The Research Of Magnetic Resonance Imaging Characteristics Of Parkinsonism-plus Syndromes

Background:Parkinsonism-plussyndromesisagroupofclinical manifestations,which is similar to Parkinson's disease,and it also is the neurodegenerative disease which have other characteristics of the neuropathology,including progressive supranuclear palsy(PSP),multiple system atrophy(MSA),basal ganglia cortical degeneration,Alzheimer's disease and others.PSP and MSA are the most common diseases in clinic.PSP clinical characteristic manifests mainly for fall repeatedly,axial rigidity,vertical supranuclear gaze palsy and Parkinson's syndrome.MSA clinical manifestation includes that significance of autonomic nerve dysfunction and cerebellar ataxia or Parkinson's syndrome.but sometimes it is difficult to identify PD,PSP and MSA from the clinical manifestations,especially when patients who response to dopamine are more difficult to be diagnosed exactly,even by autopsy pathological diagnosis can be confirmed.In neurology,magnetic resonance imaging(MRI)is the common examination method.The magnetic resonance images of PSP and MSA have their own characteristics,being of great significance for disease diagnosis.Objective:This research explores the value of differential diagnosis for Parkinsonism-plus syndromes through the conventional magnetic resonance imaging studies.Methods:Collecting the patients from January 2016 to November 2017 in the first affiliated hospital of Zhengzhou University neurology,we analyze the 22 patients with Progressive supranuclear paralysis(PSP),28 patients with multiple system atrophy(MSA),32 patients with Parkinson's disease(PD)and 21 patients as normal control group.We compare the cranial MRI characteristics of all the subjects by quantitative measurement.These MRI characteristics were measured on T1-weighted or T2-weighted images,including that the midbrain area(M),pons area(P),length of vertical line on long axis of midbrain(Lm),length of vertical line on long axis of pons(Lp),superior cerebellar peduncle(SCP),middle cerebellar peduncle(MCP),cerebral peduncle angle,the ratio of Lm/Lp,and magnetic resonance parkinsonism index(MRPI).We statistically analyze the differences of all parameters between the four groups,and analyze various parameters on the sensitivity and specificity of the differential diagnosis of Parkinsonism-plus syndromes,and the optimal cut-off points for diagnosis.Results:1.In the midline sagittal T1WI imaging of PSP patients,the midbrain tegmentum atrophies and flattens obviously.The image made by the midbrain tegmentum,pons and cerebellum is as hummingbirds,called hummingbird sign.In the axial T2WI imaging of patients with MSA,the pons,cerebellum,and middle cerebellar peduncle atrophy obviously,being visible similar as"cruciform".The part of them are with slit sign and putaminal hypointensity.2.The statistical analysis show that the midbrain area of PSP group is much smaller than PD,MSA and,normal control group(P<0.01).The pons area of MSA group is much smaller than PSP,PD and normal control group(P<0.01).The Lm of PSP group is less than PD,MSA and normal control group(P<0.01).The Lp of MSA group is much less than PSP,PD and normal control group(P<0.01).The ratio of Lm/Lp of PSP group is less than PD,MSA and normal control group(P<0.01).The ratio of Lm/Lp of MSA group is larger than PSP,PD and the control group(P<0.01).The SCP of PSP group is less than PD,MSA and normal control group(P<0.01).The MCP of MSA group is less than PSP,PD and normal control group(P<0.01).The MRPI of PSP group is larger than PD,MSA and normal control group(P<0.01).The MRPI of MSA group is less than PSP,PD and normal control group(P<0.01).The difference of cerebral peduncle angle between PSP,PD and MSA group have no statistical significance(P>0.01),while the difference between PSP,MSA and normal control group have statistically significant(P<0.01).3.The results of ROC curve analysis show that the cut-off point of the midbrain area is no more than 104.54mm~2,and the sensitivity of PSP is 100%,the specificity96.83%,and the accuracy 100%.The cut-off point of Lm is no more than 8.43mm,and the sensitivity of PSP is 95.45%,specificity 98.41%and accuracy 97.65%.The cut-off point of Lm/Lp is no more than 0.5,and the sensitivity,specificity and accuracy of the diagnostic PSP are 100%;The cut-off point of SCP is no more than3.85mm,and the sensitivity of PSP is 100%,the specificity 96.83%,and the accuracy97.65%.MRPI's cut-off point is more than 17.55.For PSP,the MRPI's diagnostic sensitivity,specificity and accuracy are 100%.The cut-off point of the pons area is no more than 464.07mm~2,the sensitivity of MSA is 95.24%,the specificity 90.62%,and the accuracy 91.76%.The cut-off point of Lp is less than 14.09mm,and the sensitivity of MSA 85.71%,the specificity 98.44%and the accuracy 95.29%.The cut-off point of Lm/Lp is more than 0.64,and the sensitivity of MSA is 95.24%,the specificity 85.94%and the accuracy 84.71%.The cut-off point of MCP is no more than 14.61mm,the sensitivity of MSA is 95.24%,the specificity 75.00%and the accuracy 80%.The cut-off point of MRPI is no more than 10.31,and the sensitivity of MSA is 95.24%,the specificity 92.19%and the accuracy 92.94%.Conclusion:1.The midbrain area,the length of the vertical line on long axis of midbrain,superior cerebellar peduncle,the ratio of Lm/Lp,and MRPI have important auxiliary value for the diagnosis of PSP,among which the sensitivity and specificity of Lm/Lp and MRPI are the highest.2.The pons area,the length of the vertical line on the long axis of pons,middle cerebellar peduncle,Lm/Lp,and MRPI have important auxiliary value for the diagnosis of MSA.Among them,the highest sensitivity and specificity are the pons area and MRPI.