Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea.
Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea.
J Neurol. 2018 Jul;265(7):1540-1547. doi: 10.1007/s00415-018-8874-z. Epub 2018 Apr 25.
The variability of the severity and regional distribution of pathological process in basal ganglia (BG) and brainstem-cerebellar systems results in clinical heterogeneity and represents the motor subtype of multiple system atrophy (MSA). This study aimed to quantify spatial patterns of multimodal MRI abnormalities in BG and stem-CB regions and define structural MRI findings that correlate with clinical characteristics.
We simultaneously measured R2*, mean diffusivity (MD), and volume in the subcortical structures (BG, thalamus, brainstem-cerebellar regions) of 39 probable MSA and 22 control subjects. Principal component analysis (PCA) and structural equation modeling (SEM) were performed to show a model consisting of multiple inter-dependencies.
Structural MRI alterations were found to be significantly interrelated within BG as well as brainstem-cerebellar regions in MSA patients. PCA extracted four factors: three factors reflected alterations in R2*, MD and volume of the BG region including the caudate nucleus, putamen, and pallidum, and the remaining one factor represented degenerative changes in MD and volume of stem-CB region. In SEM, a latent variable reflecting brainstem-cerebellar degeneration did not show a significant correlation with the other latent variables associated with BG degeneration. Putaminal MD values and a PCA-driven factor reflecting MD values in the BG showed a significant correlation with UPDRS and UMSARS scores.
Multimodal structural MRI abnormalities in MSA appear to be segregated into BG and stem-CB-related factors that can be associated with the clinical phenotype and motor severity.
基底节（BG）和脑干-小脑系统中病理过程严重程度和区域分布的可变性导致了临床异质性，代表了多系统萎缩（MSA）的运动亚型。本研究旨在定量测量 BG 和脑干-小脑区域多模态 MRI 异常的空间模式，并确定与临床特征相关的结构 MRI 发现。
我们同时测量了 39 例可能的 MSA 和 22 例对照受试者的皮质下结构（BG、丘脑、脑干-小脑区域）的 R2*、平均扩散系数（MD）和体积。进行主成分分析（PCA）和结构方程建模（SEM），以显示一个由多个相互依赖关系组成的模型。
在 MSA 患者中，BG 以及脑干-小脑区域的结构 MRI 改变被发现存在显著的相互关系。PCA 提取了四个因素：三个因素反映了 BG 区域的 R2*、MD 和体积改变，包括尾状核、壳核和苍白球，而其余一个因素代表了脑干-小脑区域 MD 和体积的退行性变化。在 SEM 中，反映脑干-小脑退行性变的潜在变量与与 BG 退行性变相关的其他潜在变量之间没有显著相关性。壳核 MD 值和反映 BG 中 MD 值的 PCA 驱动因子与 UPDRS 和 UMSARS 评分显著相关。
MSA 的多模态结构 MRI 异常似乎分为与 BG 和脑干-小脑相关的因素，这些因素可与临床表型和运动严重程度相关。
