The utility of susceptibility-weighted imaging in the diagnosis of multiple system atrophy, cerebellar type

Abstract Background We have established radiological protocol and made morphological measurement of the lentiform nucleus (LN) and the signal intensity which we used to discriminate parkinsonism predominant multiple system atrophy (MSA-P) from Parkinson’s disease (PD). But we don’t know whether it works especially in early stage of MSA-P. This case-control study aimed to investigate whether the new measurement of the morphological and intensity changes in susceptibility weighted imaging (SWI) of the LN could discriminate MSA-P from PD in their early stage and controls. Methods We retrospectively enrolled patients with MSA-P, PD, and sex- and age-matched controls between January 2015 and July 2020 at the Movement Disorder Center who underwent brain MR scanning with SWI sequence. Two specialists at the center reviewed the medical records and made the final diagnosis, and two experienced neuroradiologists performed MRI image analysis based on a defined radiological protocol to conduct the region of interest (ROI) based morphological measurements of the LN and the signal intensity. Results A total of 17 patients with MSA-P, 17 patients with PD within 2 years of the disease duration and 17 controls were enrolled in this study. We found that patients with MSA-P had significant decreased size in the short line (SL, cSL), and the ratio of the SL and the long line (SLLr, cSLLr) compared with the patients with PD and with the controls (P < 0.05). Combining these four indexes, this finding had a sensitivity of 58.8% and a specificity of 100% to distinguish MSA-P from PD. Conclusions As compared to PD and control subjects, the MSA-P patients are characterized by narrowing morphology of the posterior region of LN. The quantitative morphological change is a possible potential marker to differentiate MSA-P from PD in the early stage.

Download Full-text

A case of multiple system atrophy

Journal of International Medical Research ◽

10.1177/0300060519864182 ◽

2019 ◽

Vol 47 (11) ◽

pp. 5839-5843

Author(s):

Jing Guo ◽

Fuying Liu ◽

Tingting Liu ◽

Xin Zhang ◽

Yong Luo

Keyword(s):

Multiple System Atrophy ◽

Neurodegenerative Disorder ◽

Psychological Impact ◽

Clinical Manifestations ◽

Cerebellar Atrophy ◽

Guizhou Province ◽

Motor Deficits ◽

Autonomic Nerves ◽

Autonomic Nervous System Disorders ◽

Cerebellar Type

Multiple system atrophy (MSA) is the most rapidly progressive neurodegenerative disorder among the various types of synucleinopathies. The cause of MSA remains unknown, but it can involve the extrapyramidal system, the pyramidal system, the autonomic nerves and the cerebellum. The main clinical manifestations are Parkinson's symptoms, cerebellar ataxia, pyramidal tract signs and autonomic nervous system disorders. Depending on the initial predominant motor deficits, MSA is subclassified into either Parkinsonian type (MSA-P) or cerebellar type (MSA-C). MSA is rare in the Zunyi area of Guizhou Province, so when it is observed for the first time it often results in a convoluted diagnosis and treatment process, which takes a lot of time, money, manpower and material resources, which can also have a psychological impact on the patient. This report describes the case of a 60-year-old woman who presented with syncope for 1 year combined with dizziness for 1 day. She had been diagnosed twice with transient ischaemic attack in the previous 6 months. Cranial magnetic resonance imaging suggested widening of the cerebellar sulcus and mild cerebellar atrophy. Based on the patient’s medical history, physical signs and auxiliary examinations, she was diagnosed with MSA-C.

Download Full-text