This is a well-done study out of Queen Square Brain Bank in London. Many progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) families have donated loved one’s brains to this brain bank, and a great team has been doing research there for a decade or more.
This latest research takes the MRIs from 22 people with autopsy-confirmed PSP, 13 with autopsy-confirmed MSA, 7 with autopsy-confirmed Parkinson’s Disease (PD), 6 with autopsy-confirmed corticobasal degeneration (CBD), and 9 controls. People, without knowledge of the clinical diagnoses or post-mortem diagnoses, were shown MRIs. Seventy-two percent of the PSP cases were correctly assessed. Seventy-six percent of the MSA cases were correctly assessed. “No PSP case was misclassified as MSA or vice versa.” The authors note this is about as good as clinical diagnosis.
The authors “suggest a need for imaging techniques sensitive to microstructural abnormalities without regional atrophy.”
When I get a chance, I’ll read the full study…. Or one of you can! The abstract is copied below.
Robin
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Movement Disorders. 2012 Apr 4. [Epub ahead of print]
Conventional magnetic resonance imaging in confirmed progressive supranuclear palsy and multiple system atrophy.
Massey LA, Micallef C, Paviour DC, O’Sullivan SS, Ling H, Williams DR, Kallis C, Holton JL, Revesz T, Burn DJ, Yousry T, Lees AJ, Fox NC, Jäger HR.
Sara Koe PSP Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom; Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, University College London, London, United Kingdom; Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, University College London, London, United Kingdom. [email protected].
Abstract
Conventional magnetic resonance imaging (cMRI) is often used to aid the diagnosis of progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), but its ability to predict the histopathological diagnosis has not been systematically studied.
cMRI from 48 neuropathologically confirmed cases, including PSP (n = 22), MSA (n = 13), Parkinson’s disease (PD) (n = 7), and corticobasal degeneration (n = 6), and controls (n = 9) were assessed blinded to clinical details and systematically rated for reported abnormalities. Clinical diagnosis and macroscopic postmortem findings were retrospectively assessed.
Radiological assessment of MRI was correct in 16 of 22 (72.7%) PSP cases and 10 of 13 (76.9%) MSA cases with substantial interrater agreement (Cohen’s kappa 0.708; P < .001); no PSP case was misclassified as MSA or vice versa.
MRI was less sensitive but more specific than clinical diagnosis in PSP and both more sensitive and specific than clinical diagnosis in MSA.
The “hummingbird” and “morning glory” signs were highly specific for PSP, and “the middle cerebellar peduncle sign” and “hot cross bun” for MSA, but sensitivity was lower (up to 68.4%) and characteristic findings may not be present even at autopsy.
cMRI, clinical diagnosis, and macroscopic examination at postmortem have similar sensitivity and specificity in predicting a neuropathological diagnosis. We have validated specific radiological signs in pathologically confirmed PSP and MSA. However, the low sensitivity of these and macroscopic findings at autopsy suggest a need for imaging techniques sensitive to microstructural abnormalities without regional atrophy.
Copyright © 2012 Movement Disorder Society.
PubMed ID#: 22488922 (see pubmed.gov for this abstract only)