An update on advances in magnetic resonance imaging of multiple system atrophy

Abstract

In this review, we describe how different neuroimaging tools have been used to identify novel MSA biomarkers, highlighting their advantages and limitations. First, we describe the main structural MRI changes frequently associated with MSA including the ‘hot cross-bun’ and ‘putaminal rim’ signs as well as putaminal, pontine, and middle cerebellar peduncle (MCP) atrophy. We discuss the sensitivity and specificity of different supra- and infratentorial changes in differentiating MSA from other disorders, highlighting those that can improve diagnostic accuracy, including the MCP width and MCP/superior cerebellar peduncle (SCP) ratio on T1-weighted imaging, raised putaminal diffusivity on diffusion-weighted imaging, and increased T2* signal in the putamen, striatum, and substantia nigra on susceptibility-weighted imaging. Second, we focus on recent advances in structural and functional MRI techniques including diffusion tensor imaging (DTI), resting-state functional MRI (fMRI), and arterial spin labelling (ASL) imaging. Finally, we discuss new approaches for MSA research such as multimodal neuroimaging strategies and how such markers may be applied in clinical trials to provide crucial data for accurately selecting patients and to act as secondary outcome measures.

Spatial Patterns of Decreased Cerebral Blood Flow and Functional Connectivity in Multiple System Atrophy (Cerebellar-Type): A Combined Arterial Spin Labeling Perfusion and Resting State Functional Magnetic Resonance Imaging Study

“…Structurally, most MSA neuroimaging researches have been focused on the gray matter atrophy detected by the structural magnetic resonance imaging (MRI) (Matsusue et al, 2009; Deguchi et al, 2015; Chelban et al, 2018; Krismer et al, 2018; Dash et al, 2019). As the results, atrophy of the putamen, middle cerebellar peduncle (MCP), pons, or cerebellum on MRI reflected the pathological changes of MSA (Matsusue et al, 2009; Deguchi et al, 2015).…”

Discriminative pattern of reduced cerebral blood flow in Parkinson’s disease and Parkinsonism-Plus syndrome: an ASL-MRI study

“…However, it is not widely available and suffers from shortcomings of high cost and radiation hazards [ 12 , 13 ]. Besides structural MRI, functional MRI has additional value for differential diagnosis [ 14 – 18 ]. Among these functional imaging, arterial spin labeling (ASL)-based perfusion-weighted imaging is a novel, non-invasive method that does not require the injection of contrast agent.…”

Discriminative Pattern of Reduced Cerebral Blood Flow in Parkinson's Disease and Parkinsonism-Plus Syndrome: an ASL-MRI study

“…However, it is not widely available and suffers from shortcomings of high cost and radiation hazards [12,13]. Besides structural MRI, functional MRI has additional value for differential diagnosis [14][15][16][17][18]. Among these functional imaging, arterial spin labeling (ASL)-based perfusion-weighted imaging is a novel, noninvasive method that does not require the injection of contrast agent.…”