Diagnostics (Feb 2022)

The Strengths and Obstacles in the Differential Diagnosis of Progressive Supranuclear Palsy—Parkinsonism Predominant (PSP-P) and Multiple System Atrophy (MSA) Using Magnetic Resonance Imaging (MRI) and Perfusion Single Photon Emission Computed Tomography (SPECT)

  • Piotr Alster,
  • Michał Nieciecki,
  • Bartosz Migda,
  • Michał Kutyłowski,
  • Natalia Madetko,
  • Karolina Duszyńska-Wąs,
  • Ingeborga Charzyńska,
  • Dariusz Koziorowski,
  • Leszek Królicki,
  • Andrzej Friedman

DOI
https://doi.org/10.3390/diagnostics12020385
Journal volume & issue
Vol. 12, no. 2
p. 385

Abstract

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Multiple System Atrophy—Parkinsonism Predominant (MSA-P) and Progressive Supranuclear Palsy—Parkinsonism Predominant (PSP-P) are the clinical manifestations of atypical parkinsonism. Currently, there are no efficient in vivo methods available relating to neuroimaging or biochemical analysis in the examination of these entities. Among the advanced methods available, using positron emission tomography is constrained by high cost and low accessibility. In this study the authors examined patients with two types of atypical parkinsonism—MSA-P and PSP-P, which are difficult to differentiate, especially in the early years of their development. The aim of this study was to assess whether the examination of patients in the period following the early years (3–6-year duration of symptoms) could be enhanced by perfusion single photon emission computed tomography (SPECT), magnetic resonance imaging (MRI) or evaluation of cognitive abilities. Extended examination using MRI and perfusion SPECT showed that the evaluation of the mesencephalon/pons ratio, mesencephalic volume decrease, the Magnetic Resonance Parkinsonism Index (MRPI) and frontal perfusion should be considered more feasible than screening cognitive evaluation in MSA-P and PSP-P with a 3–6-year duration of symptoms.

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