RESEARCH: Brain magnetic resonance imaging in multiple-system atrophy and Parkinson

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Arch Neurol 2002 May;59(5):835-42

Brain magnetic resonance imaging in multiple-system atrophy and Parkinson

disease: a diagnostic algorithm.

Bhattacharya K, Saadia D, Eisenkraft B, Yahr M, Olanow W, Drayer B, Kaufmann

H.

Mount Sinai School of Medicine, Campus Box 1052, New York, NY 10029.

Horacio.Kaufmann@...

BACKGROUND: Brain magnetic resonance (MR) imaging offers the potential for

objective criteria in the differential diagnosis of multiple system atrophy

with

predominant parkinsonism (MSA-P) and Parkinson disease (PD), since it

frequently

shows characteristic abnormalities in patients with MSA-P and is believed to

be

normal in patients with PD. OBJECTIVE: To determine concordance between

clinical

and MR imaging-based diagnoses of MSA-P and PD. DESIGN: Two

neuroradiologists

identified and rated striatal and infratentorial abnormalities in 39 brain

MR

images and assigned a diagnosis of PD, MSA-P, or MSA with additional marked

cerebellar ataxia (MSA-C). SETTING: Academic medical center. PATIENTS:

Thirty-nine patients with parkinsonism, including 21 with a clinical

diagnosis

of PD, 14 with MSA-P, and 4 with MSA-C. RESULTS: All patients with MSA and

14

(67%) of 21 patients with PD had some abnormality on brain MR imaging.

Brainstem

atrophy was seen in patients with MSA-P and MSA-C. Putaminal atrophy was

seen

only in MSA-P. Putaminal hypointensity and lateral slitlike hyperintensity

were

seen in both PD and MSA-P but were always mild in PD. Cerebellar

abnormalities,

seen in all patients with MSA-C and 11 patients with MSA-P, were also

identified

in 6 patients with PD, albeit always rated as mild. Nonconcordance between

clinical and radiological diagnosis occurred in 2 patients with PD, 5 with

MSA-P, and 1 with MSA-C. CONCLUSION: Since several features on brain MR

imaging

are seen only in MSA-P, a simple diagnostic algorithm may improve the MR

imaging

diagnosis of MSA-P and PD.

PMID: 12020268 [PubMed - in process]