| Objective:Progressive supranuclear palsy(progressive supranuclear,palsy,PSP)is an atypical Parkinson syndrome,which is a neurodegenerative disease caused by the abnormal accumulation of tau protein.Recent studies show that PSP has obvious clinical heterogeneity.The "gold standard" diagnosticis is the pathological examination,the diagnosis is still lack of objective biological markers,it is easy to be misdiagnosed as Parkinson's disease(PD)and other neurodegenerative diseases,such as multiple system atrophy(MSA),corticobasal degeneration(CBD),dementia with Lewy's bodies(DLB).Based on the development of neuroimaging,the role of head MRI morphometry in the early diagnosis and differential diagnosis of PSP has been paid more and more attention.However,the value of different measurement methods in the differential diagnosis of PSP and its associated diseases remains controversial.The aim our present study is to compare the diagnostic validity of the midbrain-to-pontine area ratio(m/p)and the midbrain to pons ratio(midbrain to pons ratio,MTPR)to differentiate progressive supranuclear palsy from Parkinson's disease(PD),cerebellar variant of MSA(MSA-C)and the Parkinson variant of MSA(MSA-P).Methods: The clinical and radiological data of four groups of patients with PSP,PD,MSA-C and MSA-P in the Department of Neurology,the First Affiliated Hospital of Dalian Medical University from March 2007 to October 2016 were retrospectively analyzed..A total of 114 cases were included,including 23 cases of PSP,24 cases of PD,20 cases of MSA-C,22 cases of MSA-P and 25 cases of normal control group.All subjects were examined by head MRI,and the visual acuity was first compared with the midbrain and pons.Then,the length and ratio of m / p,midbrain and pontine long axis and the ratio of MTPR were calculated and calculated.Each data was measured three times after taking the average as the final value,using SPSS software for statistical analysis of data,measurement data to mean ± standard deviation,the test data in line with the normal distribution.After the variance homogeneity test,the variance of the same LSD test,variance of the Dunnett's T3 test.P <0.05 for the difference was statistically significant.Results: In 23 PSP patients,there were 18 patients whose head magnetic showed mesencephalon,superior cerebellar peduncle atrophy and third ventricle dilation;in axial MRI,midbrain anteroposterior diameter was significantly shorter shape like "Mickey Mouse" sign;the midbrain tegmentum lateral margin of sag shape like "morning glory syndrome".The median sagittal planes,on the tectal plate flat or concave,rostral midbrain becomes sharp,called the "hummingbird" or "Penguin silhouette" sign.MSA-P showed mild atrophy of the pons,but the atyophy of cerebellar peduncle is obvious,some patients bilateral putamen atrophy is visible in T1W1,in T2W2 has high signal as "clefts".MSA-C patients have cerebellar atrophy of the four ventricle enlargement in pons,but midbrain atrophy is not obvious,some patients T2 WI pontine cross section visible "cross sign".There was significant difference between any group(P < 0.05),and the differences between the two groups in any other four groups had no statistical significance(P > 0.05),midbrain overlap group PSP line perpendicular to the long axis diameter and the other four groups have different levels.9.35 mm as the long axis vertical line diameter of midbrain pons boundaries the differential diagnosis value of PSP,calculates that five groups of patients with our sensitivity,specificity,positive predictive value,negative predictive rate was 60.87%,93.41%,70%,and MSA-P overlap ratio is very small part of the 90.43%.The midbrain pons area among PSP with the other three groups(MSA-C group,PD group,health the control group)did not have overlap(P < 0.05).PD and MSA-C,PD and health control group,there were significant differences between MSA-C and MSA-P(P < 0.05),while PD and MSA-P control group,MSA-P and MSA-C in health and health.The difference between the control group had no statistical significance(P > 0.05).The area ratio of 0.19 for the midbrain pontine boundary value,obtained the value of differential diagnosis of the other four groups of sensitivity,specificity,positive predictive value,negative predictive rate was 100%,84.62%,62.16%,with statistical significance in 100%.Axis vertical line diameter PSP and the other four groups of any group differences(P < 0.05),and the differences between the two groups in any other four groups had no statistical significance(P > 0.05),midbrain overlap group PSP line perpendicular to the long axis diameter and the other four groups have different levels.The long axis vertical line diameter of midbrain pons 9.35 mm as the threshold value,the calculation,the five groups of patients the sensitivity,specificity,positive predictive value,negative predictive rate was 60.87%,93.41%,70%,90.43%.in the pons line perpendicular to the long axis diameter ratio of PSP and the other four groups almost no overlap Divided,there was statistical significance in PSP and the other four groups in the midbrain pons line perpendicular to the long axis diameter ratio difference(P < 0.05).In addition,MSA-C and the other three groups except PSP the difference was statistically significant(P < 0.05).The ratio of the midbrain pons line perpendicular to the long axis diameter of 0.52 to define the value calculated in the PSP in the differential diagnosis of sensitivity,specificity,positive predictive rate and negative predictive rate were 39.13%,97.80%,81.82%,86.41%.Conclusion: Both M/p and MTPR have good application value in the differential diagnosis of PSP and its related diseases,but the sensitivity of m/p is better than that of MTPR,and the specificity of MTPR is better than m/ p. |
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