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Research ArticleBRAIN

MR Imaging of the Superior Profile of the Midbrain: Differential Diagnosis between Progressive Supranuclear Palsy and Parkinson Disease

Andrea Righini, Angelo Antonini, Roberta De Notaris, Elena Bianchini, Nicoletta Meucci, Giorgio Sacilotto, Margherita Canesi, Danilo De Gaspari, Fabio Triulzi and Gianni Pezzoli
American Journal of Neuroradiology June 2004, 25 (6) 927-932;
Andrea Righini
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Angelo Antonini
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Roberta De Notaris
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Elena Bianchini
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Nicoletta Meucci
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Giorgio Sacilotto
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Margherita Canesi
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Danilo De Gaspari
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Fabio Triulzi
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Gianni Pezzoli
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    Fig 1.

    Top row, Midsagittal T1-weighted spin-echo sections in PD (A) and PSP (B and C) show the midbrain region. Bottom row, Same images with outlined profiles of the upper midbrain, which appears convex in A, linear (flat) in B, and concave in C.

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    Fig 2.

    Axial, 3-mm-thick, T2-weighted spin-echo sections show different degrees of midbrain atrophy.

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    Fig 3.

    Axial, 3-mm-thick, T2-weighted spin-echo sections show no abnormal tegmental hyperintensity (A) and abnormal tegmental hyperintensity (B, arrow).

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    Fig 4.

    Axial, 3-mm-thick, T2-weighted spin-echo section depicts the method used to measure the AP diameter of the midbrain at the level of the superior colliculus.

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    Fig 5.

    Graph illustrates the distribution of midbrain transverse AP diameters for the PSP and PD populations. A threshold value of 12 mm included only seven of 25 patients with PSP.

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    Fig 6.

    Diagrammatic representation of an axial section of the midbrain at the level of superior colliculus (modified from figure 54 of Duvernoy HM, The Human Brain Stem and Cerebellum, 1995, with permission of Springer-Verlag, Wien). Some of the structures affected in PSP have been reported. Other structures of the dorsal and cranial part of the midbrain affected in PSP (ie, nucleus interstitialis of Cajal and pretectal area) are located on the contiguous cranial section.

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    TABLE 1:

    Demographic and clinical data

    GroupMean Age, ySymptom Duration, yHoehn-Yahr Stage
    PD (n = 27)67.63 ± 3.665.25 ± 3.482.30 ± 0.72*
    PSP (n = 25)68.88 ± 6.485.30 ± 3.282.78 ± 0.64*
    • * P < .001, unpaired t test.

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    TABLE 2:

    Results of the assessment of parameters 1–5

    ParameterPD (n = 27)PSP (n = 25)
    1) Upper midbrain profile sign
     Convex248
     Linear311
     Concave06
    2) Global midbrain atrophy
     Normal218
     Mild68
     Moderate06
     Severe03
    3) Tegmental T2 hyperintensity
     Yes07
     No2718
    4) Putaminal T2 hypointensity
     Yes46
     No2319
    5) Putaminal proton-density hyperintensity
     Yes00
     No2725
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American Journal of Neuroradiology: 25 (6)
American Journal of Neuroradiology
Vol. 25, Issue 6
1 Jun 2004
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Cite this article
Andrea Righini, Angelo Antonini, Roberta De Notaris, Elena Bianchini, Nicoletta Meucci, Giorgio Sacilotto, Margherita Canesi, Danilo De Gaspari, Fabio Triulzi, Gianni Pezzoli
MR Imaging of the Superior Profile of the Midbrain: Differential Diagnosis between Progressive Supranuclear Palsy and Parkinson Disease
American Journal of Neuroradiology Jun 2004, 25 (6) 927-932;

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MR Imaging of the Superior Profile of the Midbrain: Differential Diagnosis between Progressive Supranuclear Palsy and Parkinson Disease
Andrea Righini, Angelo Antonini, Roberta De Notaris, Elena Bianchini, Nicoletta Meucci, Giorgio Sacilotto, Margherita Canesi, Danilo De Gaspari, Fabio Triulzi, Gianni Pezzoli
American Journal of Neuroradiology Jun 2004, 25 (6) 927-932;
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