Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Mov Disord. 2022 Oct;37(10):1963-1984. doi: 10.1002/mds.29195. Epub 2022 Aug 29.
Multiple system atrophy (MSA) is a neurodegenerative disease characterized by autonomic failure, ataxia, and/or parkinsonism. Its prominent pathological alterations can be investigated using diffusion magnetic resonance imaging (dMRI), a technique that exploits the characteristics of water random motion inside brain tissue. The aim of this report was to review currently available literature on the application of dMRI in MSA and to describe microstructural abnormalities, diagnostic applications, and pathophysiological correlates. Sixty-four published studies involving microstructural investigation using dMRI in MSA were included. Widespread microstructural abnormalities of white matter were described, especially in the middle cerebellar peduncle, corticospinal tract, and hemispheric fibers. Gray matter degeneration was identified as well, with diffuse involvement of subcortical structures, especially in the putamina. Diagnostic applications of dMRI were mostly explored for the differential diagnosis between MSA parkinsonism and Parkinson's disease. Recently, machine learning algorithms for image processing and disease classification have demonstrated high diagnostic accuracy, showing potential for translation into clinical practice. To a lesser extent, clinical correlates of microstructural abnormalities have also been investigated, and abnormalities related to motor, ocular, and cognitive impairments were described. dMRI in MSA has contributed to in vivo identification of known pathological abnormalities. Translation into clinical practice of the latest advancements for the differential diagnosis between MSA and other forms of parkinsonism seems feasible. Current limitations involve the possibility of correctly diagnosing MSA in the very early stages, when the clinical diagnosis is most uncertain. Furthermore, pathophysiological correlates of microstructural abnormalities remain understudied. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
多系统萎缩（MSA）是一种以自主神经衰竭、共济失调和/或帕金森病为特征的神经退行性疾病。其突出的病理改变可以通过扩散磁共振成像（dMRI）进行研究，这是一种利用脑组织内水分子随机运动特征的技术。本报告旨在回顾 dMRI 在 MSA 中的应用的现有文献，并描述其微观结构异常、诊断应用和病理生理相关性。共纳入 64 项关于 MSA 使用 dMRI 进行微观结构研究的已发表研究。描述了广泛的白质微观结构异常，特别是在小脑中脚、皮质脊髓束和半球纤维中。还发现了灰质变性，涉及皮质下结构的弥漫性受累，特别是壳核。dMRI 的诊断应用主要探索了 MSA 帕金森病与帕金森病的鉴别诊断。最近，用于图像处理和疾病分类的机器学习算法已经证明了较高的诊断准确性，显示出转化为临床实践的潜力。在较小程度上，也研究了微观结构异常的临床相关性，描述了与运动、眼部和认知障碍相关的异常。dMRI 在 MSA 中的应用有助于在体内识别已知的病理异常。将最新的鉴别诊断 MSA 和其他形式的帕金森病的进展转化为临床实践似乎是可行的。目前的局限性在于正确诊断 MSA 的早期阶段，即临床诊断最不确定的阶段。此外，微观结构异常的病理生理相关性仍有待研究。
