Preliminary Study of the MRI Diagnosis and Differential Diagnosis in Multiple System Atrophy , Progressive Supranuclear Palsy and IPD
|Course||Medical Imaging and Nuclear Medicine|
|Keywords||Neurodegenerative disease Multiple system atrophy Idiopathic Parkinson disease Magnetic resonance imaging DWI Diagnosis,differential T2 relaxation time|
Objective: To morphologically explore the MRI features of multiple system atrophy ,progressive supranuclear palsy and IPD and to provide early evidence in differentiating these diseases. Methods: MRI was performed by using a 1.5-T imager（Philips Achieva system） and standard quadrature head coil.MRI features of 24 patients with MSA ,12 patients with PSP and 35 patients with IPD were retrospectively analyzed , and 32 healthy people were regarded as controls. All measurements were performed on imaging workstation（DELL incorporation） by using View Forum 4.1 software. Midbrain area and pons area were measured on sagittal T1WI,and middle cerebellar peduncles width were measured on axial T1WI. The main outcome measures were included: the hot-cross bun sign , the slit-like sign , cerebellar atrophy,strophy of the middle cerebellar peduncles,medulla oblongata atrophy,pontine atrophy and midbrain atrophy.Results: Infratentorial MRI findings included the hot-cross bun sign,cerebellar atrophy,atrophy of the middle cerebellar peduncles,medulla oblongata atrophy,pontine atrophy and midbrain atrophy. Supratentorital MRI findings were the slit-like changes and putaminal atrophy. The high sensitive features were the atrophies of middle cerebellar peduncles（83.3%）, the pontine atrophy （79.2%）and the hot-cross bun sign（75.0%）. The high specific feature and positive predictive value were hot-cross bun sign（100%,100%）, the slit-like sign（100%,100%）, the atrophies of middle cerebellar peduncles（94.3%,90.9%） and pontine atrophy（97.1%,95.0%）. MSA group had the smallest pons area,middle cerebellar peduncles width and pons area-midbrain area ratio in all groups （288.7±75.4mm2,10.7±2.8mm and 2.4±0.8 respectively）,compared PSP group （452.2±57.2mm2, 15.8±1.6mm and 5.1±0.8 respectively）, IPD group（460.5±54.3mm2,16.2±1.3mm and 3.3±0.6 respectively） and healthy group（454.5±36.8mm2,16.7±1.2mm and 3.1±0.4 respectively）,and significant difference was found （P<0.05）. PSP findings were penguin silhouette sign.Midbrain area of the PSP group was the smallest（91.3±17.0mm2）,and there was statistically significant difference,comparing with MSA group（527.8±25.8mm2）,IPD group（145.9±21.6mm2） and control group（146.4±17.4mm2） （P<0.05）. PSP group had the largest pons area-midbrain area ratio （5.1±0.8）in all groups ,compared MSA group（2.4±0.8）, IPD group（3.3±0.6） and healthy group（3.1±0.4）,and significant difference was found （P<0.05）.But the IPD group and control group had no statistically significant difference in midbrain area,pons area, pons area-midbrain area ratio and middle cerebellar peduncles width（P>0.05）. There were special findings in subtypes of MSA, the hot-cross bun signs were mainly observed on OPCA patients and the slit-like signs were mainly observed on SND patients .But SDS patients had nothing specific MRI findings,although the atrophy of brain stem and middle cerebellar was not obvious in the early stage.Conclusions: The routine MRI parkinsonism index is helpful in differential diagnosis in MSA, PSP and IPD ,and to some extent it has some values in diagnosing the subtypes of MSA.Objective:To explore the DWI values in diagnosis and differential diagonsis among MSA,PSP and IPD.Methods:MRI was performed by using a 1.5-T imager（Philips Achieva system） and standard quadrature head coil.We performed DWI sequences to 24 MSA patients,12 PSP patients,35 IPD patients, and 32 age-matched healthy control subjects.Regional apparent diffusion coefficients were determined in different brain regions including basal ganglia,thalamus,middle cerebellar peduncles ,superior cerebellar peduncles,substantia nigra and red nucleus.Results:PSP group had the largest rADC in putamen(0.75×10﹣3mm2/s) ,globus pallidus(0.77×10﹣3mm2/s),caudate(0.77×10﹣3mm2/s), red nucleus(0.74×10﹣3mm2/s) and superior cerebellar peduncles(1.11×10﹣3mm2/s).The rADC of globus pallidus and caudate had statistically difference comparing with MSA (0.73×10﹣3mm2/s, 0.73×10﹣3mm2/s),IPD(0.67×10﹣3mm2/s, 0.73×10﹣3mm2/s) and control group(0.71×10﹣3mm2/s, 0.72×10﹣3mm2/s).MSA group had the largest rADC in middle cerebellar peduncles(0.95×10﹣3mm2/s) ,and there was statistically significant difference, comparing with PSP(0.74×10﹣3mm2/s),IPD (0.69×10﹣3mm2/s)and control group（0.68×10﹣3mm2/s）.But the rADC of IPD group and control group had no statistically significant difference in putamen ,globus pallidus,caudate,thalamus,red nucleus, substantia nigra , middle cerebellar peduncles and superior cerebellar peduncles（P>0.05）.Conclusion: The DWI is helpful in differential diagnosis in MSA ,PSP and IPD.Objective: To quantitatively analyze the variations of brain iron in IPD by using T2 relaxation time of brain gray nucleus.Methods: MRI was performed by using a 1.5-T imager（Philips Achieva system） and standard quadrature head coil. We performed duel echo（DE）sequences to 35 patients and 32 age-matched healthy control subjects,And T2 relaxation time was measured in both sides of putamen ,globus pallidus,caudate, thalamus, red nucleus,substantia pars reticulata and substantia pars compacta. Results:IPD group T2 relaxation time decreaseed in substantia pars compacta （80.03±3.95ms） and substantia pars reticulata （73.04±4.82ms）,when compared to the control group（84.59±4.40ms, 74.46±5.68ms）, and significant difference was found （P<0.01）,But there were no significant difference in putamen ,globus pallidus,caudate, thalamus,red nucleus between IPD group and control group（P>0.05）. Conclusion:The T2 relaxation time decreased in substantia pars reticulata and substantia pars compacta.The quantitative measurements of T2 relaxation time can be used as an atraumatic method of IPD diagnosis.