Constantinides Vasilios C, Giagkou Nikolaos, Brinia Maria-Evgenia, Kapsali Ioanna, Velonakis Georgios, Papageorgiou Sokratis G, Paraskevas George P, Kapaki Elisabeth, Stefanis Leonidas
First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, 72-74 Vas. Sofias Ave., 11528, Athens, Greece.
Research Unit of Radiology, Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon Hospital, Athens, Greece.
J Neurol. 2025 Jul 21;272(8):523. doi: 10.1007/s00415-025-13262-2.
Multiple MRI markers have been introduced as surrogate markers of progressive supranuclear palsy (PSP). Midbrain surface, midbrain/pons surface ratio (M/P) and the Magnetic Resonance Parkinsonism Index (MRPI) have produced high diagnostic accuracy in differentiating PSP from other parkinsonian disorders. A systematic comparison of the diagnostic accuracy of available MRI markers, and the effect of disease duration, clinical presentation, level of clinical certainty on the performance of these markers is lacking.
In this single-center, retrospective study, 244 subjects were included (80 PSP, 38 corticobasal degeneration, 45 multiple system atrophy, 36 Parkinson's disease patients, 45 control subjects). All patients underwent a standardized MRI acquisition protocol and automated MRI data preprocessing through Freesurfer for volumetric data. Midbrain distance, surface and volume, superior cerebellar peduncle (SCP) width and volume, and composite markers including the M/P and M/P 2.0 ratios and the MRPI and MRPI 2.0 were measured. The diagnostic accuracy of these markers was calculated, and the effect of clinical phenotype, level of disease certainty and disease duration were investigated.
Surface-based MRI markers were superior to distance- and volume-based markers. Midbrain surface was the optimal MRI marker for PSP (AUC = 0.937; sensitivity 88.8%; specificity 84.2%). MRI markers were more accurate in diagnosing probable PSP vs. possible/suggestive PSP and PSP-Richardson syndrome vs. PSP variants. MRI markers exhibited comparable diagnostic accuracy in early (≤ 24 months) vs. late (≤ 48 months) disease stages. Midbrain atrophy correlated with PSP disease severity as well as ocular motor, gait and bulbar deficit severity.
Planimetric MRI markers are optimal for PSP diagnosis. Level of disease certainty (i.e. probable vs. possible/suggestive) and clinical presentation (PSP-RS vs. PSP variants) affect the diagnostic accuracy of MRI markers. MRI markers are useful even in early (≤ 24 months) stages of PSP.
多种MRI标记物已被引入作为进行性核上性麻痹（PSP）的替代标记物。中脑表面、中脑/脑桥表面比率（M/P）和磁共振帕金森病指数（MRPI）在区分PSP与其他帕金森病性疾病方面具有较高的诊断准确性。目前尚缺乏对现有MRI标记物诊断准确性以及疾病持续时间、临床表现、临床确定性水平对这些标记物性能影响的系统比较。
在这项单中心回顾性研究中，纳入了244名受试者（80例PSP、38例皮质基底节变性、45例多系统萎缩、36例帕金森病患者、45例对照受试者）。所有患者均接受标准化MRI采集方案，并通过Freesurfer对容积数据进行自动MRI数据预处理。测量中脑距离、表面和体积、上小脑脚（SCP）宽度和体积，以及包括M/P和M/P 2.0比率、MRPI和MRPI 2.0在内的复合标记物。计算这些标记物的诊断准确性，并研究临床表型、疾病确定性水平和疾病持续时间的影响。
基于表面的MRI标记物优于基于距离和体积的标记物。中脑表面是PSP的最佳MRI标记物（AUC = 0.937；敏感性88.8%；特异性84.2%）。MRI标记物在诊断可能的PSP与可能/疑似PSP以及PSP-理查森综合征与PSP变异型方面更准确。MRI标记物在疾病早期（≤24个月）与晚期（≤48个月）阶段表现出相当的诊断准确性。中脑萎缩与PSP疾病严重程度以及眼球运动、步态和延髓功能缺损严重程度相关。
平面MRI标记物对PSP诊断最为理想。疾病确定性水平（即可能与可能/疑似）和临床表现（PSP-RS与PSP变异型）会影响MRI标记物的诊断准确性。MRI标记物即使在PSP的早期（≤24个月）阶段也很有用。
