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Updated: Jul 11, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
White Matter Abnormalities Track Disease Progression in Multiple System Atrophy
Sheelakumari Raghavan1, Timothy G Lesnick2, Anna M Castillo2
1Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Background:
White matter (WM) abnormalities have been implicated in clinically relevant functional decline in multiple system atrophy (MSA).
Objective:
To identify the WM and gray matter (GM) abnormalities in MSA and assess the utility of longitudinal structural and diffusion changes as surrogate markers for tracking disease progression in MSA.
Methods:
Twenty-seven participants with early MSA [15 with clinically predominant cerebellar (MSA-C) and 12 with clinically predominant parkinsonian features (MSA-P)] and 14 controls were enrolled as a part of our prospective, longitudinal study of synucleinopathies. Using structural magnetic resonance imaging (MRI) and diffusion MRI (diffusion tensor and neurite orientation and dispersion density imaging), we analyzed whole and regional brain changes in these participants. We also evaluated temporal imaging trajectories based on up to three annual follow-up scans and assessed the impact of baseline diagnosis on these imaging biomarkers using mixed-effect models.
Results:
MSA patients exhibited more widespread WM changes than GM, particularly in the cerebellum and brainstem, with greater severity in MSA-C. Structural and diffusion measures in the cerebellum WM and brainstem deteriorated with disease progression. Rates of progression of these abnormalities were similar in both MSA subtypes, reflecting increasing overlap of clinical features over time.
Conclusion:
WM abnormalities are core features of MSA disease progression and advance at similar rates in clinical MSA subtypes. Multimodal MRI imaging reveals novel insights into the distribution and pattern of brain abnormalities and their progression in MSA. Selected structural and diffusion measures may be useful for tracking disease progression in MSA clinical trials.
Insights
White matter abnormalities are central to multiple system atrophy (MSA) progression, affecting both subtypes similarly. Longitudinal MRI can track these brain changes in clinical trials.
Area of Science:
- Neuroimaging
- Neurology
- Neurodegeneration
Background:
- White matter (WM) abnormalities are linked to functional decline in multiple system atrophy (MSA).
- Understanding these changes is crucial for tracking disease progression.
Purpose of the Study:
- Identify white matter (WM) and gray matter (GM) abnormalities in MSA.
- Assess longitudinal structural and diffusion MRI changes as surrogate markers for disease progression.
Main Methods:
- Prospective, longitudinal study of 27 early MSA patients (MSA-C and MSA-P) and 14 controls.
- Utilized structural and diffusion MRI (DT-MRI, NODDI) to analyze brain changes.
- Evaluated temporal imaging trajectories with up to three annual follow-up scans.
Main Results:
- MSA patients showed more widespread WM than GM changes, especially in the cerebellum and brainstem.
- Cerebellum WM and brainstem structural and diffusion measures worsened with disease progression.
- Progression rates were similar across MSA subtypes, indicating clinical feature overlap.
Conclusions:
- WM abnormalities are key features of MSA progression, advancing at similar rates in subtypes.
- Multimodal MRI provides insights into MSA brain abnormalities and their progression.
- Selected MRI measures show potential for tracking MSA progression in clinical trials.
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