↓ midbrain area in PSP versus PD and MSA-P ↓ pons area in MSA-P versus PD and PSP ↓ SCP width in PSP versus PD and MSA-P ↓ MCP width in MSA-P versus PD and PSP ↑ pons/midbrain ratio in PSP versus PD and MSA-P ↑ MCP/SCP ratio in PSP versus PD and MSA-P ↑ MRPI in PSP versus PD and MSA-P
Se/Sp for PSP diagnosis: pons/midbrain ratio = 90.9%/93.5% (versus PD), 97%/94.7% (versus MSA-P); MCP/SCP ratio = 78.8%/88.9% (versus PD), 93.9%/89.5% (versus MSA-P); MRPI = 100%/100% (versus PD and MSA-P)
↓ midbrain area in PSP and MSA-P versus PD, of PSP versus MSA-C and MSA-P and of MSA-P versus MSA-C ↓ pons area PSP, MSA-P, and MSA-C versus PD, of MSA-C and MSA-P versus PSP ↓ MCP diameter in PSP, MSA-C, and MSA-P versus PD, and MSA-C versus PSP ↓ SCP diameter in PSP and MSA-C vs PD, PSP vs MSA-C and MSA-P
Acc/Se/Sp of midbrain area in discriminating PD, PSP, and MSA-C: 80.0%/65.5%/93.5%, 96.7%/95.0%/97.5%, and 51.7%/66.7%/93.8%, respectively Acc/Se/Sp of pons area in discriminating PD and MSA-C: 90.0%/80.0%/97.1%, 88.3%/77.5%/100% Acc/Se/Sp of MCP diameter in discriminating PD, PSP, and MSA-C: 85.0%/71.4%/96.9% and 90.0%/66.7%/97.8% Acc/Se/Sp of SCP diameter in discriminating PD and PSP: 80.0%/65.5%/93.5%
↑ pons/midbrain ratio in PSP-RS and PSP-P versus PD ↑ MR parkinsonism index in PSP-RS and PSP versus PD
Se/Sp for PSP diagnosis: pons/midbrain ratio = 90%/96% (PSP-RS versus PD) and 60%/96% (PSP-P versus PD); MRPI = 100%/92% (PSP-RS versus PD) and 70%/68% (PSP-P versus PD)
↓ mean width and FA of MCP, anteroposterior diameter and volume of pons, FA and volume of cerebellum, volume of putamen, FA of rostral substantia nigra, and ↑ MD of MCP in MSA versus PD
Overall performance of the decision tree (including mean MCP width and FA and anteroposterior diameter of pons) was 92% sensitivity, 96% specificity, 92% PPV, and 96% NPV
↓ MCP and SCP diameters, pons and midbrain areas and ↑ MCP/SCP diameter, pons/midbrain area, and MRPI in PSP-RS versus PD ↑ MD in SCP, thalamus, putamen, pallidus, parietooccipital and prefrontal WM, brain hemispheres, posterior fossa, brainstem, and cerebellar hemispheres in PSP-RS versus PD ↓ FA in SCP, midbrain (SCPs decussation), parietooccipital and prefrontal WM, brain hemispheres, posterior fossa, and brainstem in PSP-RS versus PD ↓ volume of brainstem, nucleus accumbens, globus pallidus, putamina, thalami, and ↑ volume of lateral ventricles in PSP-RS versus PD
Acc/Se/Sp of midbrain area in discriminating PSP-RS from PD: 99%/96%/98% Acc/Se/Sp of pons/midbrain area in discriminating PSP-RS from PD: 97%/96%/90% Acc/Se/Sp of MRPI in discriminating PSP-RS from PD: 95%/87%/93% Acc/Se/Sp of posterior fossa MD in discriminating PSP-RS from PD: 90%/80%/83% Acc/Se/Sp of SCP MD in discriminating PSP-RS from PD: 88%/70%/98% Acc/Se/Sp of thalamic volume in discriminating PSP-RS from PD: 83%/73%/90% Acc/Se/Sp of putaminal volume in discriminating PSP-RS from PD: 83%/93%/70%
↓ TIV-corrected brainstem volume in PSP, MSA-P, and MSA-C versus HC ↓ TIV-corrected cerebellar volume in MSA-P and MSA-C versus HC ↓ TIV-corrected caudate volume in PSP and MSA-P versus PD and HC ↓ TIV-corrected putaminal volume in PSP and MSA-P versus PD and HC
PSP = 33; CBS = 18; HC = 22 DD (y, M ± SD): PSP = 3.6 ± 2.2; CBS 4.6 ± 1.6
↓ brainstem volume (>midbrain) in PSP versus CBS and HC ↓ parietal and occipital lobes volumes (>white matter) in CBS versus PSP and HC ↓ area of CC in CBS versus PSP and HC
Discriminating capacity of a function including midbrain, parietal WM, temporal GM, brainstem, frontal WM, and pons volumes in differentiating PSP from CBS from HC: 84% (95%, 76%, and 83%, resp.)
↓ midbrain and SCP volumes in PSP versus MSA-P, PD, and HC ↓ frontal lobe volume in PSP versus PD and HC ↑ 3rd ventricle volume in PSP versus HC ↓ cerebellar and pontine volumes in MSA-P versus PD and HC ↓ midbrain volume in MSA-P versus HC
Se/Sp for regression analysis including midbrain, SCPs, frontal lobe, 3rd ventricle, and whole brain volumes in discriminating PSP from MSA-P, PD, and NC: 88.9% and 97.3% Se/Sp of midbrain, SCP, pons, and cerebellar volumes in discriminating PSP from MSA-P: 94.4% and 88.9%
↓ cerebellar cortex, thalamus, putamen, pallidum, hippocampus, and brainstem and ↑ lateral, 3rd and 4th ventricles volumes in PSP versus PD and HC ↓cerebellar cortex, putamen, pallidum, hippocampus, and brainstem and ↑ 4th ventricle volumes in MSA-P versus PD and HC ↓thalamus volume in PSP versus MSA-P
↑ rADC in putamen, caudate, pallidum, thalamus, MCP, and pons in MSA-P versus PD ↑ rADC in putamen, caudate, pallidum, and thalamus in PSP versus PD ↑ rADC in putamen, MCP in MSA-P versus PSP
PSP-RS = 10; CBS = 7; PD = 13; HC = 9 DD (y, M ± SD): PSP-RS = 4 ± 3; CBS = 4 ± 3; PD = 14 ± 8
↑ ADC in putamen and SCP in PSP-RS versus PD ↑ ADC in putamen in CBS versus PD ↑ hemispheric median ADC in CBS versus PD and PSP-RS ↓ HSR in CBS versus PD and PSP-RS
Se/Sp for PSP-RS diagnosis (versus PD): putaminal ADC = 80%/77%; SCP ADC = 90%/85%. Se/Sp for CBS diagnosis: putaminal ADC = 86%/92% (versus PD); hemispheric median ADC = 86%/85% (versus PD), 100%/90% (versus PSP-RS); HSR = 100%/100% (versus PD and PSP-RS)
↑ trace (D) values in whole and anterior putamen in MSA-P versus MSA-C and HC ↑ trace (D) values in the cerebellum (WM) and MCP in MSA-C versus MSA-P and HC
↑ rADC in midbrain and globus pallidus in PSP versus PD, MSA, and HC ↑ rADC in the SCP and in the head of the caudate nucleus in PSP versus MSA and HC ↑ rADC in pons, middle cerebellar peduncle, cerebellar white matter, and dentate nucleus in MSA versus PD, PSP, and HC ↑ rADC in the posterior putamen in MSA versus PSP ↑ rADC values in the putamen, globus pallidus, and head of caudate nucleus in MSA-P versus MSA-C ↑ rADC in the pons, middle cerebellar peduncle, and cerebellar white matter in MSA-C versus MSA-P
↑ MD in MCP and pons in MSA versus PSP and PD ↓ FA in MCP in MSA versus PSP and PD ↑ MD in decussation of SCP in PSP versus MSA and PD ↓ FA in decussation of SCP in PSP versus PD
MSA = 20 (10 MSA-P and 10 MSA-C); PD = 21; HC = 20 DD (y, M ± SD): MSA = 4 ± 2; PD = 10 ± 8
↑ ADC in putamen, pons, and cerebellum in MSA-P versus PD ↓ FA in putamen, pons, and cerebellum in MSA-P versus PD
Se/Sp for MSA-P diagnosis (versus PD): ADC: putamen = 70%/63.6%, pons = 70%/70%, cerebellum = 60%/87.5%; FA: putamen = 70%/87.5%, pons = 70%/100%, and cerebellum = 70%/63.6% 90% of MSA-P had ↑ ADC and ↓ FA in any of the three areas
↑ ADC in CC1 in PSP versus PD and HC and in CC2 in PSP versus PD ↓ FA in CC1 in PSP versus HC and in CC2 in PSP versus PD and HC
Se/Sp of ADC in CC1 and CC2 in differentiating PSP from PD: 100% and 75.9%, and 49.2% and 82.8%, respectively Se/Sp of FA in CC1 and CC2 in differentiating PSP from PD: 85.7% and 65.5%, and 28.5% and 90.0%, respectively
↑ MD infratentorial compartment, brainstem, cerebellar vermis, and hemispheres in MSA-P and MSA-C versus PD and HC ↑ MD infratentorial compartment, brainstem, and cerebellar hemispheres in MSA-P and MSA-C versus PSP-RS ↑ MD infratentorial compartment, brainstem, and cerebellar vermis in PSP-RS versus PD and HC ↑ MD in cerebellar vermis in MSA-C versus MSA-P
Se/Sp of MD of cerebellar hemispheres in discriminating MSA from other groups: 100%/100%
PD = 15; MSA-P = 14; PSP = 12; ET = 14; HC = 17 DD (y, M ± SD): PD = 10.5 ± 7.3; MSA-P = 7.4 ± 4.0; PSP = 10.5 ± 2.5; ET = 28.2 ± 21.0
FA of SN, AD of putamen, and MD of dentate in discriminating PD from MSA-P and PSP: AUC = 0.99; Se = 90%; and Sp = 100% FA of SN, RD of SCP, and MCP in discriminating PD from MSA-P: AUC = 0.99; Se = 94%; and Sp = 100% FA of SN, AD of putamen in discriminating PD from PSP: AUC = 0.96; Se = 87%; and Sp = 100% FA of caudate, RD of MCP in discriminating MSA-P from PSP: AUC = 0.97; Se = 90%; and Sp = 100%
↑ MD in posterior putamen in MSA-P versus PD, PSP, and HC ↑ MD in anterior putamen in MSA-P versus PD ↓ putaminal volume in MSA-P versus PD, PSP, and HC
AUC/Se/Sp of posterior putamen MD in discriminating MSA-P from PD, PSP, and NC: 89%/72.7%/100% AUC/Se/Sp of putaminal volume in discriminating MSA-P from PD, PSP, and NC: 84%/54.5%/100%
↑ MD, RD, and ↓ FA in CC in PSP versus PD and HC ↓ apparent area coefficient in CG and ↑ MD in CST in PSP versus PD ↑ RD in CST in MSA-P versus PD
AUC/Se/Sp of CG apparent area coefficient in differentiating PSP from PD: 0.88/87%/80% AUC/Se/Sp of CST MD in differentiating PSP from PD: 0.85/94%/80% AUC/Se/Sp of CC MD in differentiating PSP from PD: 0.85/81%/80%
↑ MD in thalamus, ventral anterior, and ventral posterior thalamic nuclei and midbrain in PSP versus MSA-P, PD, and HC ↑ MD in pons and putamen in MSA-P versus PD and HC ↑ MD and ↓ FA of bilateral DRTT in PSP versus MSA-P, PD, and HC ↓ thalamus, putamen, and pallidus volumes and midbrain area in PSP versus MSA-P, PD, and HC in both cohorts ↓ putamen and pallidus volumes in MSA-P versus PD and HC
Se/Sp of MD of the thalamus, right DRTT, and midbrain in discriminating PSP from PD and MSA-P: 81–77%, 92–81%, and 81-81%, respectively
↓ MTR of globus pallidus in PSP versus PD, MSA and HC ↓ MTR of putamen in MSA versus PD and HC ↓ MTR in substantia nigra in PD, PSP, and MSA versus HC ↓ MTR in caudate and prefrontal WM in PSP versus HC
↓ signal intensity of red nucleus, substantia nigra in PSP versus MSA-P PD and HC ↓ signal intensity in posterolateral putamen in PSP versus PD
Se/Sp of red nucleus hypointensity score in differentiating PSP from PD and from MSA-P: 66.7%/81.8%–66.7%/83.3% Se/Sp of putamen hypointensity score in differentiating PSP from PD: 50.0%/90.9%
↑ (phase shift values) iron content in the red nucleus, putamen, globus pallidus, and thalamus in PSP versus PD ↑ (phase shift values) iron content in the red nucleus and putamen in MSA-P versus PD ↑ (phase shift values) iron content in substantia nigra in PD versus MSA-P and HC
AUC of putamen in discriminating MSA-P from PSP and PD: 0.836 AUC of globus pallidus and thalamus in discriminating PSP from MSA-P and PD: 0.869 and 0.884, respectively
↑ R2 in the putamen in MSA-P versus PD and HC ↑ R2 in globus pallidus and caudate in PSP versus PD and HC ↑ R2 in caudate nucleus in PSP versus MSA-P ↓ volume of caudate, putamen, globus pallidus, and thalamus in PSP and MSA-P versus PD and HC ↓ volume of globus pallidus in PSP versus MSA-P ↓ volume of putamen in MSA-P versus PSP
AUC of putaminal volume in discriminating MSA-P from PSP and PD: 0.832 AUC of globus pallidus volume in discriminating PSP from MSA-P and PD: 0.856
↓ signal intensity of bilateral posterior halves, mean values of the anterior and posterior halves, and the dominant-side posterior half of the putamen in MSA-P versus PD
AUC of signal intensity of the dominant-side posterior half of the putamen in discriminating MSA-P from PD: 0.947
PD = 10; PSP = 12; CBS = 9; HC = 11 DD (m, M ± SD): PD = 103 ± 9; PSP = 48 ± 9; CBS = 40 ± 5
↓ NAA/Cr in brainstem, centrum semiovale, and precentral cortices and ↓ NAA/Cho in lenticular nucleus in PSP versus HC ↓ NAA/Cr in centrum semiovale and ↓ NAA/Cho in lenticular nucleus and parietal cortex in CBS versus HC
↓ NAA/Cr of frontal cortex in PSP, MSA, CBD, and VP versus HC ↓ NAA/Cr of putamen in PSP, MSA, CBD, and PD versus HC ↓ NAA/Cr of frontal cortex and putamen in CBD versus PD, MSA, and VP ↓ NAA/Cr of putamen in PSP versus VP and MSA
↓ NAA/Cr of lenticular nucleus in PSP versus PD and HC ↓ NAA/Cr of the hippocampus in PSP versus HC ↓ NAA/Cho of the midbrain in PSP versus MSA-P and HC
↓ cerebellar NAA/Cr and NAA/mI ratios in aPS versus PD and HC and in MSA-C versus PSP-RS, MSA-P, and PD () ↓ cerebellar NAA/Cr ratio in PSP-RS versus PD and NC () and ↓ cerebellar NAA/mI in PSP-RS versus NC ()
Se/Sp of cerebellar NAA/Cr ratio value in discriminating PD from aPS: 100% and 64%.
Acc/Se/Sp: accuracy/sensitivity/specificity; T: Tesla; PSP: Progressive Supranuclear Palsy; PD: Parkinson’s disease; HC: healthy controls; DD: disease duration; y: years; M: mean; SD: standard deviation; MSA: Multiple System Atrophy; MSA-P: parkinsonian variant of MSA; MCP: middle cerebellar peduncle; SCP: superior cerebellar peduncle; MRPI: MR parkinsonism index; MSA-C: cerebellar variant of MSA; PSP-RS: PSP-Richardson’s syndrome; PSP-P: PSP-parkinsonism; m: months; FA: fractional anisotropy; MD: mean diffusivity; TIV: total intracranial volume; SEM: standard error mean; CBS: corticobasal syndrome; CC: corpus callosum; WM: white matter; DWI: diffusion-weighted imaging; rADC: regional ADC; rTrace(D): trace of diffusion tensor; ADC: ADC average; HSR: hemispheric symmetry ratio; ADC: apparent diffusion coefficient; GRE: gradient echo; DTI: diffusion tensor imaging; IR: interquartile range; aPS: atypical parkinsonian syndromes; DLB: dementia with Lewy bodies; MTRI: magnetization transfer imaging; MTR: magnetization transfer; SWI: susceptibility-weighted imaging; AUC: area under the curve; 1H-MRS: proton magnetic resonance spectroscopy; NAA: N-acetyl-aspartate; Cr: creatine; Cho: choline; VP: vascular parkinsonism.
