RESEARCH: MRI study of multiple system atrophy

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J Neurol 2002 Jul;249(7):847-54

Longitudinal MRI study of multiple system atrophy - when do the findings

appear,

and what is the course?

Horimoto Y, Aiba I, Yasuda T, Ohkawa Y, Katayama T, Yokokawa Y, Goto A, Ito

Y.

Second Department of Internal Medicine, Medical School, Nagoya City

University,

Mizuho, Nagoya 467-8601, Japan.

Several investigators have revealed features of multiple system atrophy

(MSA) by

magnetic resonance imaging (MRI). For use in clinical diagnosis, we

determined

the exact time when two main features of pontine and putaminal intensity

changes

appeared. Furthermore, in order to reveal the course from when the disorder

first appeared and how it spread, we also investigated the course of MRI

findings and differences between clinical subtypes. The cranial MRI of 42

patients with MSA were longitudinally studied including comments on the so

called " cross sign " of pontine T2 high intensity, which was divided into 6

stages, and also on the linear T2 high intensity of the dorsolateral side of

the

putamen ( " putaminal slit " ) which was divided into 4 stages. Patients were

classified as 16 MSA-C, 7 autonomic dominant type (MSA-A), and 19 MSA-P. The

age

at onset ranged from 41 to 74 years (mean, 55 +/- 9). The duration of the

disease in the MRI study ranged from 1 to 24 years. The pontine " cross sign "

was

completed (shows Cross, stage IV) earlier in MSA-C mainly before 5 years,

later

in MSA-P and even much later in MSA-A. Regarding the " putaminal slit " , MSA-P

shows earlier bilateral changes (stage II), mostly before 3 years, compared

with

MSA-C, which requires 4 years to reveal even a unilateral change (stage I),

or

MSA-A which requires even more time. MRI findings showed a tendency to

relate to

clinical findings, since MSA-C exhibits " cross sign " completion earlier than

bilateral " putaminal slit " ; however, MSA-P shows bilateral " putaminal slit "

earlier than " cross sign " , and MSA-A requires much more time to show both.

Clinically, MSA-C, MSA-A, or MSA-P showed different MRI courses so that

three

subtypes could be defined also with MRI findings. Therefore these

observations

are useful not only for diagnosis of MSA itself, but also to distinguish

clinical subtypes (MSA-C, MSA-A, or MSA-P) which have different rates of

lesion

progression.

PMID: 12140668 [PubMed - in process]