Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, 2-1-1 Nishitokuta, Yahaba, Iwate, Japan.
Department of Neurology and Gerontology, Iwate Medical University, Morioka, Iwate, Japan.
Acad Radiol. 2019 Nov;26(11):e333-e339. doi: 10.1016/j.acra.2018.12.015. Epub 2019 Jan 16.
Differentiation between multiple system atrophy (MSA) and other spinocerebellar degenerations showing cerebellar ataxia is often difficult. Hence, we investigated whether magnetic resonance diffusion kurtosis imaging (DKI) could detect pathological changes that occur in these patients and be used for differential diagnosis.
Thirty-six subjects (12 patients with MSA accompanied by predominant cerebellar ataxia [MSA-C], 10 patients with spinocerebellar ataxias [SCAs] or sporadic adult-onset ataxia of unknown etiology [SAOA], and 14 healthy controls) were examined using 1.5- or 3-T magnetic resonance scanners. From the DKI data, the mean kurtosis, fractional anisotropy, and mean diffusivity values of the pontine crossing tract (PCT), middle cerebellar peduncle, and cerebellum were automatically measured, and the ratios against the values of the corpus callosum were calculated.
We found significant decreases in mean kurtosis and fractional anisotropy ratios in the PCT and middle cerebellar peduncle, and a significant increase in the mean diffusivity ratio in the PCT in the MSA-C group, as compared with the SCA/SAOA and control groups (p < 0.027-0.001). Among these metrics, there were no significant differences in the diagnostic performance. By contrast, the ratios in the cerebellum showed no significant differences between the MSA-C and SCA/SAOA groups but were significantly altered when compared with the controls (p < 0.001).
Quantitative DKI analyses can be used to differentiate between patients with MSA-C and those with SCA/SAOA.
多系统萎缩（MSA）与表现为小脑性共济失调的其他脊髓小脑变性的鉴别往往较为困难。因此，我们研究了磁共振扩散峰度成像（DKI）是否可以检测到这些患者的病变并用于鉴别诊断。
使用 1.5T 或 3.0T 磁共振扫描仪对 36 名受试者（12 名 MSA 伴明显小脑性共济失调[MSA-C]患者、10 名脊髓小脑共济失调或散发性成人发病原因不明的小脑共济失调[SAOA]患者和 14 名健康对照者）进行检查。从 DKI 数据中自动测量桥横纤维束（PCT）、小脑中脚和小脑的平均峰度、各向异性分数和平均弥散度值，并计算与胼胝体值的比值。
与 SCA/SAOA 组和对照组相比，MSA-C 组 PCT 和小脑中脚的平均峰度和各向异性分数比值显著降低，而 PCT 的平均弥散度比值显著升高（p<0.027-0.001）。在这些指标中，诊断性能无显著差异。相比之下，小脑的比值在 MSA-C 组和 SCA/SAOA 组之间无显著差异，但与对照组相比则显著改变（p<0.001）。
定量 DKI 分析可用于鉴别 MSA-C 患者与 SCA/SAOA 患者。
