Objective: We aimed to evaluate the magnetic resonance imaging-derived parameters in differentiation of patients with progressive supranuclear palsy from patients with Parkinson’s disease and other atypical parkinsonisms.

Background: In early stage, precise differential diagnosis of parkinsonism is challenging. Therefore, Various MRI parameters have been proposed to make an accurate diagnosis of parkinsonism.

Method: 90 patients [mean age, 72.6±7.7 years; progressive supranuclear palsy (PSP) (n=18), Parkinson disease (PD) (n=40), diffuse Lewy body disease (DLB) (n=6), corticobasal syndrome (CBS) (n=11), multiple system atrophy with predominant parkinsonism (MSA-P) (n=5), and multiple system atrophy with cerebellar features (MSA-C) (n=10)] who have undergone brain MRI were included in this study. MRI-derived parameters including midbrain area-to-pons area (M/P), magnetic resonance parkinsonism index (MRPI), and MRPI 2.0 were compared in patients with PSP, PD, DLB, CBS, MSA-P, and MSA-C. The cut-off value, sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristic (ROC) of MRI-based characteristics were analyzed in different groups.

Results: The M/P, MRPI and MRPI 2.0 differentiated patients with PSP from those with PD, DLB, CBS, MSA-P and MSA-C. The MRPI 2.0 was the best method to distinguish between PSP and PD (cut-off value: 4.38, sensitivity: 94.4%, specificity 92.5%, positive predictive value 85.0%, negative predictive value: 97.4%).

Conclusion: Various MRI parameters are useful for differentiating PSP from PD, DLB, CBS, MSA-P and MSA-C. However, pathological confirmation is necessary for more accurate evaluation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mri-evaluation-of-progressive-supranuclear-palsy/