Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan,
J Neurol. 2015 Jun;262(6):1433-9. doi: 10.1007/s00415-015-7728-1. Epub 2015 Apr 7.
Although the sensitive detection of putaminal iron deposition by T2*-weighted imaging (T2*-WI) is of diagnostic value for multiple system atrophy (MSA), the diagnostic significance of the pontine hot-cross bun (HCB) sign with increased ferritin-bound iron in the background remains unknown. We retrospectively evaluated the cases of 33 patients with cerebellar-form MSA (MSA-C) and 21 with MSA of the parkinsonian form (MSA-P) who underwent an MRI study with a 1.5-T system. Visualization of the HCB sign, posterior putaminal hypointensity and putaminal hyperintense rim on T2*-WI was assessed by two neurologists independently using an established visual grade, and were compared with those on T2-weighted imaging (T2-WI). The visual grade of pontine and putaminal signal changes was separately assessed for probable MSA (advanced stage) and possible MSA (early stage). T2*-WI demonstrated significantly higher grades of HCB sign than T2-WI (probable MSA-C, n = 27, p < 0.001; possible MSA-C, n = 6, p < 0.05; probable MSA-P, n = 13, p < 0.01). The visual grade of the HCB sign on T2*-WI in the possible MSA-C patients was comparable to that in the probable MSA-C patients. Although the HCB sign in MSA-P was of lower visual grade than in MSA-C even on T2*-WI, some patients showed evolution of the HCB sign preceding the appearance of the putaminal changes. These findings suggest that T2*-WI is of extreme value for detecting the HCB sign, which is often cited as a hallmark of MSA. The appearance of the HCB sign on T2*-WI might not only support but also improve the diagnosis of MSA.
虽然 T2*-加权成像（T2*-WI）对多系统萎缩（MSA）的壳核铁沉积的敏感检测具有诊断价值，但铁蛋白结合铁背景下桥脑热点十字面包（HCB）征的诊断意义尚不清楚。我们回顾性评估了 33 例小脑型 MSA（MSA-C）和 21 例帕金森型 MSA（MSA-P）患者的病例，这些患者均接受了 1.5-T 系统的 MRI 研究。两名神经科医生独立使用既定的视觉分级评估 HCB 征、后壳核低信号和 T2*-WI 上壳核高信号环的可视化，同时与 T2 加权成像（T2-WI）进行比较。分别评估桥脑和壳核信号变化的视觉分级，用于可能的 MSA（晚期）和可能的 MSA（早期）。T2*-WI 显示 HCB 征的分级明显高于 T2-WI（可能的 MSA-C，n=27，p<0.001；可能的 MSA-C，n=6，p<0.05；可能的 MSA-P，n=13，p<0.01）。可能的 MSA-C 患者的 T2*-WI 上 HCB 征的视觉分级与可能的 MSA-C 患者的视觉分级相当。尽管 MSA-P 中的 HCB 征的视觉分级低于 MSA-C 中的 HCB 征，即使在 T2*-WI 上，一些患者也表现出 HCB 征的演变早于壳核改变的出现。这些发现表明 T2*-WI 对检测 HCB 征具有极高的价值，HCB 征通常被认为是 MSA 的标志。T2*-WI 上 HCB 征的出现不仅可能支持 MSA 的诊断，而且可能改善 MSA 的诊断。
