July 27, 2026

@michaelokun

Do you know all the imaging signs of progressive supranuclear palsy (PSP)? Jen Goldman reviewed this morning in Aspen. Over the last two decades, neuroimaging has transformed how we recognize this challenging disorder. Many clinicians are familiar with the classic hummingbird (or penguin) sign on midsagittal MRI and the Mickey Mouse sign on axial imaging, but don't forget the morning glory sign, the midbrain-to-pons ratio, and the magnetic resonance parkinsonism index (MRPI and MRPI 2.0), which can improve diagnostic confidence, particularly in earlier disease. Although DaTSCAN is helpful in confirming a degenerative parkinsonian syndrome, it does not reliably distinguish Parkinson's disease from PSP or multiple system atrophy (MSA). Exciting advances are also emerging in tau PET imaging and quantitative MRI. One of the most exciting recent developments is the FDA clearance of NeuroPACS AIDP, an AI-powered MRI analysis platform designed to assist clinicians in differentiating Parkinson's disease, PSP, and MSA using routine brain MRI. While no imaging test replaces a careful history and neurological examination, combining expert clinical assessment with advanced imaging and artificial intelligence is bringing us closer to earlier and more accurate diagnoses for people living with parkinsonian syndromes. The future is arriving faster than many of us imagined.