Philipps University in Marburg, Germany is very active in PSP research. This is a good review article of various advanced MRI techniques being used to help in the diagnosis of PSP. Many of the studies reviewed are related to a differential diagnosis between PSP, CBD, and MSA. MSA-P is described as the “most relevant clinical differential diagnosis” for PSP.
I learned a few things from this article:
1. For every study that shows good results from a technique, there is typically a later study showing not-as-good results.
2. All of the PSP imaging studies include patients with the Richardsons’s syndrome form of PSP. The clinical diagnostic criteria is based upon this “classic” form of PSP. So, these imaging studies really only apply to those with RS (or PSP-RS). Nearly half of those with PSP are excluded from these studies!
3. The “humming bird sign” (also known as the “penguin-silhouette sign”) for PSP on conventional MRI is described as “controversial.”
4. Voxel-based morphometry seems to be a good technique for differentiating PSP and CBD.
Robin
Journal of Neurology. 2010 Dec 22. [Epub ahead of print]
Magnetic resonance imaging in progressive supranuclear palsy.
Stamelou M, Knake S, Oertel WH, Höglinger GU.
Department of Neurology, Philipps University, Marburg, Germany.
Abstract
Progressive supranuclear palsy (PSP) is a tauopathy, presenting clinically most often with a symmetrical akinetic-rigid syndrome, postural instability, supranuclear gaze palsy and frontal dementia.
In the absence of reliably validated biomarkers, the diagnosis of PSP in vivo is presently based on clinical criteria, which to date do not include supporting imaging findings, as is accepted for other neurodegenerative diseases.
However, data from conventional magnetic resonance imaging (MRI) and various advanced MRI techniques including magnetic resonance volumetry, voxel-based morphometry, diffusion-weighted and diffusion-tensor imaging, magnetization transfer imaging and proton resonance spectroscopy suggest that MRI can contribute valuable information for the differential diagnosis of PSP.
We review here the presently published literature concerning MRI in PSP and discuss the potential role of MRI in differentiating PSP from other parkinsonian syndromes.
PubMed ID#: 21181185 (see pubmed.gov for this abstract only)