Skip to main content

Advertisement

SpringerLink
Log in

MR imaging of brainstem atrophy in progressive supranuclear palsy

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

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 gendermatched 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 mm2, 95%CI: 90.5–107.6) was smaller than in controls (141.0 ± 18.1 mm2, 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adachi M,Kawanami T, Ohshima H, Sugai Y,Hosoya T (2004) Morning glory sign: a particular MR finding in progressive supranuclear palsy. Magn Reson Med Sci 3:125–132

    Article  PubMed  Google Scholar 

  2. Aiba I, Hashizume Y, Yoshida M, Okuda S, Murakami N, Ujihira N (1997) Relationship between brainstem MRI and pathological findings in progressive supranuclear palsy – study in autopsy cases. J Neurol Sci 152:210–217

    Article  PubMed  CAS  Google Scholar 

  3. Boxer AL, Geschwind MD, Belfor N, Gorno-Tempini ML, Schauer GF, Miller BL, Weiner MW, Rosen HJ (2006) Patterns of brain atrophy that differentiate corticobasal degeneration syndrome from progressive supranuclear palsy. Arch Neurol 63:81–86

    Article  PubMed  Google Scholar 

  4. Cordato NJ,Duggins AJ,Halliday GM, Morris JG, Pantelis C (2005) Clinical deficits correlate with regional cerebral atrophy in progressive supranuclear palsy. Brain 128:1259–1266

    Article  PubMed  CAS  Google Scholar 

  5. Groschel K, Hauser TK, Luft A, Patronas N, Dichgans J, Litvan I, Schulz JB (2004) Magnetic resonance imaging- based volumetry differentiates progressive supranuclear palsy from corticobasal degeneration. Neuroimage 21:714–724

    Article  PubMed  Google Scholar 

  6. Hauw JJ, Agid Y (2003) Progressive supranuclear palsy (PSP) or Steele- Richardson-Olszewski disease. In: Dickson D (ed) Neurodegeneration: the molecular pathology of dementia and movement disorders. ISN Neuropath Press, Basel, pp 103–114

  7. Hauw JJ, Daniel SE, Dickson D, Horoupian DS, Jellinger K, Lantos PL, McKee A, Tabaton M, Litvan I (1994) Preliminary NINDS neuropathologic criteria for Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy). Neurology 44:2015–2019

    PubMed  CAS  Google Scholar 

  8. Hughes AJ, Daniel SE, Ben-Shlomo Y, Lees AJ (2002) The accuracy of diagnosis of parkinsonian syndromes in a specialist movement disorder service. Brain 125:861–870

    Article  PubMed  Google Scholar 

  9. Hughes AJ, Daniel SE,Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184

    PubMed  CAS  Google Scholar 

  10. Josephs KA, Whitwell JL, Boeve BF, Shiung MM, Gunter JL, Parisi JE, Dickson DW, Jack CR (2006) Rates of cerebral atrophy in autopsy-confirmed progressive supranuclear palsy. Ann Neurol 59:200–203

    Article  PubMed  Google Scholar 

  11. Kato N, Arai K, Hattori T (2003) Study of the rostral midbrain atrophy in progressive supranuclear palsy. Neurol Sci 210:57–60

    Article  Google Scholar 

  12. Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC, Goetz CG, Golbe LI, Grafman J, Growdon JH, Hallett M, Jankovic J, Quinn NP, Tolosa E, Zee DS (1996) Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson- Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology 47:1–9

    Article  PubMed  CAS  Google Scholar 

  13. Litvan I, Agid Y, Jankovic J, Goetz C, Brandel JP, Lai EC, Wenning G, D'Olhaberriague L, Verny M, Chaudhuri KR, McKee A, Jellinger K, Bartko JJ, Mangone CA, Pearce RK (1996) Accuracy of clinical criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome). Neurology 46:922–930

    PubMed  CAS  Google Scholar 

  14. Litvan I, Bhatia KP, Burn DJ, Goetz CG, Lang AE, McKeith I, Quinn N, Sethi KD, Shults C, Wenning GK (2003) Movement Disorders Society Scientific Issues Committee Report: SIC Task Force appraisal of clinical diagnostic criteria for Parkinsonian disorders. Mov Disord 18:467–486

    Article  PubMed  Google Scholar 

  15. Oba H, Yagishita A, Terada H, Barkovich AJ, Kutomi K, Yamauchi T, Furui S, Shimizu T, Uchigata M, Matsumura K, Sonoo M, Sakai M, Takada K, Harasawa A, Takeshita K, Kohtake H, Tanaka H, Suzuki S (2005) New and reliable MRI diagnosis for progressive supranuclear palsy. Neurology 64:2050–2055

    Article  PubMed  CAS  Google Scholar 

  16. Oka M, Katayama S, Imon Y, Ohshita T, Mimori Y, Nakamura S (2001) Abnormal signals on proton densityweighted MRI of the superior cerebellar peduncle in progressive supranuclear palsy. Acta Neurol Scand 104:1–5

    Article  PubMed  CAS  Google Scholar 

  17. Paviour DC, Price SL, Jahanshahi M, Lees AJ, Fox NC (2006) Longitudinal MRI in progressive supranuclear palsy and multiple system atrophy: rates and regions of atrophy. Brain 129:1040–1049

    Article  PubMed  Google Scholar 

  18. Paviour DC, Price SL, Stevens JM, Lees AJ, Fox NC (2005) Quantitative MRI measurement of superior cerebellar peduncle in progressive supranuclear palsy. Neurology 64:675–679

    PubMed  CAS  Google Scholar 

  19. Rajput AH, Rozdilsky B, Rajput A (1991) Accuracy of clinical diagnosis in parkinsonism – a prospective study. Can J Neurol Sci 18:275–278

    PubMed  CAS  Google Scholar 

  20. Righini A, Antonini A, De Notaris R, Bianchini E, Meucci N, Sacilotto G, Canesi M, De Gaspari D, Triulzi F, Pezzoli G (2004) MR imaging of the superior profile of the midbrain: differential diagnosis between progressive supranuclear palsy and Parkinson disease. AJNR 25:927–932

    PubMed  Google Scholar 

  21. Savoiardo M, Strada L, Girotti F, D'Incerti L, Sberna M, Soliveri P, Balzarini L (1989) MR imaging in progressive supranuclear palsy and Shy-Drager syndrome. J Comput Assist Tomogr 13:555–560

    Article  PubMed  CAS  Google Scholar 

  22. Schrag A, Good CD, Miszkiel K, Morris HR, Mathias CJ, Lees AJ, Quinn NP (2000) Differentiation of atypical parkinsonian syndromes with routine MRI. Neurology 54:697–702

    PubMed  CAS  Google Scholar 

  23. Steele JC, Richardson JC, Olszewski J (1964) Progressive supranuclear palsy. Arch Neurol 10:333–359

    PubMed  CAS  Google Scholar 

  24. Tsuboi Y, Slowinski J, Josephs KA, Honer WG, Wszolek ZK, Dickson DW (2003) Atrophy of superior cerebellar peduncle in progressive supranuclear palsy. Neurology 60:1766–1769

    PubMed  CAS  Google Scholar 

  25. Victor M, Ropper AH (2001) Disorders of ocular movement and pupillary function. In: Victor M, Ropper AH (eds) Adams and Victor's principles of neurology. McGraw-Hill,New York, pp 271–300

  26. Warmuth-Metz M, Naumann M, Csoti I, Solymosi L (2001) Measurement of the midbrain diameter on routine magnetic resonance imaging. Arch Neurol 58:1076–1079

    Article  PubMed  CAS  Google Scholar 

  27. Williams DR, de Silva R, Paviour DC, Pittman A, Watt HC, Kilford L, Holton JL, Revesz T, Lees AJ (2005) Characteristics of two distinct clinical phenotypes in pathologically proven progressive supranuclear palsy: Richardson's syndrome and PSPparkinsonism. Brain 128:1247–1258

    Article  PubMed  Google Scholar 

  28. Wszolek ZK, Slowinski J, Imamura A, Tsuboi Y, Broderick DF (2006) New and reliable MRI diagnosis for progressive supranuclear palsy. Neurology 66:781

    Article  PubMed  CAS  Google Scholar 

  29. Yagishita A, Oda M (1996) Progressive supranuclear palsy: MRI and pathological findings. Neuroradiology 38 (Suppl 1):S60–S66

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, United States

    J. Slowinski, A. Imamura, R. J. Uitti, A. J. Strongosky & Z. K. Wszolek MD

  2. Dept. of Radiology, Mayo Clinic, Jacksonville, Florida, United States

    R. A. Pooley & D. F. Broderick

  3. Dept. of Pathology, Mayo Clinic, Jacksonville, Florida, United States

    D. W. Dickson

Authors
  1. J. Slowinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Imamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. J. Uitti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. A. Pooley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. J. Strongosky
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. W. Dickson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. F. Broderick
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Z. K. Wszolek MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Z. K. Wszolek MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Slowinski, J., Imamura, A., Uitti, R.J. et al. MR imaging of brainstem atrophy in progressive supranuclear palsy. J Neurol 255, 37–44 (2008). https://doi.org/10.1007/s00415-007-0656-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-007-0656-y

Key words

Search

Navigation