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Characteristic MRI findings in multiple system atrophy: comparison of the three subtypes
1Third Department of Internal Medicine, Hiroshima University School of Medicine, Japan. h.naka@do4.enjoy.ne.jp
Abstract:
We reviewed MRI findings in 29 patients with probable multiple system atrophy (MSA) to see whether there were common and or less common neuroradiological findings in the various clinical subtypes. We divided the patients into three clinical subtypes according to initial and predominant symptoms: 14 with olivopontocerebellar atrophy (OPCA), eight with the Shy-Drager syndrome (SDS) and seven with striatonigral degeneration (SND). The patients showed atrophy of the brain stem and cerebellum, high signal on T2-weighted images of the base of the pons and middle cerebellar peduncles, high and low signal on T2-weighted images of the putamen and atrophy of frontal and parietal lobes. The degree of atrophy of the middle cerebellar peduncle and cerebellum was greater in OPCA patients and a high-signal lateral rim to the putamen more frequent in SND. However, all findings were observed in all subtypes, and the degrees of atrophy of the putamen and pons and the frequency of high signal in the base of the pons were similar in the subtypes. We also found atrophy of the cerebral hemispheres, especially the frontal and parietal lobes, but its degree was not significantly different in the various subtypes. Our findings suggest that, although MSA can be divided clinically into three subtypes, most of the features on MRI are common and overlap in the subtypes, independently of the clinical presentation.
Insights
Multiple system atrophy (MSA) subtypes show overlapping MRI findings. Neuroradiological features are common across olivopontocerebellar atrophy, Shy-Drager syndrome, and striatonigral degeneration, regardless of clinical presentation.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Multiple system atrophy (MSA) is a neurodegenerative disorder with diverse clinical presentations.
- Clinical classification of MSA includes olivopontocerebellar atrophy (OPCA), Shy-Drager syndrome (SDS), and striatonigral degeneration (SND).
- Understanding common and distinct neuroradiological findings in MSA subtypes is crucial for diagnosis and research.
Purpose of the Study:
- To investigate common and less common magnetic resonance imaging (MRI) findings in probable multiple system atrophy (MSA) patients.
- To correlate MRI findings with the three main clinical subtypes of MSA: OPCA, SDS, and SND.
- To determine if specific MRI features are associated with particular clinical presentations of MSA.
Main Methods:
- Retrospective review of MRI scans from 29 patients diagnosed with probable MSA.
- Patients were categorized into three clinical subtypes: OPCA (n=14), SDS (n=8), and SND (n=7).
- Analysis of common neuroradiological features including atrophy patterns, T2-weighted signal abnormalities in the brainstem, cerebellum, and basal ganglia.
Main Results:
- Common MRI findings included brainstem and cerebellar atrophy, high T2 signal at the base of the pons and middle cerebellar peduncles, putaminal T2 signal abnormalities, and frontal/parietal lobe atrophy.
- While some differences were noted (e.g., greater cerebellar/peduncle atrophy in OPCA, putaminal rim in SND), most findings were present across all subtypes.
- The degree of putaminal and pontine atrophy, and pontine base high signal intensity, were similar across the clinical subtypes.
Conclusions:
- Despite clinical heterogeneity, multiple system atrophy (MSA) subtypes share significant overlapping MRI features.
- Neuroradiological findings on MRI are largely common across OPCA, SDS, and SND, irrespective of the predominant clinical symptoms.
- MRI patterns in MSA do not strongly differentiate between the established clinical classifications, highlighting the need for integrated clinical and imaging assessment.