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Putaminal lesion in multiple system atrophy: postmortem MR-pathological correlations

  • Diagnostic Neuroradiology
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Abstract

Introduction

Posterior putaminal atrophy, putaminal T2-hyper and/or hyposignal changes have been observed in patients with multiple system atrophy (MSA) with parkinsonism.

Methods

Postmortem T2-weighted images were compared with histological findings in seven autopsy-proven cases of putaminal lesions of MSA. All cases were evaluated on 1.5T magnetic resonance imaging (MRI) scanners and three cases were evaluated on 3T scanners.

Results

There were three types of putaminal changes: Type 1, mild putaminal atrophy and isointensity; Type 2, putaminal atrophy and diffuse hyperintensity with a hyperintense putaminal rim (HPR); Type 3, putaminal atrophy and iso-or-hypointensity with HPR. The signal intensities of the putamen in Types 1 and 3 were more hypointense on 3T images than on 1.5T images. In Type 1, mild putaminal atrophy showed mild neuronal loss and gliosis and diffuse ferritin deposition. In Types 2 and 3, the areas of putaminal atrophy, severe in the posterior region, showed severe neuronal loss and gliosis, many pigments that were positive for ferritin and Fe 3+ and diffuse ferritin deposition. Although, tissue rarefaction was more severe in Type 2 than in Type 3, pigment deposition was more severe in Type 3. The HPR showed a severe loss of myelin and axons with tissue rarefaction of the external capsule or putaminal rim in Types 2 and 3.

Conclusion

Posterior putaminal atrophy reflects neuronal loss and gliosis. While putaminal iso-or -hypointensity reflects diffuse ferritin and Fe3+ deposition, hyperintensity reflects tissue rarefaction. The HPR reflects degeneration of the putaminal lateral margin and/or external capsule. These findings reflect characteristic histological findings of MSA with parkinsonism.

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References

  1. Papp MI, Kahn JE, Lantos PL (1989) Glial cytoplasmic inclusions in the CNS of patients with multiple system atrophy (striatonigral degeneration, olivopontocerebellar atrophy and Shy-Drager syndrome). J Neurol Sci 94:78–100

    Article  Google Scholar 

  2. Dickson DW, Lin W, Liu WK, Yen SH (1999) Multiple system atrophy: a sporadic synucleinopathy. Brain Pathol 9:721–732

    PubMed  CAS  Google Scholar 

  3. Gilman S, Low PA, Quinn N, Albanese A, Ben-Shlomo Y, Fowler CJ et al. (1999) Consensus statement on the diagnosis of multiple system atrophy (review). J Neurol Sci 163:94–98

    Article  PubMed  CAS  Google Scholar 

  4. Schrag A, Kingsley D, Phatouros C, Mathias CJ, Lees AJ, Daniel SE, Guinn NP (1998) Clinical usefulness of magnetic resonance imaging in multiple system atrophy. J Neurol Neurosurg Psychiatry 65:65–71

    PubMed  CAS  Google Scholar 

  5. Savoiardo M, Strada L, Girotti F, Zimmerman RA, Grisoli M, Testa D, Petrillo R (1990) Olivopontocerebellar atrophy: MR diagnosis and relationship to multiple system atrophy. Radiology 174:693–696

    PubMed  CAS  Google Scholar 

  6. Kraft E, Schwarz J, Trenkwalder C, Vogl T, Pfluger T, Oertel WH (1999) The combination of hypointense and hyperintense signal changes on T2-weighted magnetic resonance imaging sequences. Arch Neurol 56:225–228

    Article  PubMed  CAS  Google Scholar 

  7. Schrag A, Kingsley D, Phatouros C, Mathias CJ, Lees AJ, Caniel SE, Quinn NP (1998) Clinical usefulness of magnetic resonance imaging in multiple system atrophy. J Neurol Neurosurg Psychiatry 65:65–71

    Article  PubMed  CAS  Google Scholar 

  8. Naka H, Ohshita T, Murata Y, Imon Y, Mimori Y, Nakamura S (2002) Characteristic MRI findings in multiple system atrophy: comparison of the three subtypes. Neuroradiology 44:204–209

    Article  PubMed  CAS  Google Scholar 

  9. Bhattacharya K, Saadia D, Eisenkraft B, Yahr M, Olanow W, Drayer B, Kaufmann H (2002) Brain magnetic resonance imaging in multiple-system atrophy and Parkinson disease. A diagnostic algorithm. Arch Neurol 59:835–842

    Article  PubMed  Google Scholar 

  10. Yagishita A (1994) MR-pathologic correlations of putaminal lesion in multiple system atrophy (in Japanese). Pathol Clin Med 12:327–334

    Google Scholar 

  11. Konagaya M, Sakai M, Matsuoka Y, Goto Y, Yoshida M, Hashizume Y (1999) Pathological correlate of the slitlike changes on MRI at the putaminal margin in the multiple system atrophy (in Japanese). J Neurol 246:142–143

    Article  PubMed  CAS  Google Scholar 

  12. Schwarz J, Weis S, Kraft E, Tatsch K, Bandmann O, Mehraein P, Vogl T, Oertel WH (1996) Signal changes on MRI and increases in reactive microgliosis, astrogliosis, and iron in the putamen of two patients with multiple system atrophy. J Neurol Neurosurg Psychiatry 60:98–101

    PubMed  CAS  Google Scholar 

  13. Lang AE, Curran T, Provias J, Bergeron C (1994) Striatonigral degeneration: deposition in putamen correlate with the slit-like void signal of magnetic resonance imaging. Can J Neurol Sci 21:311–318

    PubMed  CAS  Google Scholar 

  14. Martin WR, Roberts TE, Ye FQ, Allen PS (1998) Increased basal ganglia iron in striatonigral degeneration: in vivo estimation with magnetic resonance. Can J Neurol Sci 25:44–47

    PubMed  CAS  Google Scholar 

  15. Blamire AM, Rowe JG, Styles P, McDonald B (1999) Optimising imaging parameters for post mortem MR imaging of the human brain. Acta Radiol 40:593–597

    Article  PubMed  CAS  Google Scholar 

  16. Fearnley JM, Lees AJ (1990) Striatonigral degeneration. A clinicopathological study. Brain 113:1823–1842

    Article  PubMed  Google Scholar 

  17. Wenning GK, Seppi K, Tison F, Jellinger K (2002) A novel grading scale for striatonigral degeneration (multiple system atrophy). J Neural Transm 109:307–320

    Article  PubMed  CAS  Google Scholar 

  18. Haque TL, Miki Y, Kanagaki M, Takahashi T, Yamamoto A, Konishi J, Nozaki K, Hashimoto N, Konishi J (2003) MR contrast of ferritin and hemosiderin in the brain: comparison among gradient-echo, conventional spin-echo and fast spin-echo sequences. Eur J Radiol 48:230–236

    Article  PubMed  Google Scholar 

  19. Kato S, Meshitsuka S, Ohama E, Tanaka J, Llena JF, Hirano A (1992) Increased iron content in the putamen of patients with striatonigral degeneration. Acta Neuropathol 84:328–330

    PubMed  CAS  Google Scholar 

  20. Lowe JS, Leigh N (2002) Multiple system atrophy. In: Graham DI, Lantos PL (eds) Green field’s neuropathology, 7th edn. Edward Arnold, London, pp 343–346

    Google Scholar 

  21. Lee WH, Lee CC, Shyu WC, Chong PN, Lin SZ (2005) Hyperintense putaminal rim sign is not a hallmark of multiple system atrophy at 3T. AJNR Am J Neuroradiol 26:2238–2342

    PubMed  Google Scholar 

  22. Fujii S, Matsusue E, Kinoshita T, Sugihara S, Ohama E, Ogawa T (2007) Hyperintense putaminal rim at 3T reflects fewer ferritin deposits in the lateral marginal area of the putamen. AJNR Am J Neuroradiol 28:777–781

    PubMed  CAS  Google Scholar 

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Acknowledgements

We are grateful to Eiji Yamashita, B.S., Naoki Iwata, B.S., Takuro Tanaka, B.S., Hiroki Katayama, B.S., and Takeshi Yamane, B.S., for technical support in obtaining high-quality MR images for this study.

Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori Prefecture, 683-8504, Japan

    Eiji Matsusue, Shinya Fujii, Yoshiko Kanasaki, Shuji Sugihara & Toshihide Ogawa

  2. Department of Neuropathology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori Prefecture, 683-8504, Japan

    Hajime Miyata & Eisaku Ohama

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  1. Eiji Matsusue
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  2. Shinya Fujii
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  3. Yoshiko Kanasaki
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  4. Shuji Sugihara
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  5. Hajime Miyata
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  6. Eisaku Ohama
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  7. Toshihide Ogawa
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Correspondence to Eiji Matsusue.

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Matsusue, E., Fujii, S., Kanasaki, Y. et al. Putaminal lesion in multiple system atrophy: postmortem MR-pathological correlations. Neuroradiology 50, 559–567 (2008). https://doi.org/10.1007/s00234-008-0381-y

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  • DOI: https://doi.org/10.1007/s00234-008-0381-y

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