• Marina Picillo, Maria Francesca Tepedino, Filomena Abate, Roberto Erro, Sara Ponticorvo, Salvatore Tartaglione, Giampiero Volpe, Daniela Frosini, Paolo Cecchi, Mirco Cosottini, Roberto Ceravolo, Fabrizio Esposito, Maria Teresa Pellecchia, Paolo Barone, and Renzo Manara.
• Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy.
• J. Neurol. Neurosurg. Psychiatr. 2020 Jan 1; 91 (1): 98-103.

ObjectivesTo explore the role of the available midbrain-based MRI morphometric assessments in (1) differentiating among progressive supranuclear palsy (PSP) subtypes (PSP Richardson's syndrome (PSP-RS), PSP with predominant parkinsonism (PSP-P) and the other variant syndromes of PSP (vPSP)), and (2) supporting the diagnosis of PSP subtypes compared with Parkinson's disease (PD) and healthy controls (HC).MethodsSeventy-eight patients with PSP (38 PSP-RS, 21 PSP-P and 19 vPSP), 35 PD and 38 HC were included in the present analysis. Available midbrain-based MRI morphometric assessments were calculated for all participants.ResultsCurrent MRI midbrain-based assessments do not display an adequate sensitivity and specificity profile in differentiating PSP subtypes. On the other hand, we confirmed MR Parkinsonism Index (MRPI) and pons area to midbrain area ratio (P/M) have adequate diagnostic value to support PSP-RS clinical diagnosis compared with both PD and HC, but low sensitivity and specificity profile in differentiating PSP-P from PD as well as from HC. The same measures show acceptable sensitivity and specificity profile in supporting clinical diagnosis of vPSP versus HC but not versus PD. Similar findings were detected for the newer MRPI and P/M versions.ConclusionsFurther studies are warranted to identify neuroimaging biomarkers supporting the clinical phenotypic categorisation of patients with PSP. MRPI and P/M have diagnostic value in supporting the clinical diagnosis of PSP-RS.Classification Of EvidenceThis study provides class III evidence that available MRI midbrain-based assessments do not have diagnostic value in differentiating the Movement Disorder Society PSP subtypes.© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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