Brain Advance Access originally published online on September 26, 2008
Brain 2008 131(10):2690-2700; doi:10.1093/brain/awn195
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Diffusion-weighted brain imaging study of patients with clinical diagnosis of corticobasal degeneration, progressive supranuclear palsy and Parkinson's disease
1MR Spectroscopy Unit, Department of Internal Medicine, Ageing and Nephrology and 2Department of Neurological Sciences, University of Bologna, Bologna, Italy
Correspondence to: Raffaele Lodi, 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
Corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP) are two neurodegenerative disorders within the category of tauopathies, which must be considered in differential diagnosis of Parkinson's disease. Although specific clinical and neuroradiological features help to guide the clinician to a likely diagnosis of Parkinson's disease, CBD or PSP, differential diagnosis remains difficult. The aim of our study was to analyse apparent diffusion coefficient (ADCave) maps from patients with clinical diagnosis of CBD (corticobasal syndrome, CBS), classical phenotype of PSP (Richardson's syndrome, RS) and Parkinson's disease (PD) in order to identify objective markers to discriminate between these groups. Thirteen Parkinson's disease patients, 10 RS patients, 7 CBS patients and 9 healthy volunteers were recruited and studied in a 1.5 T MR scanner. Axial diffusion-weighted images were obtained and the ADCave map was generated. Regions of interest (ROIs) included mesencephalon, corpus callosum and left and right superior cerebellar peduncle (SCP), thalamus, caudate, putamen, pallidus, posterior limb of internal capsule, frontal and parietal white matter. Histograms of ADCave were generated for all voxels in left and right cerebral hemispheres and in left and right deep grey matter regions separately, and the 50th percentile values (medians) were determined. The ratio of the smaller to the larger median value (symmetry ratio) was calculated for left and right hemispheres and for left and right deep grey matter regions (1 = perfect symmetry). Putaminal ADCave values in CBS and RS were significantly greater than those in Parkinson's disease and healthy volunteers, but could not distinguish CBS from RS patients. In CBS patients, the values of the medians of cerebral hemispheres histograms were significantly higher than those in RS, Parkinson's disease and healthy volunteers, while the hemispheric symmetry ratio in CBS (0.968, range 0.952–0.976) was markedly reduced compared with RS (0.993, range 0.992–0.994), Parkinson's disease (0.991, range 0.988–0.993) and healthy controls (0.990, range 0.988–0.993). The hemispheric symmetry ratio differentiated CBS patients from RS and Parkinson's disease patients with a sensitivity and specificity of 100%. In RS patients, the ADCave values of the SCPs were significantly greater than those in Parkinson's disease and healthy volunteers. Our findings confirm that putaminal ADCave values evaluation provides a good discrimination between Parkinson's disease and atypical parkinsonisms, including RS and CBS. Furthermore, diffusion-weighted imaging, by detecting the brain microstructural correlates of the typical asymmetric signs and symptoms in CBS and the SCP involvement in RS, was shown to aid characterization and differentiation of atypical parkinsonism.
Key Words: diffusion imaging; corticobasal degeneration; progressive supranuclear palsy; Richardson's syndrome; Parkinson's disease
Abbreviations: CBD, corticobasal degeneration; CBS, corticobasal syndrome; PSP, progressive supranuclear palsy; DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficients; ROI, region of interest; SCP, superior cerebellar peduncle; PPV, positive predictive values; NPV, negative predictive values
Received November 13, 2007. Revised July 24, 2008. Accepted July 31, 2008.
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