Magnetic resonance imaging in multiple system atrophy Hirohisa WATANABE 1 , Mizuki ITO 1 , Naoki ATSUTA 1 , Shinji NAGANAWA 2 , Hiroshi FUKATSU 2 , Gen SOBUE 1 1Department of Neurology, Nagoya University Graduate School of Medicine 2Department of Radiology, Nagoya University Graduate School of Medicine Keyword: 多系統萎縮症 , MRI , 早期診断 pp.397-407
Published Date 2006/6/10
DOI https://doi.org/10.11477/mf.1431100148
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Multiple system atrophy(MSA)is a sporadic neurodegenerative disease that is still difficult to clinical diagnose. In particular, discriminating clearly between MSA-P(predominantly parkinsonian motor subtype)and Parkinson's disease has long been a diagnostic problem from both therapeutic and prognostic viewpoints. This review discusses the utility of the different MR techniques in the diagnosis and management of MSA. Conventional MRI are widely used and can show characteristic signal abnormalities such as putaminal hyperintensity, hyperintense putaminal rim, putaminal hypointensity, hot cross bun sign in the pontine base, and hyperintensity in the middle cerebellar peduncles strengthening a diagnosis of MSA. However, the diagnostic utility of these signal abnormalities in early MSA remains restricted. In addition, it should be considered that different magnetic field strengths and sequences could be influenced on the findings resulting false negative. On the other hand, proton magnetic resonance spectroscopy(1H-MRS), magnetization transfer imaging(MTI), diffusion weighted imaging(DWI), diffsion tensor imaging(DTI)and three-dimensional MRI-based volumetry(3D MRV)in the pontine base and putamen will be informative in the early diagnosis of MSA prior to conventional MRI changes and even before any clinical manifestation of symptoms. Moreover, DWI and MRV are expected to have potential as surrogate markers of disease progression. Although consensus criteria showed excellent positive predictive values for both possible and probable MSA, sensitivity for probable MSA, particularly early in the course of illness, was poor. Further prospective and large studies including earlier disease stages will be needed to clarify whether these novel MR techniques will aid in the future sets of diagnostic criteria and therapeutic trials.

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