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Trajectories of Pontine Volume in Patients with Multiple System Atrophy
Kazuya Kawabata1,2,3,4, Florian Krismer1,5, Mizuki Ito2,4,6
1Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Summary
Pontine atrophy is a sensitive indicator of multiple system atrophy cerebellar subtype (MSA-C) progression. This brain volume decline is nonlinear, with significant loss early in the disease, potentially preceding symptom onset.
Area of Science:
- Neuroimaging
- Neurology
- Biomarker Discovery
Background:
- Reliable biomarkers are crucial for tracking multiple system atrophy (MSA) progression.
- Current neuroimaging markers often lack individual-level reliability and reproducibility.
Purpose of the Study:
- To investigate regional brain volume changes in MSA.
- To assess the utility of these changes as surrogate markers for disease progression in MSA cerebellar subtype (MSA-C).
Main Methods:
- Longitudinal 3D-T1 MRI scans from MSA-C, MSA-parkinsonian subtype (MSA-P), Parkinson's disease patients, and controls.
- FreeSurfer longitudinal pipeline used for volume extraction.
- Analysis of individual trajectories, variability, and pontine volume decline.
Main Results:
- Pontine volumes demonstrated lower measurement variability compared to other infratentorial regions.
- All MSA-C patients showed significant annual pontine volume decline (-9.1% mean), exceeding healthy control means.
- Pontine atrophy in MSA-C followed nonlinear dynamics, with early progressive loss and a later pre-plateau phase.
Conclusions:
- Pontine volume serves as a sensitive marker for MSA progression, characterized by nonlinear decline.
- Low intra-individual variability and greater early-stage volume loss highlight its potential as a reliable biomarker.
- Predictive modeling suggests pontine atrophy may precede clinical symptom onset in MSA-C.
