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Brain Magnetic Resonance Imaging in Multiple-System Atrophy and Parkinson Disease
A Diagnostic Algorithm
Kirsty Bhattacharya, MD;
Daniela Saadia, MD;
Barbara Eisenkraft, MD;
Melvin Yahr, MD;
Warren Olanow, MD;
Burton Drayer, MD;
Horacio Kaufmann, MD
Arch Neurol. 2002;59:835-842.
Background Brain magnetic resonance (MR) imaging offers the potential for objective
criteria in the differential diagnosis of multiple system atrophy with predominant
parkinsonism (MSA-P) and Parkinson disease (PD), since it frequently shows
characteristic abnormalities in patients with MSA-P and is believed to be
normal in patients with PD.
Objective To determine concordance between clinical and MR imaging–based
diagnoses of MSA-P and PD.
Design Two neuroradiologists identified and rated striatal and infratentorial
abnormalities in 39 brain MR images and assigned a diagnosis of PD, MSA-P,
or MSA with additional marked cerebellar ataxia (MSA-C).
Setting Academic medical center.
Patients Thirty-nine patients with parkinsonism, including 21 with a clinical
diagnosis of PD, 14 with MSA-P, and 4 with MSA-C.
Results All patients with MSA and 14 (67%) of 21 patients with PD had some abnormality
on brain MR imaging. Brainstem atrophy was seen in patients with MSA-P and
MSA-C. Putaminal atrophy was seen only in MSA-P. Putaminal hypointensity and
lateral slitlike hyperintensity were seen in both PD and MSA-P but were always
mild in PD. Cerebellar abnormalities, seen in all patients with MSA-C and
11 patients with MSA-P, were also identified in 6 patients with PD, albeit
always rated as mild. Nonconcordance between clinical and radiological diagnosis
occurred in 2 patients with PD, 5 with MSA-P, and 1 with MSA-C.
Conclusion Since several features on brain MR imaging are seen only in MSA-P, a
simple diagnostic algorithm may improve the MR imaging diagnosis of MSA-P
and PD.
From the Departments of Neurology (Drs Bhattacharya, Saadia, Yahr,
Olanow, and Kaufmann) and Radiology (Drs Eisenkraft and Drayer), Mount Sinai
School of Medicine, New York, NY.
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