Clinical Study Of Multiple System Atrophy, Progressive Supranuclear Palsy By MRI And TCS

Objective: To explore the clinical features in multiple system atrophy and progressivesupranuclear palsy.Methods: We choose36patients with MSA,7patients with PSP diagnosed in thesecond affiliated hospital of Soochow University, Detailed history and physicalexamination of were collected, mainly includes the onset age, onset symptoms, symptomsduring progress of the disease, course of disease, diagnosis time, effect of anti-Parkinson’sdisease drug, and education, living environment, family history of cerebral vascular disease,special medication history, carbon monoxide poisoning history and poison contact history.Results: The onset age of MSA-P group, MSA-C group, PSP group and PD groupwere62.548.12years、59.026.12years、68.387.05years，62.67.8years respectively.The onset age of MSA-C group was significantly lower （P <0.05） compared with PDgroup. The incidence of tremor in MSA-P group, MSA-C group and PSP group （48.0%,36.4%,42.9%respectively） was significantly lower than that in PD group （88.4%）（P <0.05）, The incidence of rigidity in MSA-C group （90.1%） was higher than PD group（86.0%）（P<0.05）. The positive rate of Romberg sign in group MSA-P （32%） was higherthan PD group （9.3%）（P <0.05）.The positive rate of nasal test （63.6%） and Romberg sign（63.6%） in MSA-C group were higher than PD group （23.3%,9.3%respectively）（P <0.05）. The incidence of orthostatic hypotension （36.4%） in MSA-C group was higher thanPD group （4.7%）（P<0.05）. The incidence of cognitive impairment, palsy, pyramidal signs/tendon reflexes hyperfunction in MSA-P group （16%,12%,16%respectively） werehigher than group PD （4.7%,0,0respectively）（P<0.05）, The incidence of dysarthria, gazepalsy, orthostatic hypotension, extrapyramidal syndrome/tendon reflexes hyperfunction in MSA-C group （63.6%,18.2%,36.4%,36.4%respectively） were higher than PD group（23.3%,0,4.7%,0respectively）（P <0.05）; The incidence of falls, saccade/tracking down,cognitive impairment, gaze palsy, pyramidal signs/tendon reflexes hyperfunction in PSPgroup （85.7%,57.1%,42.9%,71.4%,28.6%respectively） were higher than PD group（16.3%,11.6%,4.7%,0,0respectively）（P <0.05）.Conclusion: MSA and PSP have their own unique clinical features, the incidence ofthe same symptoms/signs were different in each group, may be helpful in differentialdiagnosis with PD group Objective: To explore and quantitatively analyze morphology features in multiplesystem atrophy and progressive supranuclear palsy, provided objective evidence fordiagnosis and differential diagnosis of these diseases.Methods:29cases of MSA,7cases of PSP, gender, age matched36cases ofParkinson’s disease （PD） as case group, and gender, age matched36healthy objects ascontrols, using Philips Achieva1.5T superconducting whole-body magnetic resonanceimaging instrument and standard Sense-head head coil conventional MRI examination.Main measures:（1） T₂WI signal changes: the pontine cross sign （the basal portion of thepons visible cross high signal）;â‘¡middle cerebellar peduncle high signal;â‘¢putaminalslit syndrome （putamen outer margin fissured high signal）.（2） T1WI images, the brainatrophy;â‘¡cerebellar atrophy;â‘¢brainstem （medulla oblongata, midbrain, pons）atrophy. The datas were measured by of software View Forum4.1in the graphicworkstation: measuring area of pons and midbrain in the T1WI sagittal; measuring bilateralcerebellar peduncle width in the T1WI axis.Results:5cases（17.2%） of MSA show cross sign,4cases （13.8%） show slicksyndrome;The incidence of cerebellum atrophy, medulla atrophy in MSA-P group（33.3%,14.3%）, and temporal lobe atrophy, cerebellum atrophy, midbrain atrophy, pons atrophy,medulla atrophy in MSA-C group （37.5%,.62.5%,37.5%,37.5%,37.5%respectively） was significantly higher than PD group （4.7%,7%,4.7%,4.7%,0） and control group （4.7%,2.3%,0,0,0）（P <0.05）, The incidence of temporal lobe atrophy, midbrain atrophy,pontine atrophy in PSP group （42.9%,85.7%,28.6%, respectively） were significantlyhigher than PD group （4.7%,4.7%,4.7%） and control group （4.7%,0,0）（P <0.05）. Theincidence of crusade, high signal on MCP in MSA-C group （50%,50%） was significantlyhigher than PD group （0,0） and control group （0,0）（P <0.05）.5cases （71.4%） of PSPshow hummingbird sign, the incidence of hummingbird sign in PSP group（71.4%） wassignificantly higher than PD group （0） and control group （0）（P <0.05）. The midbrain area,pons area and middle cerebellar peduncle width in the21cases of MSA-P （130.9±51.9mm²,414.4±93.5mm²,12.0±2.5mm） and cerebellar peduncle width in MSA-C （12.8±2.9mm） decreased significantly than PD group （149.325.3mm²ã€502.664.8mm²ã€15.81.4mm） and control group （150.617.2mm²ã€503.844.9mm²ã€16.11.0mm）（P<0.05）. The midbrain area of PSP （97.434.2mm²ï¼‰ was significantly reduced than PDgroup and healthy control group （P <0.05）.Conclusion: Quantitative analysis of morphological features by conventional MRI,contributed to the diagnosis and differential diagnosis of MSA, PSP and IPD. and hadcertain value to the MSA subtype. Objective: To explore the TCS characteristics of multiple system atrophy, provideobjective evidence for diagnosis and differential diagnosis.Methods:21cases of MSA, gender, age-matched21cases of Parkinson’s disease （PD）patients as case group. The instrument adopts GE vivid7, M3S probe, probe frequency:2².5MHz, dynamic range:45⁵5dB,15¹7mm depth. The probe is arranged in thetemporal window close to the skin, the orbital line parallel to the ear （tip of ear and eyeline）. Main measures:（1） Semiquantitatively graded substantia nigra echogenicity;（2）Theratio: area of bilateral substantia nigra hypoechogenicity/total area of midbrain.Results: TCS was performed in22cases of MSA and22cases of PD,1patients withMSA and2patients with PD were excluded for the image ineffective,7cases （33.3%） of the remaining21MSA showed nigral hyperechogenicity,13cases （65%） of the remaining20PD cases showed the substantia nigra hyperechogenicity. Chi-square analysis showedthat the incidence of substantia nigra hyperechogenicity in MSA group was significantlyhigher than PD group （χ2=4.11, P=0.043）.7cases of MSA （33.3%） in substantia nigrahyperechogenicity≥grade â…¢, the area was0.16⁰.97cm².12cases （54.2%） of PD insubstantia nigra hyperechogenicity≥grade â…¢, area0.23¹.3cm², there were nosignificant difference of the area in substantia nigra hyperechogenicity≥Ⅲ and theratio of S/M between MSA and PD group （P<0.05）. The distribution of grade in positivesubstantia nigra echogenic was significant different between MSA and PD （Z=-3.12, P <0.05）.Conclusion: The incidence of substantia nigra hyperechogenicity in MSA wassignificantly lower than in PD.TCS was helpful for the differential diagnosis of MSA andPD.