MR imaging of brainstem atrophy in progressive supranuclear palsy.
BACKGROUND
To enhance the sensitivity and specificity of the clinical diagnosis of progressive supranuclear palsy (PSP), neuroradiological parameters established in pathologically proven cases are needed.


METHODS
We examined brainstem atrophy in five pathologically confirmed PSP patients (three men, mean age at death 77 years, range 64-84 years). Time interval between symptom onset and MRI ranged from 1 to 5 years, and between MRI and death from 33 to 52 months. Only one patient had clinical diagnosis of PSP at the time of MRI. Control group consisted of 19 age- and gender-matched healthy subjects. Seventeen morphometric parameters of the midbrain and pons were measured on T1-weighted midsagittal and T2-weighted axial MRI scans with Image Analyzer. Measurements of superior cerebellar peduncle (SCP) width were performed on PSP autopsy specimens.


RESULTS
Mean SCP width on MRI in PSP (2.7 +/- 0.8 mm, 95%CI: 2.1-3.3) was smaller than in controls (3.7 +/- 0.5 mm, 95%CI: 3.5-3.9). Mean SCP width at autopsy was 8% smaller than mean SCP width on MRI. Midsagittal midbrain area in PSP (99.1 +/- 6.9 mm(2), 95%CI: 90.5-107.6) was smaller than in controls (141.0 +/- 18.1 mm(2), 95%CI: 132.2-149.7). Midbrain/pons area ratio in PSP was 1:5 and in controls was 1:4 (p < 0.01). Repeat MRI 17 months later in one PSP case revealed 30% decrease of SCP width.


CONCLUSIONS
MR imaging with quantitative analysis may be useful in the diagnosis of early PSP and in monitoring disease course.
Slowinski
Jerzy
J
Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States.
Imamura
Akiko
A
Uitti
Ryan J
RJ
Pooley
Robert A
RA
Strongosky
Audrey J
AJ
Dickson
Dennis W
DW
Broderick
Daniel F
DF
Wszolek
Zbigniew K
ZK
D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000473:pathology* / Q000503:physiopathology; D001933:Brain Stem / Q000473:pathology* / Q000503:physiopathology; D002531:Cerebellum / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008636:Mesencephalon / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D011149:Pons / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D013494:Supranuclear Palsy, Progressive / Q000473:pathology* / Q000503:physiopathology