doi: 10.3174/ajnr.A1443
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American Journal of Neuroradiology 30:689-692, April 2009
© 2009 American Society of Neuroradiology
BRAIN
Putaminal Hyperintensity on T1-Weighted MR Imaging in Patients with the Parkinson Variant of Multiple System Atrophy
a From the Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
Please address correspondence to Shoichi Ito, MD, Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; e-mail: sito{at}faculty.chiba-u.jp
BACKGROUND AND PURPOSE: A hyperintense putaminal rim, putaminal hypointensity, and putaminal atrophy on T2-weighted MR images are findings suggestive of parkinsonian-dominant multiple system atrophy (MSA-P). However, putaminal hyperintensity on T1-weighted images, which has not been discussed in previous reports, is also frequently observed in patients with MSA-P. Here, we investigated whether putaminal hyperintensity on T1-weighted images is helpful to diagnose MSA-P.
MATERIALS AND METHODS: Patients with MSA-P (n = 17), Parkinson disease (PD; n = 37) and progressive supranuclear palsy (PSP; n = 11), and healthy control subjects (n = 16) were enrolled in this study. Two examiners, who were blind to the diagnoses, independently rated the putaminal hyperintensity on T1-weighted images (T1H), hyperintense putaminal rim on T2-weighted images (T2H), putaminal hypointensity on T2-weighted images (T2 L), and putaminal atrophy by using a visual analog scale, and performed a receiver operating characteristic (ROC) analysis. The area under the curve (AUC; minimum, 0.5; maximum, 1.0) was automatically calculated as a positive parameter, indicating its usefulness to differentiate between diseases.
RESULTS: For differentiating patients with MSA-P from healthy control subjects, AUC values were 0.983 for T1H, 0.923 for T2H, 0.726 for T2 L, and 0.967 for putaminal atrophy. Between MSA-P and PD, the respective AUC values were 0.990, 0.921, 0.739, and 0.923; and between MSA-P and PSP, the respective AUC values were 0.984, 0.923, 0.727, and 0.967.
CONCLUSIONS: All putaminal findings except T2 L were useful for the diagnosis of MSA-P. T1H was superior to T2H to differentiate MSA-P from other diseases.