Skip to main content
SpringerLink
Log in

T2*-weighted MRI in diagnosis of multiple system atrophy

A practical approach for clinicians

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background

Putaminal iron deposition is a histopathological feature of multiple system atrophy (MSA), which is not observed in patients with idiopathic Parkinson’s disease (PD). T2*-weighted magnetic resonance imaging (MRI) gradient echo (GE) sequences are sensitive for paramagnetic susceptibility changes and therefore may support the clinical differential diagnosis between MSA and PD.

Methods

We evaluated putaminal signal intensities on 1.0 Tesla scans of 52 MSA patients, 88 patients with PD and 29 healthy control subjects.

Results

The typical finding in T2* GE sequences of MSA patients was a signal loss of the dorsolateral putamen, which showed a high specificity (>0.91), but was present in only a subpopulation of patients (sensitivity 0.64–0.69). The combination of the latter with additional presence of a hyperintense lateral rim in fluid attenuated inversion recovery (FLAIR) sequences increased the specificity to 0.97. Using a quantitative evaluation of putaminal signal intensities in defined regions of interest MSA and PD could be discriminated with a diagnostic accuracy (r) of up to 0.82.

Conclusion

Although the separation of groups remains incomplete, the use of T2*-weighted GE sequences combined with FLAIR may be helpful for the differential diagnosis of MSA versus PD considering its fast application, easy evaluation, broad availability, the specificity of findings and the presence of putaminal signal loss already at early disease stages.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ghaemi M, Hilker R, Rudolf J, Sobesky J, Heiss WD (2002) Differentiating multiple system atrophy from Parkinson’s disease: contribution of striatal and midbrain MRI volumetry and multi-tracer PET imaging. J Neurol Neurosurg Psychiat 73:517–523

    Article  CAS  PubMed  Google Scholar 

  2. Plotkin M, Amthauer H, Klaffke S, Kuhn A, Ludemann L, Arnold G, Wernecke KD, Kupsch A, Felix R, Venz S (2005) Combined (123)I-FP-CIT and (123)I-IBZM SPECT for the diagnosis of parkinsonian syndromes: study on 72 patients. J Neural Transm 112:677–692

    Article  CAS  PubMed  Google Scholar 

  3. Seppi K, Schocke MF, Donnemiller E, Esterhammer R, Kremser C, Scherfler C, Diem A, Jaschke W, Wenning GK, Poewe W (2004) Comparison of diffusion-weighted imaging and [123I]IBZM-SPECT for the differentiation of patients with the Parkinson variant of multiple system atrophy from those with Parkinson’s disease. Mov Disord 19:1438–1445

    Article  PubMed  Google Scholar 

  4. Seppi K, Schocke MF (2005) An update on conventional and advanced magnetic resonance imaging techniques in the differential diagnosis of neurodegenerative parkinsonism. Curr Opin Neurol 18:370–375

    Article  PubMed  Google Scholar 

  5. Schocke MF, Seppi K, Esterhammer R, Kremser C, Jaschke W, Poewe W, Wenning GK (2002) Diffusion-weighted MRI differentiates the Parkinson variant of multiple system atrophy from PD. Neurology 58:575–580

    CAS  PubMed  Google Scholar 

  6. Schocke MF, Seppi K, Esterhammer R, Kremser C, Mair KJ, Czermak BV, Jaschke W, Poewe W, Wenning GK (2004) Trace of diffusion tensor differentiates the Parkinson variant of multiple system atrophy and Parkinson’s disease. Neuroimage 21:1443–1451

    Article  PubMed  Google Scholar 

  7. Paviour DC, Price SL, Jahanshahi M, Lees AJ, Fox NC (2006) Longitudinal MRI in progressive supranuclear palsy and multiple system atrophy: rates and regions of atrophy. Brain 129:1040–1049

    Article  PubMed  Google Scholar 

  8. Schulz JB, Skalej M, Wedekind D, Luft AR, Abele M, Voigt K, Dichgans J, Klockgether T (1999) Magnetic resonance imaging-based volumetry differentiates idiopathic Parkinson’s syndrome from multiple system atrophy and progressive supranuclear palsy. Ann Neurol 45:65–74

    Article  CAS  PubMed  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. Horimoto Y, Aiba I, Yasuda T, Ohkawa Y, Katayama T, Yokokawa Y, Goto A, Ito Y (2002) Longitudinal MRI study of multiple system atrophy–when do the findings appear, and what is the course? J Neurol 249:847–854

    Article  PubMed  Google Scholar 

  11. Lee EA, Cho HI, Kim SS, Lee WY (2004) Comparison of magnetic resonance imaging in subtypes of multiple system atrophy. Parkinsonism Relat Disord 10:363–368

    Article  PubMed  Google Scholar 

  12. Righini A, Antonini A, Ferrarini M, de Notaris R, Canesi M, Triulzi F, Pezzoli G (2002) Thin section MR study of the basal ganglia in the differential diagnosis between striatonigral degeneration and Parkinson disease. J Comput Assist Tomogr 26:266–271

    Article  PubMed  Google Scholar 

  13. Savoiardo M (2003) Differential diagnosis of Parkinson’s disease and atypical parkinsonian disorders by magnetic resonance imaging. Neurol Sci 24(Suppl 1):S35–S37

    Article  PubMed  Google Scholar 

  14. Schrag A, Good CD, Miszkiel K, Morris HR, Mathias CJ, Lees AJ, Quinn NP (2000) Differentiation of atypical parkinsonian syndromes with routine MRI. Neurology 54:697–702

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  16. Fearnley JM, Lees AJ (1990) Striatonigral degeneration. A clinicopathological study. Brain 113(Pt 6):1823–1842

    Article  PubMed  Google Scholar 

  17. Kraft E, Trenkwalder C, Auer DP (2002) T2*-weighted MRI differentiates multiple system atrophy from Parkinson’s disease. Neurology 59:1265–1267

    PubMed  Google Scholar 

  18. Gilman S, Low PA, Quinn N, Albanese A, Ben-Shlomo Y, Fowler CJ, Kaufmann H, Klockgether T, Lang AE, Lantos PL, Litvan I, Mathias CJ, Oliver E, Robertson D, Schatz I, Wenning GK (1999) Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci 163:94–98

    Article  CAS  PubMed  Google Scholar 

  19. Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiat 55:181–184

    Article  CAS  PubMed  Google Scholar 

  20. 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: a specific marker of multiple system atrophy? Arch Neurol 56:225–228

    Article  CAS  PubMed  Google Scholar 

  21. Dexter DT, Carayon A, Javoy-Agid F, Agid Y, Wells FR, Daniel SE, Lees AJ, Jenner P, Marsden CD (1991) Alterations in the levels of iron, ferritin and other trace metals in Parkinson’s disease and other neurodegenerative diseases affecting the basal ganglia. Brain 114(Pt 4):1953–1975

    Article  PubMed  Google Scholar 

  22. Bartzokis G, Beckson M, Hance DB, Marx P, Foster JA, Marder SR (1997) MR evaluation of age-related increase of brain iron in young adult and older normal males. Magn Reson Imaging 15:29–35

    Article  CAS  PubMed  Google Scholar 

  23. Cohen CR, Duchesneau PM, Weinstein MA (1980) Calcification of the basal ganglia as visualized by computed tomography. Radiology 134:97–99

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Paracelsus-Elena-Klinik, Klinikstr. 16, 34128, Kassel, Germany

    Friederike von Lewinski, Friederike Sixel-Döring & Claudia Trenkwalder

  2. Abteilung Klinische Neurophysiologie, Georg-August-Universität Göttingen, Robert-Koch Str. 40, 37075, Gottingen, Germany

    Friederike von Lewinski & Claudia Trenkwalder

  3. Abteilung Medizinische Statistik, Georg-August-Universität Göttingen, Humboldtallee 32, 37073, Gottingen, Germany

    Carola Werner

  4. Gemeinschaftspraxis für Diagnostische Radiologie Baunatal, Stettiner Str. 1, 34225, Baunatal Großenritte, Germany

    Torsten Jörn

  5. Abteilung Neuroradiologie, Georg-August-Universität Göttingen, Robert Koch Str. 40, 37075, Gottingen, Germany

    Alexander Mohr

Authors
  1. Friederike von Lewinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carola Werner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Torsten Jörn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander Mohr
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Friederike Sixel-Döring
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Claudia Trenkwalder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Friederike von Lewinski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

von Lewinski, F., Werner, C., Jörn, T. et al. T2*-weighted MRI in diagnosis of multiple system atrophy. J Neurol 254, 1184–1188 (2007). https://doi.org/10.1007/s00415-006-0496-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-006-0496-1

Key words

Search

Navigation