Surface-Based Neuroimaging Pattern of Multiple System Atrophy.

RATIONALE AND OBJECTIVES

Overlapping parkinsonism, cerebellar ataxia, and pyramidal signs render challenges in the clinical diagnosis of multiple system atrophy (MSA). The neuroimaging pattern is valuable to understand its pathophysiology and improve its diagnostic effect.

MATERIALS AND METHODS

We retrospectively obtained magnetic resonance imaging and susceptibility-weighted imaging in patients with MSA (including parkinsonian type [MSA-P] and cerebellar type [MSA-C]), Parkinson's disease, and normal controls. We quantified neuroimaging features to identify the optimal threshold for diagnosis. Furthermore, we explore neuroimaging patterns of MSA by mapping the subcortical morphological alterations and constructing a diagnostic model.

RESULTS

Compared to controls, normalized putaminal volume significantly decreased in patients with MSA-P (P < .001) and normalized pontine volume significantly decreased in patients with MSA-C (P < .001). The Youden index of the threshold-based clinical prediction model was 0.871-0.928 in patients with MSA. The neuroimaging pattern in patients with MSA was jointly located in the lateral putamen, and the neuroimaging pattern prediction model achieved a classification accuracy of 83.9%-100%.

CONCLUSION

The quantitative neuroimaging features and surface-based morphologic anomalies represent the markers of MSA and open new avenues for personalized clinical diagnosis.