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New and reliable MRI diagnosis for progressive supranuclear palsy

From the Departments of Radiology (Drs. Oba, Kutomi, Yamauchi, Furui, Sakai, Takada, Harasawa, Takeshita, Kohtake, Tanaka, and Suzuki) and Neurology (Drs. Shimizu, Matsumura, and Sonoo), Teikyo University School of Medicine, Tokyo, Japan; Department of Neuroradiology (Dr. Yagishita), Tokyo Metropolitan Neurological Hospital, Tokyo, Japan; Second Department of Radiology (Dr. Terada), Toho University School of Medicine, Tokyo, Japan; Department of Radiology (Dr. Barkovich), University of California San Francisco, San Francisco CA; Department of Neurology (Dr. Uchigata), Showa General Hospital, Tokyo, Japan.

Address correspondence and reprint requests to Dr. Hitoshi Terada, 2nd Department of Radiology, Toho University School of Medicine, 2-17-6 Ohashi, Meguro, Tokyo 153-8515 Japan; e-mail: terada{at}h08.itscom.net

Objective: To evaluate the area of the midbrain and pons on mid-sagittal MRI in patients with progressive supranuclear palsy (PSP), Parkinson disease (PD), and multiple-system atrophy of the Parkinson type (MSA-P), compare these appearances and values with those of normal control subjects, and establish diagnostic MRI criteria for the diagnosis of PSP.

Methods: The authors prospectively studied MRI of 21 patients with PSP, 23 patients with PD, 25 patients with MSA-P, and 31 age-matched normal control subjects. The areas of the midbrain tegmentum and the pons were measured on mid-sagittal MRI using the display tools of a workstation. The ratio of the area of the midbrain to the area of the pons was also evaluated in all subjects.

Results: The average midbrain area of the patients with PSP (56.0 mm²) was significantly smaller than that of the patients with PD (103.0 mm²) and MSA-P (97.2 mm²) and that of the age-matched control group (117.7 mm²). The values of the area of the midbrain showed no overlap between patients with PSP and patients with PD or normal control subjects. However, patients with MSA-P showed some overlap of the values of individual areas with values from patients with PSP. The ratio of the area of the midbrain to the area of pons in the patients with PSP (0.124) was significantly smaller than that in those with PD (0.208) and MSA-P (0.266) and in normal control subjects (0.237). Use of the ratio allowed differentiation between the PSP group and the MSA-P group.

Conclusion: The area of the midbrain on mid-sagittal MRI can differentiate PSP from PD, MSA-P, and normal aging.

Received November 23, 2004. Accepted in final form March 14, 2005.

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