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Diagnostic accuracy of MRI parameters in pure akinesia with gait freezing

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Abstract

Objective

To determine the usefulness of MRI measurements in patients with pure akinesia with gait freezing (PAGF), Richardson’s syndrome, and Parkinson’s disease for diagnosis.

Methods

We obtained MRI measurements for patients with PAGF, Richardson’s syndrome, or Parkinson’s disease: 9 patients with PAGF, 26 with Richardson’s syndrome, and 93 with Parkinson’s disease. We measured the area of the pons and midbrain on midsagittal MRIs and the midbrain width on axial MRIs. We also calculated the mean values of the superior cerebellar peduncle, middle cerebellar peduncle, and cerebral crus width; the pons area-to-midbrain area ratio; the middle cerebellar peduncle width-to-superior cerebellar peduncle width ratio; and the magnetic resonance (MR) Parkinsonism index.

Results

The Richardson’s syndrome group had the highest pons area-to-midbrain area ratio and MR Parkinsonism index; the Parkinson’s disease group had the lowest values. The Parkinson’s disease group also had the highest midbrain width and cerebral crus width, with the lowest values being seen in the Richardson’s syndrome group. The PAGF group had the intermediate values of the pons area-to-midbrain area ratio and MR Parkinsonism index between the Richardson’s syndrome group and the Parkinson’s disease group, whereas significant differences were found only in the pons area-to-midbrain area ratio. Results from receiver operating characteristic curve analyses showed that the pons area-to-midbrain area ratio has a higher sensitivity, specificity, and accuracy than the MR Parkinsonism index.

Conclusions

The pons area-to-midbrain area ratio is more useful to distinguish PAGF from Richardson’s syndrome and Parkinson’s disease than the MR Parkinsonism index.

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Data availability

Anonymized data will be shared by request from any qualified investigator. The present study was approved by the institutional review board (IRB). We posted the details of this study on a website. All patients had the opportunity to opt out at any time and were exempt by the IRB from providing informed consent because of the retrospective design of the study.

Abbreviations

CCW:

Cerebral crus width

IRB:

Institutional review board

MBW:

Midbrain width

MCP:

Middle cerebellar peduncle

MCP/SCP:

MCP width-to-SCP width ratio

MP-RAGE:

Magnetization-prepared rapid acquisition gradient echo

MR:

Magnetic resonance

MRPI:

Magnetic resonance Parkinsonism index

PAGF:

Pure akinesia with gait freezing

PD:

Parkinson’s disease

P/MB:

Pons area-to-midbrain area ratio

PSP:

Progressive supranuclear palsy

ROC:

Receiver operating characteristic

RS:

Richardson’s syndrome

SCP:

Superior cerebellar peduncle

SE T1WI:

Spin-echo T1-weighted imaging

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Acknowledgements

We would like to thank all members of the Department of Neurology at Kumamoto University Hospital and the Department of Neurology at National Hospital Organization Nagasaki Kawatana Medical Center for helping with collection of clinical data.

Funding

No funding was provided for this research.

Author information

Authors and Affiliations

  1. Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1−1−1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Keiichi Nakahara, Shunya Nakane & Yukio Ando

  2. Department of Molecular Neurology and Therapeutics, Kumamoto University Hospital, 1−1−1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Shunya Nakane

  3. Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1−1−1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Mika Kitajima

  4. Department of Neurology, National Hospital Organization Nagasaki Kawatana Medical Center, 2005-1 Shimogumigo, Kawatana-cho, Higashisonogi-gun, Nagasaki, 859-3615, Japan

    Tomoko Masuda-Narita & Hidenori Matsuo

Authors
  1. Keiichi Nakahara
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  2. Shunya Nakane
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  3. Mika Kitajima
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  4. Tomoko Masuda-Narita
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  5. Hidenori Matsuo
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  6. Yukio Ando
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Contributions

KN contributed to study conception and design, collect and analyzed the data, drafted the manuscript for intellectual content. SN contributed to study conception and design, collected the data, drafted the manuscript for intellectual content. MK interpreted the data, drafted the manuscript for intellectual content. TMN collected the data, revised the manuscript for intellectual content. HM collected the data, revised the manuscript for intellectual content. YA collect and interpreted the data, drafted the manuscript for intellectual content.

Corresponding author

Correspondence to Shunya Nakane.

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Conflicts of interest

K.N. has received honoraria for lectures at symposia from Kyowa Hakko Kirin Co., Ltd., Takeda Pharmaceutical Co., Ltd., Eisai Co., Ltd., and Otsuka Pharmaceutical Co., Ltd. S.N. has received honoraria for lectures at symposia from Kyowa Hakko Kirin Co., Ltd., and Sumitomo Dainippon Pharma Co., Ltd., and was supported by the Ministry of Health, Labor, and Welfare, Japan, and the Ministry of Education, Culture, Sports, Science, and Technology of Japan (JSPS KAKENHI Grant Number 16K09695). M.K. has received honoraria for lectures at symposia from Bayer Yakuhin, Ltd, and Canon Medical Systems Corporation, and was supported by the Ministry of Health, Labor, and Welfare, Japan (JSPS KAKENHI Grant Number 15K09930). T.M–N. has received honoraria for lectures at symposia from Sumitomo Dainippon Pharma Co., Ltd. H.M. has received honoraria for lectures at symposia from Kyowa Hakko Kirin Co., Ltd., Takeda Pharmaceutical Co., Ltd., FP Pharmaceutical Corporation, Japan Blood Products Organization, Eisai Co., Ltd., Fujifilm Co., Ltd., Alexion Pharmaceuticals, Inc., and Sumitomo Dainippon Pharma Co., Ltd., and was supported by the Ministry of Health, Labor, and Welfare, Japan. Y.A, was supported by grants from the Amyloidosis Research Committee; the Pathogenesis, Therapy of Hereditary Neuropathy Research Committee; the Surveys and Research on Specific Disease; the Ministry of Health and Welfare of Japan; the Charitable Trust Clinical Pathology Research Foundation of Japan; and Research for the Future Program Grant; and Grants-in-Aid for Scientific Research (B) 15DH04841 from the Ministry of Education, Science, Sports and Culture of Japan.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards (permit number: 1401).

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Nakahara, K., Nakane, S., Kitajima, M. et al. Diagnostic accuracy of MRI parameters in pure akinesia with gait freezing. J Neurol 267, 752–759 (2020). https://doi.org/10.1007/s00415-019-09635-z

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  • DOI: https://doi.org/10.1007/s00415-019-09635-z

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