Cooperrider Jessica, Bluett Brent, Jones Stephen E
Cleveland Clinic Lerner College of Medicine, 9980 Carnegie Ave, Cleveland, OH 44195, United States of America.
Cleveland Clinic Imaging Institute, 9500 Euclid Ave, Cleveland, OH 44195, United States of America.
Clin Park Relat Disord. 2020 Jan 14;3:100033. doi: 10.1016/j.prdoa.2020.100033. eCollection 2020.
The clinical diagnosis of progressive supranuclear palsy can be challenging, as the clinical presentation overlaps with that of Parkinson's disease and multiple system atrophy. We sought to examine the practical utility of radiologic markers of progressive supranuclear palsy by investigating whether these markers could distinguish between patients with progressive supranuclear palsy-Richardson syndrome (PSP-RS) and those with Parkinson's disease based on imaging obtained in a typical clinical setting, not in a prospective research environment.
This retrospective study included 13 patients with PSP-RS and 13 patients with Parkinson's disease who were followed for either condition at our institution at the time of the study and who had MRI records available. Patients were selected without regard to type of imaging obtained. All diagnoses were confirmed by a trained movement disorders specialist using validated diagnostic criteria. Groups were matched for age and disease duration at the time of scanning. MRI records were retrospectively obtained, and image analysis was performed by investigators blinded to disease classification. Midbrain area, midbrain to pons area ratio, midbrain anterior-posterior diameter, and MR parkinsonism index were calculated for each patient.
All established measures of identifying progressive supranuclear palsy (midbrain area, midbrain to pons area ratio, midbrain anterior-posterior diameter, and MR parkinsonism index) were significantly different between patients with PSP-RS and those with Parkinson's disease.
Previously established radiographic markers distinguishing between PSP-RS and Parkinson's disease have practical utility in the clinical setting and not just in well-designed prospective analyses.
进行性核上性麻痹的临床诊断可能具有挑战性，因为其临床表现与帕金森病和多系统萎缩的临床表现存在重叠。我们试图通过研究这些标志物能否在典型临床环境而非前瞻性研究环境中获取的影像基础上，区分进行性核上性麻痹-理查森综合征（PSP-RS）患者和帕金森病患者，来检验进行性核上性麻痹影像学标志物的实际效用。
这项回顾性研究纳入了13例PSP-RS患者和13例帕金森病患者，这些患者在研究时在我们机构因上述任何一种疾病接受随访且有MRI记录。患者的选择不考虑所获取的影像类型。所有诊断均由一名经过培训的运动障碍专家使用经过验证的诊断标准进行确认。两组在扫描时的年龄和病程相匹配。回顾性获取MRI记录，由对疾病分类不知情的研究人员进行图像分析。计算每位患者的中脑面积、中脑与脑桥面积比、中脑前后径以及MR帕金森指数。
所有已确立的用于识别进行性核上性麻痹的指标（中脑面积、中脑与脑桥面积比、中脑前后径以及MR帕金森指数）在PSP-RS患者和帕金森病患者之间均存在显著差异。
先前确立的区分PSP-RS和帕金森病的影像学标志物在临床环境中具有实际效用，而不仅仅在精心设计的前瞻性分析中有用。
