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Brain Advance Access published online on June 30, 2006
Brain, 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
Received January 5, 2006
Revised May 22, 2006
Accepted May 24, 2006

Article

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

Giuseppe Nicoletti 1, Raffaele Lodi 2 *, Francesca Condino 1, Caterina Tonon 2, Francesco Fera 1, Emil Malucelli 3, David Manners 3, Mario Zappia 4, Letterio Morgante 5, Paolo Barone 6, Bruno Barbiroli 7, and Aldo Quattrone 8

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; Dipartimento dell'Area Radiologica, Policlinico S. Orsola, Bologna, Italy
3 Dipartimento di Medicina Clinica e Biotecnologia Applicata D. Campanacci, Universita', di Bologna, Bologna, Italy
4 Institute of Neurology, University Magna Graecia, Catanzaro, Italy; Present address: Clinica Neurologica I, Dipartimento di Neuroscienze, Università di Catania, Catania, 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 Institute of Neurological Sciences, National Research Council, Mangone (Cosenza), Italy; Dipartimento dell'Area Radiologica, Policlinico S. Orsola, Bologna, Italy
8 Institute of Neurological Sciences, National Research Council, Mangone (Cosenza), Italy; Institute of Neurology, University Magna Graecia, Catanzaro, Italy

* To whom correspondence should be addressed.
Raffaele Lodi, E-mail: raffaele.lodi{at}unibo.it


  Abstract

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.

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