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Putaminal hypointensity on T2*-weighted MR imaging is the most practically useful sign in diagnosing multiple system
Atsuhiko Sugiyama1, Shoichi Ito2, Tomoki Suichi3
1Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Objective:
To identify useful MRI abnormalities in the putamen for diagnosing multiple system atrophy.
Methods:
Patients with multiple system atrophy (n=15), Parkinson's disease (n=16), or progressive supranuclear palsy (n=9) and healthy controls (n=10) were enrolled. Using a visual analog scale, 4 examiners independently rated high-intensity signals along the lateral putamen on T2-weighted and T2*-weighted images, low-intensity signals within the putamen on T2-weighted and T2*-weighted images, and putaminal atrophy. Receiver operating characteristic analyses were performed, and the area under the receiver operating characteristic curve was calculated.
Results:
For differentiating multiple system atrophy from progressive supranuclear palsy, Parkinson's disease, and healthy controls, the mean area under the curve values was the highest for low-intensity signals within the putamen on T2*-weighted images (0.797, 0.867, 0.896, respectively). Variations in the area under the curve values among the 4 examiners were the smallest in low-intensity signals within the putamen on T2*-weighted images. Good inter-rater reliability was achieved for low-intensity signals within the putamen on T2*-weighted images and high-intensity signals along the lateral putamen on T2*-weighted images.
Conclusion:
Low-intensity signals within the putamen on T2*-weighted images is the most useful MRI abnormality for diagnosing multiple system atrophy.
Insights
Low-intensity signals within the putamen on T2*-weighted MRI scans are the most effective indicator for diagnosing multiple system atrophy (MSA). This finding aids in differentiating MSA from Parkinson's disease and progressive supranuclear palsy.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Multiple system atrophy (MSA) is a rare neurodegenerative disorder.
- Accurate diagnosis of MSA is crucial for appropriate patient management.
- Distinguishing MSA from other parkinsonian syndromes like Parkinson's disease (PD) and progressive supranuclear palsy (PSP) can be challenging.
Purpose of the Study:
- To determine the most useful magnetic resonance imaging (MRI) abnormalities in the putamen for diagnosing MSA.
- To evaluate the diagnostic performance of specific MRI findings in differentiating MSA from other neurological conditions.
Main Methods:
- A comparative study involving patients with MSA, PD, PSP, and healthy controls.
- Independent assessment of putaminal MRI abnormalities (high/low intensity signals, atrophy) by four examiners.
- Utilized T2-weighted and T2*-weighted imaging sequences.
- Performed receiver operating characteristic (ROC) analyses to calculate the area under the curve (AUC).
Main Results:
- Low-intensity signals within the putamen on T2*-weighted images demonstrated the highest AUC values for differentiating MSA from PD, PSP, and controls.
- This specific MRI finding exhibited the least variation among examiners, indicating good inter-rater reliability.
- High-intensity signals along the lateral putamen on T2*-weighted images also showed good inter-rater reliability.
Conclusions:
- Low-intensity signals within the putamen on T2*-weighted MRI are the most valuable imaging biomarker for diagnosing MSA.
- This MRI finding offers a reliable method for distinguishing MSA from other parkinsonian syndromes.
