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A Specific Marker of Multiple System Atrophy?

Eduard Kraft, MD; Johannes Schwarz, MD; Claudia Trenkwalder, MD; Thomas Vogl, MD; Thomas Pfluger, MD; Wolfgang H. Oertel, MD

Arch Neurol. 1999;56:225-228.

Objective  To compare the frequency and specificity of hypointense magnetic resonance imaging (MRI) signal changes alone with the frequency and specificity of a pathological MRI pattern consisting of a hyperintense lateral rim and a dorsolateral signal attenuation on T₂-weighted MRIs in patients with parkinsonism of various origins.

Patients  Ninety patients with Parkinson disease (PD) (n = 65), progressive supranuclear palsy (PSP) (n = 10), and multiple system atrophy (MSA) of the striatonigral degeneration type (n = 15) underwent MRI.

Setting  University medical center.

Results  Nine of the 15 patients with MSA showed the pattern with hyperintense lateral rim and a dorsolateral hypointense signal attenuation on T₂-weighted images within the putamen. This pattern was not found in the 65 patients with PD, nor in the 10 patients with PSP. Only hypointense changes in the putamen were found in 6 patients (9%) with PD, 4 patients (40%) with PSP, and 5 patients (36%) with MSA.

Conclusions  Our data suggest that the pattern consisting of hypointense and hyperintense T₂ changes within the putamen is a highly specific MRI sign of MSA, while hypointensity alone remains a sensitive, but nonspecific MRI sign of MSA. In clinically doubtful cases, the appearance of a hypointense and hyperintense signal pattern on MRI makes the diagnosis of PD very unlikely, while hypointense signal changes alone do not exclude idiopathic PD.

From the Department of Neurology, Klinikum Grosshadern (Drs Kraft, Schwarz, Trenkwalder, and Oertel) and Max-Planck-Institute of Psychiatry (Drs Kraft and Trenkwalder), and the Department of Radiology, Klinikum Innenstadt, Ludwig-Maximilians-Universität (Drs Vogl and Pfluger), Munich, Germany. Dr Kraft is now with the Department of Radiology, Massachusetts General Hospital, Charlestown.

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