Measurements of Brain Stem and Cerebellum on Brain MRI: for the Differential Diagnosis Between Multiple System Atrophy and Idiopathic Parkinson's Disease

J Korean Neurol Assoc > Volume 22(5); 2004 > Article

Journal of the Korean Neurological Association 2004;22(5): 478-484.

뇌 자기공명영상에서 뇌간과 소뇌 계측을 이용한 다계통위축증과 파킨슨병의 감별 진단

나상준, 박지형 김현숙 홍지만 이기욱 이명식

연세대학교 의과대학 신경과학교실

Measurements of Brain Stem and Cerebellum on Brain MRI: for the Differential Diagnosis Between Multiple System Atrophy and Idiopathic Parkinson's Disease

Sang-Jun Na

Department of Neurology, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background: Multiple system atrophy (MSA) and idiopathic Parkinson’s disease (IPD) are two common neurodegenerative disorders presenting with parkinsonism. Since a brain MRI study is an available method for differentiating MSA from IPD, we tried to find further values of brain MRI studies in differentiating MSA from IPD.
Methods: We measured anteroposterior and transverse diameters (AD and TD, respectively) of the brain stem of T2-weighted axial images. We graded the severity of atrophy (grade 0: none; grade 1: mild; grade 2: moderate; and grade 3: severe) of cerebellar vermis and hemispheres on the midsagittal and parasagittal planes.
Results: There were 36 patients with probable MSA and 40 patients with IPD. We calculated a parameter multiplying AD of the midbrain by TD of the midbrain. The mean of the AD x TD of the midbrain was 1007.5±161.8 mm2 in patients with MSA, and it was significantly smaller than that of those with IPD (1113.3±118.7 mm2). When the cut off value was decided as 1050 mm2, the sensitivity of the parameter for the diagnosis of MSA was 83.3% and specificity was 80%. The frequency of cerebellar atrophy was 72.2% in patients with MSA, and it was significantly higher than that of those with IPD (37.5%).
Conclusions: Measurements of the brain stem, particularly the midbrain, and cerebellum areas on brain MRI are helpful methods for the differential diagnosis of patients with MSA from those with IPD.Key Words: Multiple system atrophy, Idiopathic Parkinson's disease, Brain magnetic resonance imaging