Vai trò của cộng hưởng từ trong chẩn đoán phân biệt liệt trên nhân tiến triển với các hội chứng Parkinson khác

Role of MRI on distinguishing between progressive supranuclear palsy and Parkinson's disease

SUMMARY

Background: The parkinsonian syndromes include idiopathic Parkinson disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD) and other rarer causes. Differentiating between them plays a crucial role in treatment and prognosis.

Aims: To evaluate the role of MRI in differentiating PSP from PD, MSA-P and controls.

Subjects and methods: 22 PSP patients, 24 PD patients, 10 MSA-P patients, and 25 controls underwent MRI. For each patient, midbrain area (M), pons area (P), M/P ratio, MCP width, SCP width, MRPI (= P/M x MCP/SCP), and the lateral midbrain diameter were calculated. The morning glory sign and the flat or concave of the midbrain were also included.

Results: Mean MRPI in PSP patients (27.02 ± 10.77) was significantly higher than that in PD patients (11.41 ± 1.38), MSA-P patients (10.01 ± 2.64) and controls (10.14 ± 1.68). In this study, MRPI was 100% sensitive, specific, and accurate in differentiating PSP from other groups. Mean M/P ratio were smaller in patients with PSP than in patients in other groups. The mean lateral midbrain width in PSP patients (10,53 ± 0,88) was smaller than that in PD (12,32 ± 0,52) and controls (12,45 ± 0,44), not statistically different from MSA-P. The morning glory sign has a high specificity but low sensitivity in differentiating PSP from other groups. Inversely, the sensitivity of flat or concave of the midbrain sign is high but low the specificity.

Conclusions: MRI plays an important role in supporting the diagnosis of PSP based on some signs and indices. MRPI is the most sensitive, specific, and accurate index in differentiating PSP from PD and MSA-P on an individual basis.

Keywords: Parkinson disease, progressive supranuclear palsy, multiple system atrophy, MRI, Parkinsonism Index.