PSP的影像学诊断课件

1、PSP的影像学诊断第1页，共16页。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第2页，共16页。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 atroph

2、y （中脑整体萎缩）3 .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第3页，共16页。Th

3、e superior profile of the midbrainA. Parkinson B.&C. PSP第4页，共16页。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 asp

4、ect on midline sagittal T1-weighted sections The Presence of abnormal superior profile of the midbrain had 68% sensitivity and 88.8% specificity. 第5页，共16页。Midbrain global atrophyIn PSP, the main abnormalities are in the midbrain. Midbrain atrophy is particularly well appreciated in the midsagittal M

5、RI section, which allows a direct comparison with the other segments of the brainstemThe sensitivity 68% and specificity 77.7%第6页，共16页。Axias ,T2-weighted spin-echo section show different degrees of midbrain atrophy第7页，共16页。第8页，共16页。AP diameter of the midbrain at the level of the superior colliculusT

6、he superior part of the quadrigeminal plate is often particularly thin; this finding correlates with the gaze abnormalities peculiar to these patients第9页，共16页。第10页，共16页。pons(A and B), midbrain (line 1, C and D), and quadrigeminal plate(line 2, A) on sagittal T1- andaxial T2-weighted magnetic resonan

7、ce imageswith the imagers internal distance measurement device.第11页，共16页。Patients with PSP showed significantly lower midbrain diameters than Patients with PD and MSA-P and control subjects(P.001)第12页，共16页。the presence of abnormal hyperintensity in the mesencephalic tegmentumAxial, 3-mm-thick, T2-we

8、ighted spin-echo sections show no abnormal tegmental hyperintensity (A) and abnormal tegmental hyperintensity (B, arrow).第13页，共16页。The presence of abnormal tegmental T2 hyperintensity had a sensitivity of 28% and a specificity of 100%. 第14页，共16页。Hypointensity and Hyperintensity in the posterolateral putamen are less frequently observed第15页，共16页。Summary1. The superior profile of the midbra