The Cerebral to Middle Cerebellar Peduncle Width Ratio: An Imaging Biomarker for Differentiating Multiple System Atrophy from Degenerative Parkinsonism
The CP and MCP widths: biomarker for parkinsonism
Keywords:
Parkinson’s disease, Multiple system atrophy, Atypical parkinsonism, Magnetic resonance imaging, BiomarkerAbstract
Introduction: The differentiation between Parkinson’s disease (PD) and atypical parkinsonian syndromes (APS) is clinically challenging. Magnetic resonance imaging (MRI) measurement of the cerebral peduncle (CP) and middle cerebellar peduncle (MCP) axial widths have not been investigated. The objective was to evaluate the utility of the CP and MCP axial widths in the differentiation of degenerative parkinsonian syndromes and their clinical correlations.
Methods: The CP and MCP were retrospectively measured based on the axial T1-weighted MRI in 100 patients with probable PD, multiple system atrophy (MSA), progressive supranuclear palsy, Lewy body dementia, or Alzheimer’s disease from the movement disorders clinic at Thammasat University Hospital between January 2018 and December 2021 and in ten controls. Diagnostic accuracy was determined based on the final diagnosis. The Schwab & England activity of daily living (ADL), the Hoehn & Yahr (H&Y), and the levodopa equivalence dose (LED) were evaluated.
Results: Patients with parkinsonian syndromes had smaller mean CP and MCP axial widths than controls. Patients with probable MSA had the largest axial CP widths and the smallest MCP axial widths. A CP to MCP width ratio ≥ 0.88 suggested the diagnosis of probable MSA (sensitivity 90.0%, specificity 91.2%, AUC 0.93). There was no difference in the CP width between probable PD and APS. The small CP width correlated with advanced age and poor ADL, while the small MCP width was associated with poor ADL, advanced H&Y, and low LED.
Conclusion: This study shows the benefit of using CP and MCP axial widths as an imaging biomarker for patients with degenerative parkinsonian syndromes and could help differentiate MSA patients from others with parkinsonism.
Downloads
References
Adler CH, Beach TG, Hentz JG, et al. Low clinical diagnostic accuracy of early vs advanced Parkinson disease: clinicopathologic study. Neurology. 2014;83(5):406-412.
Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015;30(12):1591-1601.
Gilman S, Wenning GK, Low PA, et al. Second consensus statement on the diagnosis of multiple system atrophy. Neurology. 2008;71(9):670-676.
Hoglinger GU, Respondek G, Stamelou M, et al. Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord. 2017;32(6):853-864.
Emre M, Aarsland D, Brown R, et al. Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Mov Disord. 2007;22(12):1689-1707.
McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017;89(1): 88-100.
Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS-ADRDA criteria. Lancet Neurol. 2007;6(8):734-746.
Gama RL, Tavora DF, Bomfim RC, Silva CE, Bruin VM, Bruin PF. Morphometry MRI in the differential diagnosis of parkinsonian syndromes. Arq Neuropsiquiatr. 2010;68(3):333-338.
Lee JH, Ryan J, Andreescu C, Aizenstein H, Lim HK. Brainstem morphological changes in Alzheimer’s disease. Neuroreport. 2015;26(7):411-415.
Paviour DC, Price SL, Jahanshahi M, Lees AJ, Fox NC. Regional brain volumes distinguish PSP, MSA-P, and PD: MRI-based clinico-radiological correlations. Mov Disord. 2006;21(7):989-996.
Krismer F, Wenning GK. Multiple system atrophy: insights into a rare and debilitating movement disorder. Nat Rev Neurol. 2017;13(4):232-243.
Nicoletti G, Fera F, Condino F, et al. MR imaging of middle cerebellar peduncle width: differentiation of multiple system atrophy from Parkinson disease. Radiology. 2006;239(3):825-830.
Seppi K, Poewe W. Brain magnetic resonance imaging techniques in the diagnosis of parkinsonian syndromes. Neuroimaging Clin N Am. 2010;20(1):29-55.
Wenning GK, Tison F, Elliott L, Quinn NP, Daniel SE. Olivopontocerebellar pathology in multiple system atrophy. Mov Disord. 1996;11(2):157-162.
Stankovic I, Fanciulli A, Sidoroff V, Wenning GK. A Review on the Clinical Diagnosis of Multiple System Atrophy. Cerebellum. 2023;22(5):825-839.
Massey LA, Jager HR, Paviour DC, et al. The midbrain to pons ratio: a simple and specific MRI sign of progressive supranuclear palsy. Neurology. 2013;80(20):1856-1861.
De Marzi R, Seppi K, Hogl B, et al. Loss of dorsolateral nigral hyperintensity on 3.0 teslasusceptibility-weighted imaging in idiopathic rapid eye movement sleep behavior disorder. Ann Neurol. 2016;79(6):1026-1030.
Reiter E, Mueller C, Pinter B, et al. Dorsolateralnigral hyperintensity on 3.0T susceptibility weighted imaging in neurodegenerative Parkinsonism. Mov Disord. 2015;30(8):1068-1076.
Lehericy S, Bardinet E, Poupon C, Vidailhet M, Francois C. 7 Tesla magnetic resonance imaging: a closer look at substantia nigra anatomy in Parkinson’s disease. Mov Disord. 2014;29(13):1574-1581.
D’Amelio M, Puglisi-Allegra S, Mercuri N. The role of dopaminergic midbrain in Alzheimer’s disease: Translating basic science into clinical practice. Pharmacol Res. 2018;130:414-419.
Mueller C, Hussl A, Krismer F, et al. The diagnostic accuracy of the hummingbird and morning glory sign in patients with neurode generative parkinsonism. Parkinsonism Relat Disord. 2018;54:90-94.
Way C, Pettersson D, Hiller A. The ’Hot Cross Bun’ Sign Is Not Always Multiple System Atrophy: Etiologies of 11 Cases. J Mov Disord. 2019;12(1):27-30.
Lee WH, Lee CC, Shyu WC, Chong PN, Lin SZ. Hyperintense putaminal rim sign is not a hallmark of multiple system atrophy at 3T. AJNR Am J Neuroradiol. 2005;26(9):22382242.
Tha KK, Terae S, Tsukahara A, et al. Hyperintense putaminal rim at 1.5 T: prevalence in normal subjects and distinguishing features from multiple system atrophy. BMC Neurol. 2012;12:39.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Asian Medical Journal and Alternative Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
