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Longitudinal quantitative MRI in multiple system atrophy and progressive supranuclear palsy
William Reginold1, Anthony E Lang2, Connie Marras2
1Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Canada; Department of Medical Imaging, Toronto Western Hospital, the Joint Department of Medical Imaging, and The University of Toronto, Canada.
Objective:
MRI has been used in parkinsonism to assess atrophy, tissue water diffusivity, and mineral deposition but usually at a single time-point. However, multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) are progressive diseases. This study assessed the value of longitudinal MRI in characterizing the time course of the degenerative process.
Methods:
Two serial MRIs (mean 23 months apart) were retrospectively analyzed in 12 MSA, 6 PSP, and 18 age and sex matched controls. Assessment included selected cross-sectional areas, regional apparent diffusion coefficient (ADC) and gradient echo (GRE) intensity ratios of the lateral ventricles, caudate, putamen, middle cerebellar peduncle, pons and midbrain.
Results:
On follow-up imaging, there was a larger ADC increase in the putamen in PSP over time compared to controls (p = 0.02). In MSA there was greater volume loss in the pons over time compared to controls (p = 0.002). In MSA the changes in middle cerebellar peduncle ADC were correlated with motor symptom severity according to the Unified Parkinson's Disease Rating Scale Part III (p = 0.005).
Conclusions:
Evidence of progressive neurodegeneration can be observed on MRI in MSA and PSP within two years consisting of increasing putaminal ADC in PSP and pontine atrophy in MSA.
Insights
Longitudinal MRI reveals progressive neurodegeneration in multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) within two years. Key findings include increasing putaminal apparent diffusion coefficient (ADC) in PSP and pontine atrophy in MSA.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Magnetic Resonance Imaging (MRI) is utilized in parkinsonism to evaluate atrophy, water diffusivity, and mineral deposition, typically at a single time point.
- Multiple System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP) are characterized by progressive neurodegenerative processes.
- Assessing the temporal progression of these diseases using MRI is crucial for understanding their natural history.
Purpose of the Study:
- To evaluate the utility of longitudinal MRI in characterizing the time course of neurodegeneration in MSA and PSP.
- To identify specific MRI markers that reflect disease progression in these conditions.
Main Methods:
- Retrospective analysis of two serial MRI scans (mean 23 months apart) from 12 MSA patients, 6 PSP patients, and 18 age/sex-matched controls.
- Assessment included cross-sectional areas, regional apparent diffusion coefficient (ADC), and gradient echo (GRE) intensity ratios in key brain structures (lateral ventricles, caudate, putamen, middle cerebellar peduncle, pons, midbrain).
Main Results:
- Progressive putaminal ADC increase was significantly greater in PSP compared to controls (p = 0.02).
- MSA exhibited greater pontine volume loss over time compared to controls (p = 0.002).
- In MSA, changes in middle cerebellar peduncle ADC correlated with motor symptom severity (Unified Parkinson's Disease Rating Scale Part III, p = 0.005).
Conclusions:
- Longitudinal MRI can detect evidence of progressive neurodegeneration in MSA and PSP within a two-year period.
- Specific MRI findings, such as increasing putaminal ADC in PSP and pontine atrophy in MSA, serve as indicators of disease progression.
