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1.
J Neuroimaging ; 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38676300

RESUMO

BACKGROUND AND PURPOSE: Differentiating idiopathic normal pressure hydrocephalus (iNPH) from neurodegenerative disorders such as progressive supranuclear palsy (PSP), Multiple System Atrophy-parkinsonian type (MSA-P), and vascular dementia (VaD) is challenging due to overlapping clinical and neuroimaging findings. This study assesses if quantitative brain stem and cerebellum metrics can aid in this differentiation. METHODS: We retrospectively compared the sagittal midbrain area, midbrain to pons ratio, MR parkinsonism index (MRPI), and cerebellar atrophy in 30 PSP patients, 31 iNPH patients, 27 MSA-P patients, 32 VaD patients, and 25 healthy controls. Statistical analyses determined group differences, sensitivity, specificity, and the area under the receiver operating characteristic curves. RESULTS: There was an overlap in midbrain morphology between PSP and iNPH, as assessed with MRPI, midbrain to pons ratio, and midbrain area. A cutoff value of MRPI > 13 exhibited 84% specificity in distinguishing PSP from iNPH and 100% in discriminating PSP from all other conditions. A cutoff value of midbrain to pons ratio at <0.15 yielded 95% specificity for differentiating PSP from iNPH and 100% from all other conditions. A cutoff value of midbrain area at <87 mm2 exhibited 97% specificity for differentiating PSP from iNPH and 100% from all other conditions. All measures showed low sensitivity. Cerebellar atrophy did not differ significantly among groups. CONCLUSION: Our study questions MRPI's diagnostic performance in distinguishing PSP from iNPH. Simpler indices such as midbrain to pons ratio and midbrain area showed similar or better accuracy. However, all these indices displayed low sensitivity despite significant differences among PSP, MSA-P, and VaD.

2.
Turk J Pediatr ; 65(3): 445-455, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37395964

RESUMO

BACKGROUND: Rapid changes in the size of the pituitary gland occur during the pubertal period. Therefore, measuring and reporting magnetic resonance imaging (MRI) in adolescents with pituitary disorders can cause unease among radiologists. Our aim was to compare the size of the pituitary gland, stalk and other previously described imaging tools in patients with isolated hypogonadotropic hypogonadism (HH) versus adolescents with a normal pituitary gland. METHODS: Forty-one patients (22 female, 19 male, mean age 16.3 ±2.0 years) with HH who underwent MRI prior to starting hormone treatment were enrolled. Age, sex, and genetic mutations were noted. Pituitary height, width on the coronal plane, anteroposterior (AP) diameter on the sagittal plane, stalk thickness, pons ratio (PR), clivus canal angle (CCA) and Klaus index (KI) were measured by two radiologists twice with a one-month interval blinded to each other and patient information. Measurements were compared with the control group, including 83 subjects with normal hypothalamic-pituitary-gonadal axis and normal pituitary gland on MRI. Inter-rater and intra-rater agreements were also evaluated. RESULTS: No significant differences were found between the two groups regarding height, width or AP diameter (p = 0.437, 0.836, 0.681 respectively). No significant differences were found between the two groups regarding CCA and PR (p = 0.890, 0.412 respectively). The KI of the male patients was significantly higher than that of the female patients and the control group (p < 0.001). The interrater agreement was moderate for pituitary height and width, poor for pituitary AP diameter and stalk thickness, good for PR and KI, and excellent for CCA. CONCLUSIONS: The measurements of the pituitary gland, stalk and posterior fossa structures were similar in adolescents with or without isolated HH. Consequently, pituitary gland, stalk or other posterior fossa measurements are unnecessary when evaluating a normal appearing pituitary gland on MRI.


Assuntos
Hipogonadismo , Doenças da Hipófise , Humanos , Adolescente , Masculino , Feminino , Estudos Retrospectivos , Hipófise/diagnóstico por imagem , Hipófise/patologia , Doenças da Hipófise/patologia , Imageamento por Ressonância Magnética/métodos , Hipogonadismo/diagnóstico por imagem , Hipogonadismo/patologia
3.
Indian J Radiol Imaging ; 31(3): 596-600, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34790303

RESUMO

Context Progressive supranuclear palsy (PSP) is a neurodegenerative disorder which comes under Parkinsonism plus syndrome. As this spectrum of disease has many overlapping clinical as well as imaging findings, some quantitative parameters like magnetic resonance Parkinsonism index and midbrain/pons ratio are useful to differentiate PSP from other PD patients. Aims The study aimed to detect sensitivity and specificity of magnetic resonance Parkinsonism index in differentiating PSP from PD. Settings and Design It was a retrospective case-control study conducted in Sri Manankula Vinayagar Medical College, Puducherry, during the period of January 2018 to June 2019. Materials and Methods The 87 subjects, who were diagnosed and grouped into three categories (PSP, PD, and control) after performing magnetic resonance imaging brain, were reviewed. The parameters like the area of Pons and midbrain, width of MCP and SCP, P/M, M/P, and MRPI were calculated. Statistical Analysis One-way ANOVA and Chi-square test was used. The sensitivity, specificity, diagnostic accuracy, and cut-off values obtained with receiver operating characteristic curve analysis were determined. Results The mean age of presentation was approximately 75 years with male predominance. The cut-off value of MRPI obtained in this study was 13.4 with 100% sensitivity and specificity. Even though M/P ratio was found to be statistically significant among PSP patients; cut-off value was not obtained. Conclusion MRPI was concluded as the better tool in diagnosing PSP compared with the M/P ratio. Hence the combined qualitative as well as quantitative measurement of MRPI will increase the diagnostic accuracy of PSP.

4.
J Neurol ; 268(4): 1526-1532, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33277666

RESUMO

BACKGROUND: A reliable measure of PSP-specific midbrain atrophy, the midbrain-to-pons ratio (MTPR) has been reported to support the differential diagnosis of progressive supranuclear palsy (PSP) from idiopathic Parkinson's disease (IPD). Since longitudinal analyses are lacking so far, the present study aimed to evaluate the diagnostic value of the relative change of MTPR (relΔt_MTPR) over a 1-year period in patients with PSP, IPD, and healthy controls (HC). METHODS: Midsagittal individual MRIs of patients with PSP (n = 15), IPD (n = 15), and healthy controls (HC; n = 15) were assessed and the MTPR at baseline and after 1 year were defined. The diagnostic accuracy of the MTPR and its relative change were evaluated using ROC curve analyses. RESULTS: PSP-patients had a significantly lower MTPR at baseline (M = 0.45 ± 0.06), compared to both non-PSP groups (F (2, 41) = 62.82, p < 0.001), with an overall predictive accuracy of 95.6% for an MTPR ≤ 0.54. PSP-patients also presented a significantly stronger 1-year decline in MTPR compared to IPD (p < 0.001). Though predictive accuracy of relΔt_MTPR for PSP (M = - 4.74% ± 4.48) from IPD (M = + 1.29 ± 3.77) was good (76.6%), ROC analysis did not reveal a significant improvement of diagnostic accuracy by combining the MTPR and relΔt_MTPR (p = 0.670). Still, specificity for PSP increased, though not significantly (p = 0.500). CONCLUSION: The present results indicate that the relΔt_MTPR is a potentially useful tool to support the differential diagnosis of PSP from IPD. For its relative 1-year change, still, more evaluation is needed.


Assuntos
Doença de Parkinson , Paralisia Supranuclear Progressiva , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Mesencéfalo/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Ponte , Paralisia Supranuclear Progressiva/diagnóstico por imagem
5.
J Pediatr Endocrinol Metab ; 33(6): 735-742, 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32436858

RESUMO

Backgrounds Limitations in the evaluation of the pituitary size and changes according to pubertal status make its validity questionable. Recently, in a small-scale study, pons ratio (PR) has been suggested as a more sensitive tool for diagnosis and etiological evaluation of growth hormone deficiency (GHD). The aim of the study is to evaluate the diagnostic value of PR in the diagnosis of GHD. Methods We retrospectively evaluated the pituitary magnetic resonance imaging (MRI) of 133 patients with a diagnosis of GHD. Primary axis (PA) was assigned as a line crossing the mid-sagittal dorsum sella and fourth ventricle. PR was defined as the pons height above the PA divided by total pons height. The PR of patients with GHD was compared to subjects without GHD. Results Study included 133 patients with GHD and 47 controls. In total, 121 (91%) patients had isolated GHD and 12 (9%) patients had multiple pituitary hormone deficiency. The PR of the patient group (mean: 0.32 ± 0.89; range: 0.14-0.63) was significantly higher than controls (mean: 0.26 ± 0.067; range 0.19-0.44) (p: 0.000). The optimal cut-off value of PR for GHD diagnosis was 0.27 (sensitivity 71% specificity 56%). There was a negative correlation between anterior pituitary height (APH)-SDS and PR (p: 0.002; r: -0.27). APH was increased, but PR remained unchanged in pubertal patients (p: 0.089). Conclusions PR measurement is a noninvasive, practical method with a cost-benefit clinical value. As it is not affected by pubertal status, PR is potentially a more sensitive tool for evaluation of pituitary gland in GHD patients compared to APH.


Assuntos
Nanismo Hipofisário/diagnóstico , Hipotálamo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Hipófise/diagnóstico por imagem , Adolescente , Estudos de Casos e Controles , Criança , Nanismo Hipofisário/patologia , Feminino , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/patologia , Hipotálamo/patologia , Masculino , Tamanho do Órgão , Hipófise/patologia , Ponte/diagnóstico por imagem , Ponte/patologia , Valor Preditivo dos Testes , Puberdade/fisiologia , Estudos Retrospectivos , Sensibilidade e Especificidade
6.
Parkinsonism Relat Disord ; 41: 31-36, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28487107

RESUMO

INTRODUCTION: Several studies have compared the performances of midbrain to pons area ratio (M/P) and the Magnetic Resonance Parkinsonism Index (MRPI) in distinguishing patients with Progressive Supranuclear Palsy (PSP) from those with Parkinson's disease (PD) with conflicting results. The current study aimed to compare the performance of these indexes in a well-characterized sample of PSP patients using either a manual or a fully automated approach to measure the brainstem structures involved in M/P and MRPI calculation. METHODS: This study involved 179 patients affected by idiopathic PD, 35 patients affected by PSP (15 probable and 20 possible) and 87 healthy controls. Sensitivity, specificity, positive predictive value (PPV) and area under the curve (AUC) of MRPI and M/P in distinguishing possible and probable PSP from PD and controls were calculated. RESULTS: No significant difference was found between manual and automated values for both MRPI and M/P. MRPI and M/P differentiated probable PSP from PD with similar performance. By contrast, MRPI showed higher sensitivity and specificity than M/P when patients with possible PSP were compared with PD (MRPI, sensitivity 100%, specificity 98.88%; M/P, sensitivity 85%, specificity 93.85%). A significant difference was also observed in AUC between MRPI and M/P in distinguishing possible PSP from PD. CONCLUSION: Our study demonstrates that MRPI was more accurate than M/P, in differentiating patients with possible PSP from those with PD. In patients suspected of having PSP with a low level of clinic diagnostic accuracy, MRPI should be preferred to M/P for distinguishing these patients from PD.


Assuntos
Tronco Encefálico/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Transtornos Parkinsonianos/diagnóstico por imagem , Ponte/diagnóstico por imagem , Paralisia Supranuclear Progressiva/diagnóstico por imagem , Idoso , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e Especificidade
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