American Journal of Neuroradiology 2009;30:689.
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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1443
BRAIN
Putaminal Hyperintensity on T1-Weighted MR Imaging in Patients with the Parkinson Variant of Multiple System Atrophy
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.