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Progressive supranuclear palsy against everyone else: a look into the specificity of MRI markers

Year: 2025

Type: article

Abstract: INTRIDUCTION: Diagnostic accuracy of the clinical diagnosis of progressive supranuclear palsy (PSP) is suboptimal, due to its' clinical heterogeneity. Multiple MRI markers have been introduced in an effort to enhance clinical diagnosis. OBJECTIVES: This study compared the diagnostic accuracy of linear, planimetric and volumetric MRI markers for PSP diagnosis in different clinical settings. MATERIALS AND METHODS: A total of 414 patients were included, comprising 80 PSP and 334 non-PSP patients (CBD:38; MSA:45; PD:36; AD:65; bvFTD:30; PPA:18; DLB:15; PCA:14; NPH:15; MCI:14; controls:45). PSP patients were stratified based on phenotype (PSP-RS vs. PSP variants) and level of diagnostic certainty (probable vs. possible/suggestive). Midbrain and SCP distances, surfaces and volumes, pons/midbrain (P/M) ratios and Magnetic Resonance Parkinsonism Indices were measured (MRPI). ROC curve analysis was used to identify optimal MRI markers in each clinical setting. RESULTS: Midbrain surface was the optimal MRI marker in differentiating PSP from non-PSP patients (AUC = 0.930; sensitivity 88.8 %; specificity 81.1 %), followed by planimetric P/M and MRPI. MRI markers were highly accurate in differentiating PSP from MSA, PD and PCA, moderately accurate in differentiating PSP from AD, bvFTD, DLB, MCI, whereas their diagnostic accuracy was suboptimal in differentiating PSP from CBD, PPA and NPH. MRI markers were more potent in diagnosis PSP-RS over PSP variants and probable over possible/suggestive PSP patients. CONCLUSIONS: Diagnostic accuracy of PSP MRI markers varies significantly and depends heavily on the clinical setting, PSP phenotype and level of disease certainty. These limitations should be taken into consideration when applying MRI markers in clinical practice.

Source: Journal of the Neurological Sciences

DOI: 10.1016/j.jns.2025.123731