Kawabata Kazuya, Banno Fumihiko, Mizutani Yasuaki, Maeda Toshiki, Nagao Ryunosuke, Shima Sayuri, Murayama Kazuhiro, Ohno Yoshiharu, Maeda Tetsuya, Sasaki Makoto, Ueda Akihiro, Ito Mizuki, Watanabe Hirohisa
Department of Neurology, Fujita Health University School of Medicine, Toyoake, Japan; Division of BrainTheraInformatics, International Center for Brain Science, Fujita Health University, Toyoake, Japan.
Department of Neurology, Fujita Health University School of Medicine, Toyoake, Japan.
Parkinsonism Relat Disord. 2025 Feb;131:107251. doi: 10.1016/j.parkreldis.2024.107251. Epub 2024 Dec 20.
Progressive supranuclear palsy (PSP) involves midbrain structures, including the red nucleus (RN), an iron-rich region that appears as a high-contrast area on quantitative susceptibility mapping (QSM). RN may serve as a promising biomarker for differentiating parkinsonism. However, RN deformation in PSP remains elusive. This study aimed to evaluate RN deformation in PSP using coronal QSM images and compare them with those of Parkinson's disease (PD) and healthy controls (HC).
We evaluated the QSM images of 22 patients with PSP, 37 patients with PD, and 43 HC. We developed a grading system to assess RN deformation on coronal QSM images and classified them into three grades. The midbrain and RN volumes were extracted using distinct approaches, and their relationship with grading was investigated. For validation, coronal QSM images of 16 PSP patients from a different institution were assessed.
In PSP, 59 % of the patients displayed a flattened RN of grade 3, which we termed a Rice-Grain Appearance. The volume reductions in midbrain and RN were associated with deformation. Differentiation based on the presence of this appearance yielded a specificity of 1.000 (CI: 1.000-1.000) and sensitivity of 0.591 (0.385-0.796) for distinguishing PSP from others. Secondary dataset also showed that 56 % of patients with PSP were classified as grade 3.
In coronal QSM images, the flattened RN shape appears to be specific to PSP compared to PD and HC and may serve as a marker to help differentiate PSP in future clinical settings.
进行性核上性麻痹（PSP）累及中脑结构，包括红核（RN），这是一个富含铁的区域，在定量磁化率成像（QSM）上表现为高对比度区域。红核可能是区分帕金森综合征的一个有前景的生物标志物。然而，PSP中红核的变形情况仍不清楚。本研究旨在使用冠状位QSM图像评估PSP中的红核变形，并将其与帕金森病（PD）和健康对照（HC）的情况进行比较。
我们评估了22例PSP患者、37例PD患者和43名健康对照的QSM图像。我们开发了一种分级系统来评估冠状位QSM图像上的红核变形，并将其分为三个等级。使用不同方法提取中脑和红核体积，并研究它们与分级的关系。为进行验证，评估了来自不同机构的16例PSP患者的冠状位QSM图像。
在PSP患者中，59%表现为3级红核扁平，我们称之为米粒样外观。中脑和红核体积的减小与变形有关。基于这种外观的存在进行区分，在区分PSP与其他疾病时，特异性为1.000（CI：1.000 - 1.000），敏感性为0.591（0.385 - 0.796）。二次数据集也显示，56%的PSP患者被归类为3级。
在冠状位QSM图像中，与PD和HC相比，扁平的红核形状似乎是PSP所特有的，可能作为一种标志物，有助于在未来临床环境中区分PSP。
