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Erschienen in:
19.01.2017 | Neuro
Using ‘swallow-tail’ sign and putaminal hypointensity as biomarkers to distinguish multiple system atrophy from idiopathic Parkinson’s disease: A susceptibility-weighted imaging study
Erschienen in: European Radiology | Ausgabe 8/2017
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Objective
To investigate the value of ‘swallow-tail’ sign and putaminal hypointensity on 3 T susceptibility-weighted imaging (SWI) for distinguishing multiple system atrophy (MSA) from idiopathic Parkinson’s disease (IPD).
Methods
Three groups – 39 MSA patients, 18 IPD patients,and 31 healthy controls (HCs) – were administered a 3 T SWI sequence to evaluate ‘swallow-tail’ sign and putaminal hypointensity using visual scales from 0 to 2 and 0 to 3 scores, respectively. The diagnostic accuracy of the two signs separately and combined was calculated using a receiver operating characteristic curve, with clinical diagnosis as the gold standard.
Results
The scores of ‘swallow-tail’ sign were lower in IPD than in MSA or in HCs, as well as for putaminal hypointensity in IPD or HCs than in MSA (p < 0.05). The sensitivity and specificity of ‘swallow-tail’ sign and putaminal hypointensity were 87.9% and 83.3%, and 35.9% and 100%, respectively, in the respective patient groups. The area under the curve of combined signs was increased from 0.85 (‘swallow tail’) or 0.68 (putaminal hypointensity) to 0.93.
Conclusion
The combination of ‘swallow-tail’ sign and putaminal hypointensity can increase the accuracy of discriminating between MSA and IPD.
Key Points
• Differential diagnosis of MSA and IPD is still challenging in clinical practice.
• Absence of ‘swallow-tail’ sign is a valuable biomarker for IPD on SWI.
• Putaminal hypointensity is a valuable biomarker for MSA on SWI.
• Combined ‘swallow- tail’ sign and putaminal hypointensity increase diagnostic accuracy.