T2*-weighted MRI in diagnosis of multiple system atrophy

Abstract

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.

Different Iron-Deposition Patterns of Multiple System Atrophy with Predominant Parkinsonism and Idiopathetic Parkinson Diseases Demonstrated by Phase-Corrected Susceptibility-Weighted Imaging

“…38,39,41 In the present study, there was no significant difference of iron-deposition patterns in the whole thalamus; however, significantly higher iron deposition in the PT in patients with MSA-P was observed, which corresponded partially to findings in the previous study using T1 and T2 values. 37 To our knowledge, this relationship has not been described before with SWI.…”

“…von Lewinski et al 39 reported a signal-intensity loss of the dorsolateral putamen in T2*-weighted sequences of multiple system atrophy with a high specificity (Ͼ0.91). Their dorsolateral putamen may be the lower outer region of the putamen in our study, maybe including part of lower inner region or lower outer region.…”

“…Kraft et al 38 reported that hypointense putamen signal-intensity changes were more often observed in multiple system atrophy compared with IPD by using T2*-weighted sequences, but not with T2-weighted sequences. Von Lewinski et al 39 reported a signal-intensity loss of the dorsolateral putamen in T2*-weighted sequences of MSA with a high specificity (Ͼ0.91). They discriminated MSA from IPD by using a quantitative evaluation of putaminal signal intensities with a diagnostic accuracy (r) of Յ0.82.…”

Differentiation of Typical and Atypical Parkinson Syndromes by Quantitative MR Imaging

“…When we aimed for 100% sensitivity, the resulting specificity would be 72.7%. This is superior to what has been found in previous, qualitative MR imaging studies, 1 but given the few cases, ours has to be interpreted with caution. Although signal-intensity decreases of the basal ganglia based on visual inspection of T2*-weighted images have been previously described in MSA and (to a lesser extent) PSP, 1,2,15 a quantitative approach (eg, by R2* measurement) allows objectively defining a normal range and, thus, increasing the confidence in a pathologic finding.…”

“…In MSA, hypointensity of the basal ganglia on T2-weighted images is frequently observed, sometimes in combination with a lateral putaminal hyperintensity. 1,2 However at higher magnetic field strengths (3T and above), this pattern can also be found in healthy elderly subjects and its utility is, therefore, debatable. 3 In the recent consensus criteria, those features have not been incorporated, though brain atrophy defined by MR imaging has been included as an additional clinical definition criterion for possible MSA.…”