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Brain Advance Access originally published online on June 30, 2006
Brain 2006 129(10):2679-2687; doi:10.1093/brain/awl166
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© The Author (2006). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Apparent diffusion coefficient measurements of the middle cerebellar peduncle differentiate the Parkinson variant of MSA from Parkinson's disease and progressive supranuclear palsy

Giuseppe Nicoletti1, Raffaele Lodi2,3, Francesca Condino1, Caterina Tonon2,3, Francesco Fera1, Emil Malucelli2, David Manners2, Mario Zappia4,7, Letterio Morgante5, Paolo Barone6, Bruno Barbiroli2,3 and Aldo Quattrone1,4

1 Institute of Neurological Sciences, National Research Council Mangone (Cosenza), Italy 2 Dipartimento di Medicina Clinica e Biotecnologia Applicata D. Campanacci, Universita'di Bologna Bologna, Italy 3 Dipartimento dell'Area Radiologica, Policlinico S. Orsola Bologna, Italy 4 Institute of Neurology, University Magna Graecia Catanzaro, Italy 5 Department of Neuroscience, Psychiatry and Anesthesiology, University of Messina, Policlinico Universitario Italy 6 Department of Neurological Sciences, University Federico II Naples, Italy 7 Present address: Clinica Neurologica I, Dipartimento di Neuroscienze, Università di Catania Catania, Italy

Correspondence to: Raffaele Lodi, MD, Dipartimento di Medicina Clinica e Biotecnologia Applicata "D. Campanacci", "Universita" di Bologna, Policlinico S. Orsola, Via Massarenti 9, 40138 Bologna, Italy E-mail: raffaele.lodi{at}unibo.it

Clinical differentiation of parkinsonian syndromes such as the Parkinson variant of multiple system atrophy (MSA-P) and progressive supranuclear palsy (PSP) from Parkinson's disease is difficult in the early stage of the disease. In order to identify objective markers for differential diagnosis, we studied these three groups of patients with diffusion-weighted MRI (DWI). Sixteen MSA-P patients, 16 with PSP, 16 with Parkinson's disease and 15 healthy volunteers were studied. Regional apparent diffusion coefficients (rADC) were determined in different brain regions including basal ganglia, thalamus, white matter, pons and middle cerebellar peduncles (MCPs). rADC calculated in the MCP completely differentiated MSA-P patients (median: 0.93 x 10–3 mm2/s) from PSP patients (median: 0.82 x 10–3 mm2/s, P < 0.001), Parkinson's disease patients (median: 0.79 x 10–3 mm2/s, P < 0.001) and healthy volunteers (median: 0.81 x 10–3 mm2/s, P < 0.001). Other regions considered showed an overlapping among groups. DWI discriminates MSA-P from PSP and Parkinson's disease and healthy volunteers on the basis of MCP rADC values. These in vivo results confirm the pathological findings that the majority of MSA-P patients have moderate or severe degenerative changes not only in the nigrostriatal but also in the olivopontocerebellar systems. Our findings indicate that, in order to substantially contribute to the in vivo differential diagnosis of MSA-P, PSP and Parkinson's disease, rADC measurements should not be limited to the basal ganglia but should also include the MCP.

Key Words: diffusion imaging; middle cerebellar peduncle; multiple system atrophy; progressive supranuclear palsy; Parkinson's disease

Abbreviations: ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; EPI, echo planar imaging; MCP, middle cerebellar peduncle; MSA, multiple system atrophy; PPV, positive predictive values; PSP, progressive supranuclear palsy; rADC, regional ADC; ROI, region of interest

Received January 5, 2006. Revised May 22, 2006. Accepted May 24, 2006.


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