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Original research
Midbrain MRI assessments in progressive supranuclear palsy subtypes
  1. Marina Picillo1,
  2. Maria Francesca Tepedino1,
  3. Filomena Abate1,
  4. Roberto Erro1,
  5. Sara Ponticorvo2,
  6. Salvatore Tartaglione3,
  7. Giampiero Volpe4,
  8. Daniela Frosini5,
  9. Paolo Cecchi6,
  10. Mirco Cosottini6,
  11. Roberto Ceravolo5,
  12. Fabrizio Esposito2,3,
  13. Maria Teresa Pellecchia1,
  14. Paolo Barone1,
  15. Renzo Manara2
  1. 1 Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
  2. 2 Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Baronissi (SA), Italy
  3. 3 Department of Diagnostic Imaging, University Hospital A.O.U. OO.RR. San Giovanni di Dio e Ruggi D’Aragona, Scuola Medica Salernitana, Salerno, Italy
  4. 4 Neurology, University Hospital A.O.U. OO.RR. San Giovanni di Dio e Ruggi D’Aragona, Scuola Medica Salernitana, Salerno, Italy
  5. 5 Dipartimento di Medicina Clinica e Sperimentale Università di Pisa, Italy, Università di Pisa, Pisa, Italy
  6. 6 Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
  1. Correspondence to Professor Paolo Barone, Center for Neurodegenerative Disease, University of Salerno, Salerno 84084, Italy; pbarone{at}unisa.it

Abstract

Objectives To explore the role of the available midbrain-based MRI morphometric assessments in (1) differentiating among progressive supranuclear palsy (PSP) subtypes (PSP Richardson’s syndrome (PSP-RS), PSP with predominant parkinsonism (PSP-P) and the other variant syndromes of PSP (vPSP)), and (2) supporting the diagnosis of PSP subtypes compared with Parkinson’s disease (PD) and healthy controls (HC).

Methods Seventy-eight patients with PSP (38 PSP-RS, 21 PSP-P and 19 vPSP), 35 PD and 38 HC were included in the present analysis. Available midbrain-based MRI morphometric assessments were calculated for all participants.

Results Current MRI midbrain-based assessments do not display an adequate sensitivity and specificity profile in differentiating PSP subtypes. On the other hand, we confirmed MR Parkinsonism Index (MRPI) and pons area to midbrain area ratio (P/M) have adequate diagnostic value to support PSP-RS clinical diagnosis compared with both PD and HC, but low sensitivity and specificity profile in differentiating PSP-P from PD as well as from HC. The same measures show acceptable sensitivity and specificity profile in supporting clinical diagnosis of vPSP versus HC but not versus PD. Similar findings were detected for the newer MRPI and P/M versions.

Conclusions Further studies are warranted to identify neuroimaging biomarkers supporting the clinical phenotypic categorisation of patients with PSP. MRPI and P/M have diagnostic value in supporting the clinical diagnosis of PSP-RS.

Classification of evidence This study provides class III evidence that available MRI midbrain-based assessments do not have diagnostic value in differentiating the Movement Disorder Society PSP subtypes.

  • progressive supranuclear palsy
  • subtypes
  • diagnostic criteria
  • imaging
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Footnotes

  • Contributors MP: designed and conceptualised the study; major role in the acquisition of data; analysed the data; drafted the manuscript for intellectual content; approval of the version being published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MFT, FA, RE, SP, ST, GV, DF, PC, MC, RC, FE, MTP, PB: major role in the acquisition, analysis and interpretation of data; revised the manuscript for intellectual content; approval of the version being published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RM: designed and conceptualised the study; major role in the acquisition of data; interpretation of the data; revised the manuscript for intellectual content; approval of the version being published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the EC Napoli3sud (number 101, 19 October 2017), and each subject was included after signing the informed consent form.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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