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The Value of GRE, ADC and Routine MRI in Distinguishing Parkinsonian Disorders

  • Pettarusp M. Wadia (a1) (a2), Peter Howard (a3), Manuel Q. Ribeirro (a3), Jennifer Robblee (a1), Abena Asante (a1), David J. Mikulis (a3) and Anthony E. Lang (a1)...
Abstract
Objectives:

To study different radiological signs and sequences including apparent diffusion coefficient (ADC) and gradient echo (GRE) to differentiate degenerative parkinsonian syndromes.

Background:

Multiple system atrophy (MSA), Parkinson's disease (PD), progressive supranuclear palsy (PSP) and corticobasal degeneration (CbD) differ in the pattern of neurodegeneration and cellular damage. Measuring the ADC, GRE sequences for paramagnetic substances and simple anatomical assessments have been reported individually to assist in separating some of these disorders, but have not been compared.

Methods:

brain MRIs from May 2002 to February 2008 were retrospectively evaluated by raters blinded to the clinical diagnosis for predefined MRI signs on T1, T2 and GRE sequences. ADC values were quantitatively measured. Medical records were objectively analyzed using standard clinical criteria for different parkinsonian syndromes.

Results:

195 cases comprising of 61 PD, 15 MSA-P, 7 MSA-C, 21 PSP, 6 Corticobasal syndrome, 21 not fitting criteria and 64 controls were evaluated. 73% of patients with MSA-P had hypointensity of the putamen (compared to the pallidum) on GRE. The specificity of this sign to diagnose MSA-P was 90% versus PD and 76% versus PSP. When GRE hypointensity was combined with atrophy of the putamen the specificity improved to 98% (versus PD) and 95% (versus PSP) without altering the sensitivity. The ADC values were significantly higher in the middle cerebellar peduncle in cases with MSA-C versus controls, PD and PSP (p<0.001).

Conclusions:

The combination of hypointensity and atrophy of the putamen on GRE is useful in differentiating MSA-P from other parkinsonian syndromes.

Résumé: Objectif:

Le but de l'étude était d'examiner les différents signes et les différentes séquences radiologiques, dont le coefficient de diffusion apparent (CDA) et échos de gradient (ÉG) pour différencier les syndromes parkinsoniens dégénératifs.

Contexte:

Les caractéristiques de neurodégénérescence et de dommage cellulaire sont différentes dans l'atrophie multisystémique (AMS), la maladie de Parkinson (MP), la paralysie supranucléaire progressive (PSP) et la dégénérescence cortico-basale (DCb). Des mesures du CDA, des séquences ÉG des substances paramagnétiques ainsi que des évaluations anatomiques simples ont été rapportées séparément pour aider à distinguer certaines de ces maladies, mais elles n'ont jamais été comparées entre elles.

Méthode:

Des évaluateurs ont revu rétrospectivement les IRM du cerveau effectuées entre mai 2002 et février 2008, sans connaître le diagnostic clinique posé chez les patients, afin d'identifier des signes prédéfinis à l'IRM en T1, en T2 et dans les séquences ÉG. Les valeurs du CDA ont été mesurées quantitativement. Les dossiers médicaux ont été analysés objectivement au moyen des critères cliniques standards des différents syndromes parkinsoniens.

Résultats:

Cent quatre-vingt-quinze cas dont 61 cas de MP, 15 cas d'AMS-P, 7 cas d'AMS-C, 21 cas de PSP, 6 cas de syndrome cortico-basal, 21 cas qui ne rencontraient pas les critères standards et 64 témoins ont été évalués. Soixante-treize pour cent des patients atteints d'AMS-P avaient de l'hypointensité au niveau du putamen par rapport au pallidum à l'ÉG. La spécificité de ce signe pour le diagnostic de l'AMS-P était de 90% par rapport à la MP et de 76% par rapport à la PSP. Quand l'hypointensité à l'ÉG était combinée à l'atrophie du putamen, la spécificité s'élevait à 98% par rapport à la MP et à 95% par rapport à la PSP, sans en modifier la sensibilité. Les valeurs du CDA étaient significativement plus élevées dans le pédoncule cérébelleux chez les cas d'AMS-C par rapport aux témoins et par rapport aux patients atteints de MP et de PSP (p < 0,001).

Conclusion:

La combinaison d'hypointensité et d’atrophie du putamen à l'ÉG est utile pour différencier l'AMS-P des autres syndromes parkinsoniens.

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399 bathurst Street, MC-7-402, Toronto Western Hospital, Toronto, ontario, M5T 2S8, Canada
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