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Updated: Sep 20, 2025
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
The "Black Straight-Line Sign" in the Putamen in Diffusion-Weighted Imaging: A Potential Diagnostic MRI Marker for
Yiming Zheng1,2, Xiwen Wang1,3, Huajian Zhao1,4
1Department of Neurology, Peking University First Hospital, Beijing, China.
Background And Purpose:
The diagnosis of multiple system atrophy (MSA) remains challenging in clinical practice. This study investigated the value of hypointense signals in the putamen ("black straight-line sign") in diffusion-weighted imaging (DWI) of brain MRI for distinguishing (MSA) from Parkinson's disease (PD).
Methods:
We retrospectively enrolled 30 MSA patients, 30 PD patients, and 30 healthy controls who had undergone brain MRI between 2016 and 2020. Two readers independently assessed the signal intensity of the bilateral putamen on DWI. The putaminal hypointensity was scored using 4-point visual scales. Putaminal hypointensity and the presence of a "black straight-line sign" were statistically compared between MSA and PD or healthy controls.
Results:
The mean scores of putaminal hypointensity in DWI in the MSA group were significantly higher than in both the PD (U = 315.5, P = 0.034) and healthy control groups (U = 304.0, P = 0.022). Uni- or bilateral putaminal hypointensity in DWI with a score ≥2 was identified in 53.3% (16/30), 16.7% (5/30), and 13.3% (4/30) of MSA, PD, and healthy controls, respectively, with significant differences between MSA and PD (X2 = 8.864, P = 0.003) or healthy controls (X2 = 10.800, P = 0.001). Notably, the "black straight-line sign" of the putamen was observed in 16/30 (sensitivity 53.3%) patients with MSA, while it was absent in PD and healthy controls (specificity 100%). There were no significant differences for the presence of "black straight-line sign" in the MSA-P and MSA-C groups (X2 = 0.433, P = 0.510).
Conclusion:
The "black straight-line sign" of the putamen in DWI of head MRIs has the potential to serve as a diagnostic marker for distinguishing MSA from PD.
Insights
The "black straight-line sign" in brain MRI diffusion-weighted imaging (DWI) can help differentiate multiple system atrophy (MSA) from Parkinson's disease (PD). This MRI finding shows higher putaminal hypointensity in MSA patients, aiding in diagnosis.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Diagnosing multiple system atrophy (MSA) presents clinical challenges.
- Distinguishing MSA from Parkinson's disease (PD) is crucial for appropriate patient management.
Purpose of the Study:
- To evaluate the utility of the
- black straight-line sign
- observed as putaminal hypointensity on diffusion-weighted imaging (DWI) brain MRI.
- To determine if this sign can differentiate MSA from PD.
Main Methods:
- Retrospective analysis of brain MRIs from 30 MSA patients, 30 PD patients, and 30 healthy controls.
- Independent assessment of bilateral putaminal signal intensity on DWI using a 4-point visual scale.
- Statistical comparison of putaminal hypointensity and the
- black straight-line sign
- between groups.
Main Results:
- MSA patients exhibited significantly higher putaminal hypointensity scores on DWI compared to PD patients and healthy controls.
- The
- black straight-line sign
- was present in 53.3% of MSA patients but absent in all PD patients and healthy controls (100% specificity).
- Putaminal hypointensity with a score ≥2 was significantly more frequent in MSA (53.3%) than in PD (16.7%) or controls (13.3%).
Conclusions:
- The
- black straight-line sign
- in the putamen on DWI brain MRI shows promise as a diagnostic biomarker.
- This sign can aid in distinguishing multiple system atrophy (MSA) from Parkinson's disease (PD).
