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| Item Type: | Article |
|---|---|
| Title: | Planimetric and linear MRI markers for progressive supranuclear palsy classification: a large multicohort international study |
| Creators: |
Quattrone, Andrea  ORCID: https://orcid.org/0000-0003-2071-2083, Bianco, Maria Giovanna ORCID: https://orcid.org/0000-0002-2705-8718, Vescio, Basilio ORCID: https://orcid.org/0000-0002-7172-8520, Chimento, Ilaria ORCID: https://orcid.org/0000-0002-1596-4297, Sacilotti, Alisea ORCID: https://orcid.org/0009-0006-3071-2967, Oliveti, Cesare ORCID: https://orcid.org/0009-0007-5957-8690, Arcuri, Pier Paolo, Stanà, Carlo, Tinelli, Emanuele ORCID: https://orcid.org/0000-0002-3007-4022, Sabatini, Umberto, Kaasinen, Valtteri ORCID: https://orcid.org/0000-0002-3446-7093, Franzmeier, Nicolai, Stefanis, Leonidas, Velonakis, Georgios ORCID: https://orcid.org/0000-0002-0050-284X, Boxer, Adam, Constantinides, Vasilios C., Höglinger, Günter U. and Quattrone, Aldo ORCID: https://orcid.org/0000-0003-2001-957X
|
| Abstract: | BACKGROUND: Differentiating progressive supranuclear palsy (PSP) from Parkinson disease and other parkinsonisms is challenging. MRI measures have been investigated, but most studies included small samples, limiting result reliability. PURPOSE: To compare the performance of planimetric and linear MRI measurements in differentiating PSP from other parkinsonisms and identify an optimized linear marker. MATERIALS AND METHODS: Participants with PSP and non-PSP parkinsonisms and controls were included in this secondary analysis of multiple international prospective studies (enrollment: 2006–2024). The previously established midbrain line, midbrain area, pons to midbrain area ratio, and MR parkinsonism index were compared with a new simple linear marker based on two midbrain measures performed on midsagittal T1-weighted sections (dual-line midbrain PSP index [DMPI]). Logistic regression including DMPI, age, and sex was used to differentiate participants with PSP (PSP–Richardson syndrome, PSP variants) from those with non-PSP parkinsonisms and controls in two large independent cohorts and in a small cohort of participants with pathologically proven diagnoses. RESULTS: A total of 2111 participants (mean age, 67.8 years ± 8.4 [SD]; 54% male) were included (Italian: 136 PSP, 238 non-PSP, 85 controls; international: 520 PSP, 564 non-PSP, 525 controls). All markers were compared in a subcohort (PSP [n = 161]; non-PSP parkinsonisms [n = 203]) representative of the overall cohort. All measures showed area under the receiver operating characteristic curve (AUC) values over 0.90 for differentiating PSP from non-PSP parkinsonisms, with the DMPI and midbrain area performing best (AUCs, 0.97 [95% CI: 0.95, 0.98] and 0.95 [95% CI: 0.93, 0.97], respectively) and the DMPI showing the smallest percentage of uncertain cases (gray zone, 29 of 364 participants [7.97%]). In the entire Italian and international cohorts, the DMPI distinguished participants with PSP from those with non-PSP, with AUCs of 0.97 (95% CI: 0.97, 0.98) and 0.96 (95% CI: 0.95, 0.97), respectively. Excellent DMPI performance was also observed in participants with early-stage disease (AUC, 0.97 [95% CI: 0.95, 0.99]) and those with pathologically confirmed diagnoses (n = 43) (AUC, 0.94 [95% CI: 0.86, 1.00]). CONCLUSION: The DMPI and midbrain area performed well for differentiating PSP from other neurodegenerative parkinsonisms. |
| Keywords: | Differential Diagnosis, Magnetic Resonance Imaging, Progressive Supranuclear Palsy, Prospective Studies, Reproducibility of Results |
| Source: | Radiology |
| ISSN: | 0033-8419 |
| Publisher: | Radiological Society of North America |
| Volume: | 319 |
| Number: | 3 |
| Page Range: | e251394 |
| Date: | June 2026 |
| Additional Information: | Julian Hellmann-Regen and Louisa Droste zu Senden are members of the DESCRIBE-PSP Study Group. |
| Official Publication: | https://doi.org/10.1148/radiol.251394 |
| PubMed: | View item in PubMed |
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