Cosottini M, Ceravolo R, Faggioni L, Lazzarotti G, Michelassi M C, Bonuccelli U, Murri L, Bartolozzi C
Department of Neuroscience, University of Pisa, Pisa, Italy.
Acta Neurol Scand. 2007 Jul;116(1):37-42. doi: 10.1111/j.1600-0404.2006.00767.x.
To assess midbrain atrophy through morphometric (linear, surface and volumetric) measurements in patients with clinically diagnosed progressive supranuclear palsy (PSP) and to establish the most accurate measure to be implemented in routine magnetic resonance (MR) protocol in distinguishing PSP from healthy subjects and MSA-p (multiple system atrophy, parkinsonian form) patients.
We studied 15 patients with the diagnosis of probable PSP, seven patients with the diagnosis of probable MSA-p and 14 age-matched healthy volunteers. MR protocol includes a sagittal SE T1-weighted sequence for cross-sectional area and linear brainstem measurements and a 3D-FSPGR sequence for brainstem volume measurements.
A highly significant difference in the antero-posterior midbrain diameter, area and volume in PSP compared with control subjects was found. Only a measurement of the midbrain area and pons area enabled one to distinguish between PSP and MSA-p. Receiver operating characteristic analysis revealed that the midbrain area has the highest diagnostic accuracy in distinguishing between PSP and other conditions, with a sensitivity of 100% and specificity of 90.5%. The addition of the midbrain area/pons area ratio (A(ms)/A(pn) ratio) measurement improves the specificity in distinguishing between PSP and MSA.
Morphological indexes indicate midbrain atrophy in PSP patients The combination of the A(ms) and A(ms)/A(pn) ratio measurements allows to discriminate between PSP and other conditions.
通过对临床诊断为进行性核上性麻痹（PSP）患者进行形态学测量（线性、表面积和体积）来评估中脑萎缩情况，并确定在常规磁共振（MR）检查方案中用于区分PSP与健康受试者及多系统萎缩帕金森型（MSA-p）患者的最准确测量方法。
我们研究了15例确诊为可能PSP的患者、7例确诊为可能MSA-p的患者以及14名年龄匹配的健康志愿者。MR检查方案包括用于测量脑干横截面积和线性尺寸的矢状面SE T1加权序列，以及用于测量脑干体积的三维快速扰相梯度回波（3D-FSPGR）序列。
与对照组相比，PSP患者的中脑前后径、面积和体积存在高度显著差异。只有中脑面积和脑桥面积的测量能够区分PSP和MSA-p。受试者操作特征分析显示，中脑面积在区分PSP与其他疾病方面具有最高的诊断准确性，敏感性为100%，特异性为90.5%。增加中脑面积/脑桥面积比值（A(ms)/A(pn)比值）测量可提高区分PSP和MSA的特异性。
形态学指标表明PSP患者存在中脑萎缩。A(ms)和A(ms)/A(pn)比值测量相结合能够区分PSP与其他疾病。
