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AJNR - American Journal of Neuroradiology

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MR Imaging of the Superior Profile of the Midbrain: Differential Diagnosis between Progressive Supranuclear Palsy and Parkinson Disease

Andrea Righini^a, Angelo Antonini^b, Roberta De Notaris^b, Elena Bianchini^a, Nicoletta Meucci^b, Giorgio Sacilotto^b, Margherita Canesi^b, Danilo De Gaspari^b, Fabio Triulzi^a and Gianni Pezzoli^b

^a Department of Neuroradiology Istituti Clinici di Perfezionamento, Milan, Italy
^b Department of Neurology Istituti Clinici di Perfezionamento, Milan, Italy

View larger version (113K): [in a new window]   FIG 1. Top row, Midsagittal T1-weighted spin-echo sections in PD (A) and PSP (B and C) show the midbrain region. Bottom row, Same images with outlined profiles of the upper midbrain, which appears convex in A, linear (flat) in B, and concave in C.

View larger version (153K): [in a new window]   FIG 2. Axial, 3-mm-thick, T2-weighted spin-echo sections show different degrees of midbrain atrophy.

View larger version (63K): [in a new window]   FIG 3. Axial, 3-mm-thick, T2-weighted spin-echo sections show no abnormal tegmental hyperintensity (A) and abnormal tegmental hyperintensity (B, arrow).

View larger version (63K): [in a new window]   FIG 4. Axial, 3-mm-thick, T2-weighted spin-echo section depicts the method used to measure the AP diameter of the midbrain at the level of the superior colliculus.

View larger version (22K): [in a new window]   FIG 5. Graph illustrates the distribution of midbrain transverse AP diameters for the PSP and PD populations. A threshold value of 12 mm included only seven of 25 patients with PSP.

View larger version (22K): [in a new window]   FIG 6. Diagrammatic representation of an axial section of the midbrain at the level of superior colliculus (modified from figure 54 of Duvernoy HM, The Human Brain Stem and Cerebellum, 1995, with permission of Springer-Verlag, Wien). Some of the structures affected in PSP have been reported. Other structures of the dorsal and cranial part of the midbrain affected in PSP (ie, nucleus interstitialis of Cajal and pretectal area) are located on the contiguous cranial section.