scoring of three structures on coronal slices in the entire parietal lobe: parietal gyri, sulcus cingularis posterior and precuneus. Each structure was rated accord ing to the visual classification size as 0 – a normal size without atrophy, 1 – a borderline finding or 2 – a considerable atrophy. These ratings were sum marized into one score for each hemisphere and then these two were integrated into one score for the entire brain. Using a visual rating scale, we clas sified the parietal regions in 74 elderly subjects with a normal Mini-Mental State Examination score (29 ± 1 point) with a wide range of ages between 48–87 years. Results: Increas ing age is as sociated with a mild progression of the parietal lobe atrophy (r = 0.2; p = 0.05). The over all score of the parietal tissue was not as sociated with education, gender or hand dominance. Conclusion: Our new visual rating system of parietal atrophy is an easy and fast method for use in clinical practice. Natural aging is accompanied with negligible parietal atrophic changes. Parietal atrophy score on magnetic resonance imaging of the brain in normally aging people.

• DOI: 
• 10.14735/amcsnn2018414

A new MR imaging index for differentiation of progressive supranuclear palsy-parkinsonism from Parkinson's disease

Highlights

• Distinguishing PSP-P from PD is challenging in the early stages of the disease.
• Few data exist on the usefulness of MRPI for diagnosing PSP-P patients.
• MRPI 2.0 is a new version of MRPI which includes the 3rd ventricular width
• MRPI 2.0 accurately differentiated patients with PSP-P from those with PD.
• MRPI 2.0 accurately diagnosed PSP-P in the absence of vertical ocular palsy.

Reference: Quattrone A, Morelli M, Nigro S, Quattrone A, Vescio B, Arabia G, Nicoletti G,Nisticò R, Salsone M, Novellino F, Barbagallo G, Le Piane E, Pugliese P, Bosco D, Vaccaro MG, Chiriaco C, Sabatini U, Vescio V, Stanà C, Rocca F, Gullà D, Caracciolo M. A new MR imaging index for differentiation of progressive supranuclear palsy-parkinsonism from Parkinson's disease. Parkinsonism Relat Disord. 2018 Sep;54:3-8. doi: 10.1016/j.parkreldis.2018.07.016

Corpus Callosum Index: A practical method for long-term follow-up in multiple sclerosis

Corpus callosum index

References

Pérez-Álvarez AI, Suárez-Santos P, González-Delgado M, Oliva-Nacarino P. Quantification of brain atrophy in multiple sclerosis using two-dimensional measurements. Neurologia. 2018 Jun 8. pii: S0213-4853(18)30152-X. doi: 10.1016/j.nrl.2018.04.004
Figueira, Fernando Faria Andrade, Santos, Valeria Silva dos, Figueira, Gustavo Medeiros Andrade, & Silva, Ângela Correa Marques da. (2007). Corpus Callosum Index: A practical method for long-term follow-up in multiple sclerosis. Arquivos de Neuro-Psiquiatria, 65(4a), 931-935. https://dx.doi.org/10.1590/S0004-282X2007000600001

A ‘Comprehensive Visual Rating Scale’ for predicting progression to dementia in patients with mild cognitive impairment

Background Numerous efforts have been made to identify biomarkers for predicting the progression of dementia in patients with mild cognitive impairment (MCI), and recently, a comprehensive visual rating scale (CVRS) based on magnetic resonance imaging (MRI) has been validated to assess structural changes in the brain of elderly patients. Based on this, the present study investigated the use of CVRS for predicting dementia and elucidated its association with cognitive change in patients with MCI over a three-year follow-up. Methods We included 340 patients with MCI with more than one follow-up visit. Data were obtained from the Alzheimer’s disease Neuroimaging Initiative study. We assessed all the patients using CVRS and determined their progression to dementia during a follow-up period of over 3 years. The cox proportional hazards model was used to analyze hazard ratios (HRs) of CVRS for disease progression. Further, multiple cognitive measures of the patients over time were fitted using the random effect model to assess the effect of initial CVRS score on subsequent cognitive changes. Results Of 340 patients, 69 (20.2%) progressed to dementia and the median baseline score (interquartile range) of CVRS significantly differed between stable MCI and progressive MCI (9 (5–13) vs 13 (8–17), p<0.001). The initial CVRS score was independently associated with an increased risk of progression to dementia (HR 1.123, 95% confidence interval [CI] 1.059–1.192). From 12 to 24 months, the effect of the interaction between CVRS and interval of follow-up visit on cognitive performance achieved significance (p<0.001). Conclusions Baseline CVRS predicted the progression to dementia in patients with MCI, and was independently associated with longitudinal cognitive decline.

Reference: Jang J-W, Park JH, Kim S, Park YH, Pyun J-M, Lim J-S, et al. (2018) A ‘Comprehensive Visual Rating Scale’ for predicting progression to dementia in patients with mild cognitive impairment. PLoS ONE 13(8): e0201852. https://doi.org/10.1371/journal.pone.0201852

Related Radiopaedia articles

• measurements and ratios
  • midbrain to pons area ratio (for PSP)
  • Magnetic Resonance Parkinsonism Index (MRPI) (for PSP)
  • frontal horn width to intercaudate distance ratio (FH/CC) (for Huntington disease)
  • intercaudate distance to inner table width ratio (CC/IT) (for Huntington disease)
• signs
  • hummingbird sign (of PSP)
  • Mickey Mouse sign (of PSP)
  • morning glory sign (of PSP)
  • hot cross bun sign (of MSA-C)
  • hockey stick sign (of Creutzfeldt-Jakob disease)
  • pulvinar sign (of Creutzfeldt-Jakob disease)
• scoring systems
  • Fazekas scale for white matter lesions
  • posterior atrophy score of parietal atrophy (PA/PCA) (Koedam score)
  • medial temporal lobe atrophy score (MTA score)
  • global cortical atrophy scale (GCA scale)

Corpus Callosum as a biomarker of lobar degeneration

Corpus Callosum as a biomarker for Alzheimer and Multiple Sclerosis

Corpus callosal atrophy and associations with cognitive impairment in Parkinson disease