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Quantitative brain stem assessment in discriminating neurodegenerative disorders from normal pressure hydrocephalus

Georgiopoulos, Charalampos LU orcid ; Papadimitriou, Stergios ; Nyholm, Dag LU ; Kilander, Lena ; Löwenmark, Malin ; Fällmar, David and Virhammar, Johan (2024) In Journal of Neuroimaging
Abstract

Background and Purpose: Differentiating idiopathic normal pressure hydrocephalus (iNPH) from neurodegenerative disorders such as progressive supranuclear palsy (PSP), Multiple System Atrophy—parkinsonian type (MSA-P), and vascular dementia (VaD) is challenging due to overlapping clinical and neuroimaging findings. This study assesses if quantitative brain stem and cerebellum metrics can aid in this differentiation. Methods: We retrospectively compared the sagittal midbrain area, midbrain to pons ratio, MR parkinsonism index (MRPI), and cerebellar atrophy in 30 PSP patients, 31 iNPH patients, 27 MSA-P patients, 32 VaD patients, and 25 healthy controls. Statistical analyses determined group differences, sensitivity, specificity, and the... (More)

Background and Purpose: Differentiating idiopathic normal pressure hydrocephalus (iNPH) from neurodegenerative disorders such as progressive supranuclear palsy (PSP), Multiple System Atrophy—parkinsonian type (MSA-P), and vascular dementia (VaD) is challenging due to overlapping clinical and neuroimaging findings. This study assesses if quantitative brain stem and cerebellum metrics can aid in this differentiation. Methods: We retrospectively compared the sagittal midbrain area, midbrain to pons ratio, MR parkinsonism index (MRPI), and cerebellar atrophy in 30 PSP patients, 31 iNPH patients, 27 MSA-P patients, 32 VaD patients, and 25 healthy controls. Statistical analyses determined group differences, sensitivity, specificity, and the area under the receiver operating characteristic curves. Results: There was an overlap in midbrain morphology between PSP and iNPH, as assessed with MRPI, midbrain to pons ratio, and midbrain area. A cutoff value of MRPI > 13 exhibited 84% specificity in distinguishing PSP from iNPH and 100% in discriminating PSP from all other conditions. A cutoff value of midbrain to pons ratio at <0.15 yielded 95% specificity for differentiating PSP from iNPH and 100% from all other conditions. A cutoff value of midbrain area at <87 mm2 exhibited 97% specificity for differentiating PSP from iNPH and 100% from all other conditions. All measures showed low sensitivity. Cerebellar atrophy did not differ significantly among groups. Conclusion: Our study questions MRPI's diagnostic performance in distinguishing PSP from iNPH. Simpler indices such as midbrain to pons ratio and midbrain area showed similar or better accuracy. However, all these indices displayed low sensitivity despite significant differences among PSP, MSA-P, and VaD.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
idiopathic normal pressure hydrocephalus, midbrain to pons ratio, MR parkinsonism index, multiple system atrophy, progressive supranuclear palsy, vascular dementia
in
Journal of Neuroimaging
publisher
Wiley-Blackwell
external identifiers
  • pmid:38676300
  • scopus:85191717422
ISSN
1051-2284
DOI
10.1111/jon.13204
language
English
LU publication?
yes
id
183f5e10-b3b4-46d8-8353-d396780d3f12
date added to LUP
2024-05-15 12:00:17
date last changed
2024-06-12 14:45:22
@article{183f5e10-b3b4-46d8-8353-d396780d3f12,
  abstract     = {{<p>Background and Purpose: Differentiating idiopathic normal pressure hydrocephalus (iNPH) from neurodegenerative disorders such as progressive supranuclear palsy (PSP), Multiple System Atrophy—parkinsonian type (MSA-P), and vascular dementia (VaD) is challenging due to overlapping clinical and neuroimaging findings. This study assesses if quantitative brain stem and cerebellum metrics can aid in this differentiation. Methods: We retrospectively compared the sagittal midbrain area, midbrain to pons ratio, MR parkinsonism index (MRPI), and cerebellar atrophy in 30 PSP patients, 31 iNPH patients, 27 MSA-P patients, 32 VaD patients, and 25 healthy controls. Statistical analyses determined group differences, sensitivity, specificity, and the area under the receiver operating characteristic curves. Results: There was an overlap in midbrain morphology between PSP and iNPH, as assessed with MRPI, midbrain to pons ratio, and midbrain area. A cutoff value of MRPI &gt; 13 exhibited 84% specificity in distinguishing PSP from iNPH and 100% in discriminating PSP from all other conditions. A cutoff value of midbrain to pons ratio at &lt;0.15 yielded 95% specificity for differentiating PSP from iNPH and 100% from all other conditions. A cutoff value of midbrain area at &lt;87 mm<sup>2</sup> exhibited 97% specificity for differentiating PSP from iNPH and 100% from all other conditions. All measures showed low sensitivity. Cerebellar atrophy did not differ significantly among groups. Conclusion: Our study questions MRPI's diagnostic performance in distinguishing PSP from iNPH. Simpler indices such as midbrain to pons ratio and midbrain area showed similar or better accuracy. However, all these indices displayed low sensitivity despite significant differences among PSP, MSA-P, and VaD.</p>}},
  author       = {{Georgiopoulos, Charalampos and Papadimitriou, Stergios and Nyholm, Dag and Kilander, Lena and Löwenmark, Malin and Fällmar, David and Virhammar, Johan}},
  issn         = {{1051-2284}},
  keywords     = {{idiopathic normal pressure hydrocephalus; midbrain to pons ratio; MR parkinsonism index; multiple system atrophy; progressive supranuclear palsy; vascular dementia}},
  language     = {{eng}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Neuroimaging}},
  title        = {{Quantitative brain stem assessment in discriminating neurodegenerative disorders from normal pressure hydrocephalus}},
  url          = {{http://dx.doi.org/10.1111/jon.13204}},
  doi          = {{10.1111/jon.13204}},
  year         = {{2024}},
}