Morphometric MRI profiles of multiple system atrophy variants and implications for differential diagnosis

Abstract

Background Manual width measurements of the middle cerebellar peduncle on MRI were shown to improve the accuracy of an imaging‐guided diagnosis of multiple system atrophy (MSA). Recently, automated volume segmentation algorithms were able to reliably differentiate patients with Parkinson's disease (PD) and the parkinsonian variant of MSA. The objective of the current study was to integrate probabilistic information of the middle cerebellar peduncle into an existing MRI atlas for automated subcortical segmentation and to evaluate the diagnostic properties of the novel atlas for the differential diagnosis of MSA (parkinsonian and cerebellar variant) versus PD. Methods Three Tesla MRI scans of 48 healthy individuals were used to establish an automated whole‐brain segmentation procedure that includes the volumes of the putamen, cerebellar gray and white matter, and the middle cerebellar peduncles. Classification accuracy of segmented volumes were tested in early‐stage MSA patients (18 MSA‐parkinsonism, 13 MSA‐cerebellar) and 19 PD patients using a C4.5 classifier. Results Putaminal and infratentorial atrophy were present in 77.8% and 61.1% of MSA‐parkinsonian patients, respectively. Four of 18 MSA‐parkinsonian patients (22.2%) had infratentorial atrophy without evidence of putaminal atrophy. Infratentorial atrophy was present in all MSA‐cerebellar patients, with concomitant putaminal atrophy in 46.2% of these cases. The diagnostic algorithm using putaminal and infratentorial volumetric information correctly classified all PD patients and 96.8% of MSA patients. Conclusions The middle cerebellar peduncle was successfully integrated into a subcortical segmentation atlas, and its excellent diagnostic accuracy outperformed existing volumetric MRI processing strategies in differentiating MSA patients with variable atrophy patterns from PD patients. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Automated Analysis of Diffusion‐Weighted Magnetic Resonance Imaging for the Differential Diagnosis of Multiple System Atrophy from Parkinson's Disease

“…The present cohort represents a subset (those patients who have DTI registrations of sufficient quality) of a previously published cohort. 9 The clinical evaluation included the Hoehn and Yahr staging scheme, the Unified Parkinson's Disease Rating Scale, and the Mini-Mental State Examination. All rating scales in patients with PD were performed in the on state.…”

“…[23][24][25][26] Moreover, a published technique to integrate MCP segmentation into FreeSurfer was applied. 9 The preprocessing steps were visually inspected to ensure that no misalignment of brain structures had occurred. We then processed native DTI data and performed structural-to-diffusion data coregistration using FreeSurfer and FMRIB Software Library tools.…”

“…Automated segmentation of structural MRI with consecutive subcortical volume calculation and adjustment for total intracranial volume further increased the diagnostic accuracy for discriminating MSA and PD. 8,9 In addition, increased MD values were shown to be a useful measure of microstructural changes in neurodegenerative disorders. 13,27,28 In patients with MSA, previous DTI studies reported increased MD and reduced FA values in brain regions that are affected by MSA pathology.…”

Can Autonomic Testing and Imaging Contribute to the Early Diagnosis of Multiple System Atrophy? A Systematic Review and Recommendations by the Movement Disorder Society Multiple System Atrophy Study Group

“…This allowed for the correct diagnosis of MSA‐P versus PD or PSP at the first neurological visit in 100% of patients, substantially improving the clinical diagnostic accuracy of 63% 23 . The combination of automated subcortical and supra‐ and infratentorial segmentation that included the volumetric measure of the MCP confirmed the high diagnostic accuracy of this approach in separating both MSA‐P and MSA‐C from PD 24 . There is yet no comparative data from volumetric studies addressing MSA‐C versus SAOA.…”

Changes of Amide Proton Transfer Imaging in Multiple System Atrophy Parkinsonism Type

“…A recent study reported that the clinicopathological consistency of MSA was only 62% (Koga et al, 2015). Multimodal MRI technology is often applied in the diagnosis of MSA patients (Pradhan and Tandon, 2017;Krismer et al, 2019). Several MRI findings have been reported in MSA-P patients, including the presence of a bilateral T2-hyperintense rim bordering the dorsolateral margins of the putamen (the ''HPR sign''), T2-putaminal hypointensity (T2H), and atrophy of the putamen, middle cerebellar peduncles (MCP), cerebellum, or pons (Massey et al, 2012).…”