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William Liboni , Piero Pignatta, Elisabetta Salzedo, Sara Giordano, Filippo Molinari

ULTRASONOGRAPHY AND MR IMAGING IN PROGRESSIVE SUPRANUCLEAR PALSY. William Liboni , Piero Pignatta, Elisabetta Salzedo, Sara Giordano, Filippo Molinari. Bologna, 4-9 Oct 2010. Introduction.

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William Liboni , Piero Pignatta, Elisabetta Salzedo, Sara Giordano, Filippo Molinari

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  1. ULTRASONOGRAPHY AND MR IMAGING IN PROGRESSIVE SUPRANUCLEAR PALSY William Liboni, Piero Pignatta, Elisabetta Salzedo, Sara Giordano, Filippo Molinari Bologna, 4-9 Oct 2010

  2. Introduction • Non-invasive detection and monitoring of movement disorders is the purpose of a clinician and neuroradiologist: • for assessing markers useful to early diagnosis; • to verify the progression of biological events. • Up to now, conventional diagnostic tools for assessing the degeneration of substantia nigra (SN) and nigro-striatal pathways has proven inadequate due to their inability to diagnose the pathology before the onset of clear clinical pathological signs. • Moreover, discrimination among idiopathic PD and atypical (ADP) Parkinsonism disorders in early stages is difficult: only 75% patients with PSP have correct probable diagnosis. The characteristic signs are at time challenging, since they have similar apparences. • In most cases, the median interval between onset and diagnosis is 3 years.

  3. Sample population age and sex matches Subjects Sex Subjects Age MEN WOMEN

  4. Transcranial Sonography (TCS) and MRI M MCA MCA M A BR SN M LN Third ventricle Standardized scanning planes (see Walter et al. UMB, 2007) • TCS: • low cost • not invasive tool • can asses Midbrain (M), Substantia Nigra (SN), Brainstem Raphe (BR), aqueduct (A), putaminal (LN).

  5. Strio-nigratal degeneration - SN hyper-echogenicity DaTScan TCS Idiopathic PD A-PD PSP • SN Hyperichogenicity: • PD  95% almost all • PSP  20% • controls  12% • LN Hyperichogenicity: • PD  16% almost all • PSP  80% • controls  --%

  6. Quantitative evaluation in conventional MRI In 2009 MRPI = 28.2 In 2010 the same subject showed a MRPI = 48.4

  7. Advanced MRI techniques: DTI (Diffusion Tensor Imaging) (ADC-FA quantitative indices) Regions-of-Interest (ROIs) M1 frontal lobe LN SN MCP SCP DTI-based tractography

  8. Interval between symptoms onset and MRI investigation > 6 yrs 17% 50% 33% 4<x<=6 yrs <=3 yrs

  9. MRI data comparison Regional ADC-FA values were calculated in each ROI. Median ADC and FA values were adapted as rapresentative indices of ADC and FA values. ADC index – median ± dev std FA index – median ± dev std

  10. Conclusions • TCS is a low-cost diagnostic modality to assess mesencephalic and putaminal echogenicity (most likely reflecting iron not bound to ferritine) • TCS discriminates between PD and PSP • MRI is sensititve to biological and structural changes in movement disorders • Conventional MRI has limited power in assessing early pathological stages • Computer quantitative analysis can help clinicians in discriminating between PD, MSA and PSP (Quattrone et al., Radiology, 2008) • Diffusion MRI using ADC-FA values modification, in selected areas characteristic of pathology involvement, could discriminate bewteen healthy and Parkinsonism, and, further, could discriminate between PD and PSP (and possibly MSA) • Our pilot study demonstrates the possibility of obtaining indicative descriptors of the presence and the progression of the pathology • TCS is a very repeatable and low-cost techniques; MR at 1.5T is relatively diffused and accessible to population and with overall costs compatible with mass screening.

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