Brain MR Contribution to the Differential Diagnosis of Parkinsonian Syndromes: An Update

Figure 3

Typical MRI changes disclosed in PSP. (a) Bilateral posterior putaminal T2-hypointensity (white arrows). (b) Atrophy of the midbrain tegmentum on axial T2 image, with thinning of cerebral peduncles resulting in the concavity at the lateral margin of the midbrain, resembling Mickey Mouse or the flower morning glory. (c) Midbrain atrophy (white arrow) with a concave upper profile on sagittal 3D T1 image (brainstem profile resembling a “penguin silhouette” or a “hummingbird”). (d) Normal middle cerebellar peduncles (white arrow) on sagittal 3D T1 image. (e) Atrophy of superior cerebellar peduncles (white arrows) on coronal 3D T1 image.

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