Midbrain area and the hummingbird sign from brain MRI in progressive supranuclear palsy and idiopathic normal pressure hydrocephalus
(2022) In Journal of Neuroimaging 32(1). p.90-96- Abstract
BACKGROUND AND PURPOSE: The main radiological finding in progressive supranuclear palsy (PSP) is reduced midbrain volume. Both qualitative (e.g., hummingbird sign) and quantitative (e.g., area measurements) markers have been noted. Recent studies have shown a similar reduction also in idiopathic normal pressure hydrocephalus (iNPH). The purpose was to investigate the reliability and accuracy of these markers in discriminating PSP from iNPH and controls.
METHODS: Eight neuroradiologists viewed sagittal MR images of the midbrain from 104 subjects: 26 PSP patients, 40 iNPH patients, and 38 healthy controls. They visually assessed whether the hummingbird sign was present or not, grading their confidence from 1 to 5. Assessments were... (More)
BACKGROUND AND PURPOSE: The main radiological finding in progressive supranuclear palsy (PSP) is reduced midbrain volume. Both qualitative (e.g., hummingbird sign) and quantitative (e.g., area measurements) markers have been noted. Recent studies have shown a similar reduction also in idiopathic normal pressure hydrocephalus (iNPH). The purpose was to investigate the reliability and accuracy of these markers in discriminating PSP from iNPH and controls.
METHODS: Eight neuroradiologists viewed sagittal MR images of the midbrain from 104 subjects: 26 PSP patients, 40 iNPH patients, and 38 healthy controls. They visually assessed whether the hummingbird sign was present or not, grading their confidence from 1 to 5. Assessments were translated into a score between +5 and -5: from maximum confidence of presence to maximum confidence of absence. A positive median score was considered to indicate hummingbird sign. Sagittal midbrain area was manually measured in each subject.
RESULTS: Seventy-seven percent of PSP patients, 65% of iNPH, and 3% of controls were visually assessed as having the hummingbird sign. Manually measured midbrain area also showed overlap between PSP and iNPH. Regarding discrimination of PSP patients, midbrain area measurements, using a cutoff of 90 mm2 , yielded a higher area under the curve (AUC = 0.86) than visual assessment scores (AUC = 0.83), and higher reliability.
CONCLUSIONS: Measuring sagittal midbrain area is more accurate and reliable than visual assessment. Due to significant overlap in appearance, a midbrain with a hummingbird sign or reduced sagittal area should raise the suspicion of PSP only after other signs of iNPH have been considered.
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- author
- Virhammar, Johan ; Blohmé, Harald ; Nyholm, Dag LU ; Georgiopoulos, Charalampos LU and Fällmar, David
- publishing date
- 2022-01
- type
- Contribution to journal
- publication status
- published
- keywords
- Humans, Hydrocephalus, Normal Pressure/diagnostic imaging, Magnetic Resonance Imaging/methods, Mesencephalon/diagnostic imaging, Reproducibility of Results, Supranuclear Palsy, Progressive/diagnostic imaging
- in
- Journal of Neuroimaging
- volume
- 32
- issue
- 1
- pages
- 90 - 96
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85114878497
- pmid:34520581
- ISSN
- 1051-2284
- DOI
- 10.1111/jon.12932
- language
- English
- LU publication?
- no
- additional info
- © 2021 The Authors. Journal of Neuroimaging published by Wiley Periodicals LLC on behalf of American Society of Neuroimaging.
- id
- 6039c759-1ff7-4df0-b248-ec6d6426a56f
- date added to LUP
- 2023-02-09 11:19:46
- date last changed
- 2024-04-17 12:07:54
@article{6039c759-1ff7-4df0-b248-ec6d6426a56f,
abstract = {{<p>BACKGROUND AND PURPOSE: The main radiological finding in progressive supranuclear palsy (PSP) is reduced midbrain volume. Both qualitative (e.g., hummingbird sign) and quantitative (e.g., area measurements) markers have been noted. Recent studies have shown a similar reduction also in idiopathic normal pressure hydrocephalus (iNPH). The purpose was to investigate the reliability and accuracy of these markers in discriminating PSP from iNPH and controls.</p><p>METHODS: Eight neuroradiologists viewed sagittal MR images of the midbrain from 104 subjects: 26 PSP patients, 40 iNPH patients, and 38 healthy controls. They visually assessed whether the hummingbird sign was present or not, grading their confidence from 1 to 5. Assessments were translated into a score between +5 and -5: from maximum confidence of presence to maximum confidence of absence. A positive median score was considered to indicate hummingbird sign. Sagittal midbrain area was manually measured in each subject.</p><p>RESULTS: Seventy-seven percent of PSP patients, 65% of iNPH, and 3% of controls were visually assessed as having the hummingbird sign. Manually measured midbrain area also showed overlap between PSP and iNPH. Regarding discrimination of PSP patients, midbrain area measurements, using a cutoff of 90 mm2 , yielded a higher area under the curve (AUC = 0.86) than visual assessment scores (AUC = 0.83), and higher reliability.</p><p>CONCLUSIONS: Measuring sagittal midbrain area is more accurate and reliable than visual assessment. Due to significant overlap in appearance, a midbrain with a hummingbird sign or reduced sagittal area should raise the suspicion of PSP only after other signs of iNPH have been considered.</p>}},
author = {{Virhammar, Johan and Blohmé, Harald and Nyholm, Dag and Georgiopoulos, Charalampos and Fällmar, David}},
issn = {{1051-2284}},
keywords = {{Humans; Hydrocephalus, Normal Pressure/diagnostic imaging; Magnetic Resonance Imaging/methods; Mesencephalon/diagnostic imaging; Reproducibility of Results; Supranuclear Palsy, Progressive/diagnostic imaging}},
language = {{eng}},
number = {{1}},
pages = {{90--96}},
publisher = {{Wiley-Blackwell}},
series = {{Journal of Neuroimaging}},
title = {{Midbrain area and the hummingbird sign from brain MRI in progressive supranuclear palsy and idiopathic normal pressure hydrocephalus}},
url = {{http://dx.doi.org/10.1111/jon.12932}},
doi = {{10.1111/jon.12932}},
volume = {{32}},
year = {{2022}},
}