Contribution of routine brain MRI to the differential diagnosis of parkinsonism: a 3-year prospective follow-up study.
Publication year
2012Source
Journal of Neurology, 259, 5, (2012), pp. 929-35ISSN
Annotation
01 mei 2012
Publication type
Article / Letter to editor

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Organization
Radiology
Neurology
Intensive Care
Health Evidence
IQ Healthcare
Former Organization
Epidemiology, Biostatistics & HTA
Journal title
Journal of Neurology
Volume
vol. 259
Issue
iss. 5
Page start
p. 929
Page end
p. 35
Subject
DCN 2: Functional Neurogenomics NCEBP 10: Human Movement & Fatigue; DCN MP - Plasticity and memory; DCN MP - Plasticity and memory NCEBP 10: Human Movement & Fatigue; N4i 1: Pathogenesis and modulation of inflammation; NCEBP 2: Evaluation of complex medical interventions; NCEBP 6: Quality of nursing and allied health care; ONCOL 5: Aetiology, screening and detection; NCEBP 14: Cardiovascular diseases ONCOL 5: Aetiology, screening and detectionAbstract
Various signs on routine brain MRI can help differentiate between Parkinson's disease (PD) and the various forms of atypical parkinsonism (AP). Here, we evaluate what routine brain MRI contributes to the clinical diagnosis, in both early and advanced disease stages. We performed a prospective observational study in 113 patients with parkinsonism, but without definite diagnosis upon inclusion. At baseline, patients received a structured interview, comprehensive and standardized neurological assessment, and brain MRI. The silver standard diagnosis was made after 3 years of follow-up (PD n = 43, AP n = 57), which was based on disease progression, repeat standardized neurological examination and response to treatment. The clinical diagnosis was classified as having either 'low certainty' (lower than 80%) or 'high certainty' (80% or higher). The added diagnostic yield of baseline MRI results were then studied relative to clinical neurological evaluation at presentation, and at follow-up. Sensitivity and specificity for separating AP from PD were calculated for all potentially distinguishing MRI abnormalities described previously in the literature. MRI abnormalities showed moderate to high specificity but limited sensitivity for the diagnosis of AP. These MRI abnormalities contributed little over and above the clinically based diagnosis, except when the clinical diagnosis was uncertain. For these patients, presence of putaminal or cerebellar atrophy was particularly indicative of AP. Routine brain MRI has limited added value for differentiating between PD and AP when clinical certainty is already high, but has some diagnostic value when the clinical diagnosis is still uncertain.
This item appears in the following Collection(s)
- Academic publications [227883]
- Faculty of Medical Sciences [86219]
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