Department of Radiology, Akdeniz University School of Medicine, Antalya, Turkey.
Department of Neurology, Akdeniz University School of Medicine, Antalya, Turkey.
Can Assoc Radiol J. 2020 Feb;71(1):100-109. doi: 10.1177/0846537119888411. Epub 2020 Jan 24.
This study aimed to assess the sensitivity and specificity of brain stem morphologic changes to differentiate the progressive supranuclear palsy (PSP) from Parkinson disease (PD) and multiple system atrophy (MSA), by single and combined magnetic resonance imaging (MRI) measurements.
Peduncle angle (PA), pons area (P), mesencephalon area (M), middle cerebellar peduncles (MCPs), and superior cerebellar peduncles (SCPs) were measured in 14 PSP, 43 PD, 8 MSA patients, and 45 age-matched control participants on T1-weighted MRI. Neurologists clinically diagnosed all patients. Additionally, P/M ratio, MCPs/SCPs ratio, the previously defined Magnetic Resonance Parkinsonism Index, MRPI: (P/M) · (MCP/SCP), and also the Akdeniz Index (AKI) that we termed were calculated, AKI: (P/M) · (PA/180). Two blinded radiologists evaluated all MR images and inter-/intraobserver variations were measured.
Both M and SCPs were significantly lower and P/M, MCPs/SCPs, and PA were significantly higher in PSP patients than the other groups ( < .001). This significance was related to patients with PSP and PD. But all single measurements showed some overlapping values. Therefore, previously defined MRPI was calculated and shown to distinguish patients (negative predictive values: 92%, sensitivity: 78%, specificity: 82%). In this study, interobserver correlation (0.68) was found low for MRPI. Therefore, we identified a more practical index: the Akdeniz Index, which has same diagnostic power with MRPI and higher interobserver correlation (0.91).
The Akdeniz Index identified in our study is a practical index with high diagnostic power and can reinforce radiological distinguishing of PSP and PD, which are clinically difficult to distinguish.
本研究旨在通过单一和联合磁共振成像（MRI）测量，评估脑干形态变化对鉴别进行性核上性麻痹（PSP）、帕金森病（PD）和多系统萎缩（MSA）的敏感性和特异性。
在 T1 加权 MRI 上测量了 14 例 PSP、43 例 PD、8 例 MSA 患者和 45 名年龄匹配的对照组参与者的脑脚角（PA）、脑桥面积（P）、中脑面积（M）、小脑中脚（MCPs）和小脑上脚（SCPs）。神经病学家对所有患者进行了临床诊断。此外，还计算了 P/M 比、MCPs/SCPs 比、先前定义的磁共振帕金森病指数（MRPI）：（P/M）·（MCP/SCP），以及我们命名的 Akdeniz 指数（AKI）：（P/M）·（PA/180）。两名盲法放射科医生评估了所有 MRI 图像，并测量了观察者内/间变异。
与其他组相比，PSP 患者的 M 和 SCPs 明显更低，而 P/M、MCPs/SCPs 和 PA 明显更高（<.001）。这种显著性与 PSP 和 PD 患者有关。但是，所有的单项测量都显示出一些重叠的值。因此，计算了先前定义的 MRPI，并显示其可以区分患者（阴性预测值：92%，灵敏度：78%，特异性：82%）。在本研究中，MRPI 的观察者间相关性（0.68）较低。因此，我们确定了一个更实用的指数：Akdeniz 指数，其具有与 MRPI 相同的诊断能力，且观察者间相关性更高（0.91）。
我们研究中确定的 Akdeniz 指数是一种具有高诊断能力的实用指数，可以增强对 PSP 和 PD 的影像学鉴别，这两种疾病在临床上难以区分。
