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Updated: Jul 16, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
T2*-weighted MRI in diagnosis of multiple system atrophy. A practical approach for clinicians
Friederike von Lewinski1, Carola Werner, Torsten Jörn
1Paracelsus-Elena-Klinik, Klinikstr. 16, 34128 Kassel, Germany. flewins@gwdg.de
Background:
Putaminal iron deposition is a histopathological feature of multiple system atrophy (MSA), which is not observed in patients with idiopathic Parkinson's disease (PD). T2*-weighted magnetic resonance imaging (MRI) gradient echo (GE) sequences are sensitive for paramagnetic susceptibility changes and therefore may support the clinical differential diagnosis between MSA and PD.
Methods:
We evaluated putaminal signal intensities on 1.0 Tesla scans of 52 MSA patients, 88 patients with PD and 29 healthy control subjects.
Results:
The typical finding in T2* GE sequences of MSA patients was a signal loss of the dorsolateral putamen, which showed a high specificity (>0.91), but was present in only a subpopulation of patients (sensitivity 0.64-0.69). The combination of the latter with additional presence of a hyperintense lateral rim in fluid attenuated inversion recovery (FLAIR) sequences increased the specificity to 0.97. Using a quantitative evaluation of putaminal signal intensities in defined regions of interest MSA and PD could be discriminated with a diagnostic accuracy (r) of up to 0.82.
Conclusion:
Although the separation of groups remains incomplete, the use of T2*-weighted GE sequences combined with FLAIR may be helpful for the differential diagnosis of MSA versus PD considering its fast application, easy evaluation, broad availability, the specificity of findings and the presence of putaminal signal loss already at early disease stages.
Insights
Magnetic resonance imaging (MRI) using T2*-weighted gradient echo (GE) sequences can help differentiate multiple system atrophy (MSA) from Parkinson
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Putaminal iron deposition is a hallmark of multiple system atrophy (MSA), distinguishing it from idiopathic Parkinson's disease (PD).
- T2*-weighted MRI gradient echo (GE) sequences detect paramagnetic susceptibility changes, aiding in the differential diagnosis between MSA and PD.
Purpose of the Study:
- To evaluate the utility of T2*-weighted MRI GE sequences in differentiating between MSA and PD.
- To assess the diagnostic accuracy of putaminal signal intensities in distinguishing these neurodegenerative diseases.
Main Methods:
- Evaluated putaminal signal intensities on 1.0 Tesla MRI scans.
- Included 52 patients with MSA, 88 patients with PD, and 29 healthy control subjects.
- Utilized T2* GE sequences and fluid attenuated inversion recovery (FLAIR) sequences.
Main Results:
- A signal loss in the dorsolateral putamen was observed in MSA patients with high specificity (>0.91) but moderate sensitivity (0.64-0.69).
- Combining T2* GE findings with a hyperintense lateral rim on FLAIR sequences increased specificity to 0.97.
- Quantitative analysis of putaminal signal intensities achieved a diagnostic accuracy of up to 0.82 for discriminating MSA from PD.
Conclusions:
- T2*-weighted GE sequences, particularly when combined with FLAIR, offer a valuable tool for the differential diagnosis of MSA versus PD.
- This MRI approach is fast, easy to evaluate, widely available, and detects characteristic findings even in early disease stages.
