The cerebellar nuclei are a brain region with high iron content. Surprisingly little is known about iron content in the cerebellar nuclei and its possible contribution to pathology in cerebellar ataxias, with the only exception of Friedreich’s ataxia.
In the present exploratory cross-sectional study, quantitative susceptibility mapping was used to investigate volume, iron concentration and total iron content of the dentate nuclei in common types of hereditary and non-hereditary degenerative ataxias. Seventy-nine patients with spinocerebellar ataxias of type 1 (SCA1), 2 (SCA2), 3 (SCA3) and 6 (SCA6), fifteen patients with Friedreich’s ataxia, eighteen patients with multiple system atrophy, cerebellar type (MSA-C), and one hundred eleven healthy controls were included. All underwent 3T-MRI and clinical assessments. For each specific ataxia subtype, voxel-based and volumes-of-interest-based group analyses were performed in comparison to a corresponding age- and sex-matched control group, both for volume, magnetic susceptiblity (indicating iron concentration) and susceptibility mass (indicating total iron content) of the dentate nuclei.
SCA1 and MSA-C patients showed higher susceptibilities in large parts of the dentate nucleus but unaltered susceptibility masses compared to controls. Friedreich’s ataxia patients and, only on a trend level, SCA2 patients showed higher susceptibilities in more circumscribed parts of the dentate. In contrast, SCA6 patients revealed lower susceptibilities and susceptibility masses compared to controls throughout the dentate nucleus. SCA3 patients showed no significant changes in susceptibility and susceptibility mass. Lower volume of the dentate nuclei was found to varying degrees in all ataxia types. It was most pronounced in SCA6 patients and least prominent in SCA3 patients.
The findings show that alterations in susceptibility revealed by quantitative susceptibiltiy mapping are common in the dentate nuclei in different types of cerebellar ataxias. The most striking changes in susceptibility were found in SCA1, MSA-C, and SCA6. Because iron content is known to be high in glial cells but not in neurons of the cerebellar nuclei, the higher susceptibility in SCA1 and MSA-C may be explained by a reduction of neurons (increase in iron concentration) and/or an increase in iron-rich glial cells, e.g. microgliosis. Hypomyelination also leads to higher susceptibility and could also contribute. The lower susceptibility in SCA6 suggests a loss of iron-rich glial cells. Quantitative susceptibility maps warrant future studies of iron content and iron-rich cells in ataxias to gain a more comprehensive understanding of the pathogenesis of these diseases.