1、PSP影像学诊断,吴俊琦,PSP（progressive supranuclear palsy) 诊断标准,中年或中年后起病 ,进行性非家族性核上性眼肌麻痹至少有下列 5 项中的 2项:姿势不稳 ,向后跌倒; 假性球麻痹(构音障碍和吞咽困难) ; 少动和强直; 额叶综合征(智力迟钝 ,强握和模仿动作) ; 中轴肌张力异常和强直。以上症状非PSP特有，诊断还需要依靠影像学检查，特别是MRI,PSP的MRI诊断的几个参数,1 .T1 The superior profile of the midbrain(中脑上部轮廓）2 .T2 Midbrain global atrophy （中脑整体萎缩）3
2、 .T2 AP diameter of the midbrain at the level of the superior colliculus（中脑上丘水平前后径）4 .T2 the presence of abnormal hyperintensity in the mesencephalic tegmentum（中脑被盖异常高信号）5 .T2 Hypointensity in the posterolateral putamen（壳核后外侧低信号）6 .T2 Hyperintensityin the posterolateral putamen,The superior profile
3、of the midbrain,A. Parkinson B.&C. PSP,This sign is based on the observation that, in PSP, the atrophic midbrain (besides reduced AP diameter) shows a characteristic alteration in the normal convex profile of its superior surface, which tends to assume a flat or concave aspect on midline sagittal T1
4、-weighted sections The Presence of abnormal superior profile of the midbrain had 68% sensitivity and 88.8% specificity.,Midbrain global atrophy,In PSP, the main abnormalities are in the midbrain. Midbrain atrophy is particularly well appreciated in the midsagittal MRI section, which allows a direct
5、comparison with the other segments of the brainstemThe sensitivity 68% and specificity 77.7%,Axias ,T2-weighted spin-echo section show different degrees of midbrain atrophy,AP diameter of the midbrain at the level of the superior colliculus,The superior part of the quadrigeminal plate is often parti
6、cularly thin; this finding correlates with the gaze abnormalities peculiar to these patients,pons(A and B), midbrain (line 1, C and D), and quadrigeminal plate(line 2, A) on sagittal T1- andaxial T2-weighted magnetic resonance imageswith the imagers internal distance measurement device.,Patients wit
7、h PSP showed significantly lower midbrain diameters than Patients with PD and MSA-P and control subjects(P.001),the presence of abnormal hyperintensity in the mesencephalic tegmentum,Axial, 3-mm-thick, T2-weighted spin-echo sections show no abnormal tegmental hyperintensity (A) and abnormal tegmenta
8、l hyperintensity (B, arrow).,The presence of abnormal tegmental T2 hyperintensity had a sensitivity of 28% and a specificity of 100%.,Hypointensity and Hyperintensity in the posterolateral putamen are less frequently observed,Summary,1. The superior profile of the midbrain: convexflat or concave2.Midbrain global atrophy 3. AP diameter of the midbrain at the level of the superior colliculus,
