Objective: We aimed to evaluate the complementary diagnostic values of MRI characteristics to differentiate various types of parkinsonism.

Background: Although precise differential diagnosis of parkinsonism is very critical in terms of treatment and prognosis, it is not easy, especially in the early stage of disease before full-blown typical symptoms have not begun yet. Therefore, supplementary objective approach such as MRI enables clinician to make an accurate diagnosis in parkinsonism.

Methods: Patients with Parkinson disease (PD) (n=29), multiple system atrophy cerebellar type (MSA-c) (n=25), progressive supranuclear palsy (PSP) (n=29), corticobasal syndrome (CBS) (n=8) were recruited and analyzed their MRIs in each corresponding image. The 4th ventricle size, midbrain AP diameter, midbrain to pons ratio, middle cerebellar peduncle width of all the participants were calculated by two raters who were not aware of clinical symptoms and diagnosis. The cut-off value, sensitivity, specificity, positive likelihood ratio (PLR), receiver operating characteristic (ROC) of MRI-based characteristics were analyzed in different groups.

Results: Inter-rater reliability of each calculated values on MR imaging was confirmed through the Cronbach alpha, and internal consistency is feasible (alpha≥0.7). The ratio of midbrain to pons showed the best predictive value (cut off value: 0.652, sensitivity: 0.708, specificity: 0.828, PLR: 4.108, ROC: 0.793) to differentiate between PD and MSA-c. The mean 4th ventricle size was the best method to distinguish between PSP and MSA-c (cut off: 177.34, sensitivity: 0.75, specificity: 0.786, PLR: 3.5, ROC: 0.752).

Conclusions: MRI-based differential diagnosis in various types of parkinsonism may have high and objective complementary value to distinguish in early stage of parkinsonism.

« Back to 2018 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/complementary-value-of-mri-based-differential-diagnosis-in-parkinsonism/