Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India.
Department of Clinical Neuroscience and Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, Karnataka, 560029, India.
Eur Radiol. 2019 Feb;29(2):716-724. doi: 10.1007/s00330-018-5594-9. Epub 2018 Jul 4.
Multiple system atrophy (MSA) is a neurodegenerative disorder with progressive motor and autonomic dysfunction. There is a paucity of information on the early neurostructural changes in MSA, especially its subtypes, MSA-P (patients with predominant parkinsonism) and MSA-C (patients with predominant cerebellar signs). This study investigates the abnormalities of grey matter (GM) and white matter (WM) in early MSA and its subtypes using multi-modal voxel-based analysis.
Twenty-six patients with MSA with duration of symptoms ≤ 2.5 years (mean duration: 1.6 ±0.9 years) were assessed clinically and with 3T MRI. Voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) were performed to identify the structural changes in MSA and its subtypes. The GM changes and diffusion parameters of WM tracts were correlated with the clinical scores. The results were compared with MRI of 25 age- and gender-matched healthy controls.
The early structural changes in MSA included GM loss of the cerebellum and subcallosal gyrus with widespread involvement of supratentorial and infratentorial WM fibres. In MSA-C, GM loss was limited to the cerebellum with WM changes predominantly affecting the infratentorial WM and association tracts. In contrast, MSA-P did not demonstrate any GM loss and the WM involvement was mainly supratentorial. There was no significant correlation between structural changes and clinical severity score.
In early MSA, WM microstructure was more affected than GM. These changes were greater in MSA-C than in MSA-P, suggesting variable deterioration in the subtypes of MSA.
• Structural changes in early multiple system atrophy were evaluated using multi-modal neuroimaging. • White matter was more affected than grey matter in early MSA. • Clinical variables did not correlate with early structural changes.
多系统萎缩（MSA）是一种进行性运动和自主神经功能障碍的神经退行性疾病。关于 MSA 的早期神经结构变化，尤其是其亚型（以帕金森病为主的 MSA-P 和以小脑征为主的 MSA-C）的信息很少。本研究采用多模态体素基分析方法研究早期 MSA 及其亚型的灰质（GM）和白质（WM）异常。
评估了 26 例 MSA 患者（症状持续时间≤2.5 年，平均持续时间：1.6±0.9 年）的临床和 3T MRI。进行体素形态测量（VBM）和弥散张量成像（DTI）以确定 MSA 及其亚型的结构变化。GM 变化和 WM 束的弥散参数与临床评分相关。将结果与 25 名年龄和性别匹配的健康对照者的 MRI 进行比较。
MSA 的早期结构变化包括小脑和胼胝体下回 GM 丢失，以及广泛的幕上和幕下 WM 纤维受累。在 MSA-C 中，GM 丢失仅限于小脑，WM 变化主要影响幕下 WM 和联合纤维。相比之下，MSA-P 没有表现出任何 GM 丢失，WM 受累主要是幕上的。结构变化与临床严重程度评分之间没有显著相关性。
在早期 MSA 中，WM 微观结构比 GM 更受影响。MSA-C 中的这些变化比 MSA-P 更大，这表明 MSA 的亚型有不同程度的恶化。
• 采用多模态神经影像学评估早期多系统萎缩的结构变化。• 早期 MSA 中白质比灰质受影响更大。• 临床变量与早期结构变化不相关。
