Trace of diffusion tensor differentiates the Parkinson variant of multiple system atrophy and Parkinson's disease
Introduction
The differential diagnosis of parkinsonian disorders means a challenge for clinicians, especially during the early stages of disease (Poewe, 1993). The differentiation of Parkinson's disease (PD) from the parkinsonian variant of multiple system atrophy (MSA) carries a high rate of misdiagnosis (Wenning et al., 1997). MSA is a sporadic, progressive, adult-onset neurodegenerative disorder associated with varying degrees of parkinsonism, autonomic dysfunction, and cerebellar ataxia. Neuropathologically, the Parkinson variant of MSA (striatonigral degeneration (SND) type, MSA-P) is characterized by selective neuronal loss and gliosis predominantly affecting the basal ganglia, substantia nigra, olivopontocerebellar pathways, and the intermediolateral cell column of the spinal cord (Wenning et al., 1997). An early differentiation between PD and MSA-P has important prognostic and therapeutic implications Lang and Lozano, 1998a, Lang and Lozano, 1998b, Quinn and Marsden, 1993, Redmond et al., 1990, Spencer et al., 1992.
Routine, spectroscopic, and volumetric magnetic resonance imaging (MRI) may be helpful in the differential diagnosis of MSA-P vs. PD; however, both sensitivity and specificity of reported MR indices are generally suboptimal Bhattacharya et al., 2002, Davie et al., 1995, Federico et al., 1997, Kraft et al., 1999, Kraft et al., 2002, Litvan, 1999, Schrag et al., 1998, Schulz et al., 1999. A recent diffusion-weighted MRI (DWI) study by our group reported complete separation of patients with MSA-P from patients with PD (Schocke et al., 2002). In this study, the apparent diffusion coefficients (ADC) measured in z-direction were determined for several brain regions. DWI provided a full discrimination of patients with MSA-P and PD as well as normal controls by putaminal ADCs (Schocke et al., 2002).
Because the central nervous system (CNS) is organized in bundles of fiber tracts, the water molecules mainly move along these structures, whereas diffusion perpendicular to the fiber tracts is restricted (Hajnal et al., 1991). DWI only measured in one direction can lead to an underestimation of diffusion-related pathological changes because the fiber tracts are not orientated in the same direction (Pierpaoli et al., 1996). The trace of diffusion tensor Trace(D) is given by the average of ADCs measured in three orthogonal directions and is by definition independent of anisotropy (Hsu and Mori, 1995). Therefore, evaluation of Trace(D) appears to be more sensitive than ADCs measured in only one direction. We applied here mapping of Trace(D) to patients with MSA-P and PD as well as normal controls to obtain additional information about diffusion-related processes.
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Patients
We included 10 consecutive patients with probable MSA-P (Gilman et al., 1998) and 17 consecutive patients with PD (Hughes et al., 1992) matched for age, disease duration, and Hoehn and Yahr “off” stage who were recruited at the Parkinson outpatient clinic. Clinical diagnosis of probable MSA-P and PD was made according to the established criteria Gilman et al., 1998, Hughes et al., 1992 by one of our movement disorder specialists experienced in parkinsonian disorders (G.K.W., W.P.). A detailed
Patients
The clinical and demographic data of the patients and normal controls are given in Table 1. Patients' age was not significantly different between groups at the time of MRI examination. Mean age at examination was 62 (±8.0, standard deviation) years in PD patients, 64 (±5.8) years in MSA-P patients, and 60 (±5.8) years in healthy volunteers. There were no significant differences in disease duration of patients with PD (3.7 ± 1.8 years) and patients with MSA-P (3.9 ± 1.9 years). There was no
Discussion
Because the differential diagnosis between MSA-P and PD is difficult in early stages of disease, several neuroimaging methods have been previously evaluated for the differentiation of MSA from other parkinsonian disorders, in particular PD. A systematic analysis of routine MRI in MSA patients reported alterations such as hyperintensive putaminal rim, putaminal atrophy, and hyperintensive putamen (Schrag et al., 1998). However, a substantial minority of patients fulfilling the diagnostic
Acknowledgements
The study was supported by the Austrian Federal Ministry of Science and Transport (GZ 70038/2 PR 4/98).
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2023, Parkinsonism and Related DisordersDiagnosis of multiple system atrophy
2018, Autonomic Neuroscience: Basic and ClinicalCitation Excerpt :Movement of water molecules is typically increased in degenerating and ischemic neural tissue. Compared to PD, increased putaminal diffusivity in MSA-P has been consistently reported, even in early disease stages (Barbagallo et al., 2016; Baudrexel et al., 2014; Pellecchia et al., 2009; Schocke et al., 2002; Schocke et al., 2004; Seppi et al., 2004). DWI might be useful in distinguishing MSA-P from PSP (Paviour et al., 2007).
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2018, International Review of NeurobiologyCitation Excerpt :Increased putaminal diffusivity has also been reported for patients with PSP (Nicoletti, Lodi, et al., 2006; Rizzo et al., 2008; Seppi et al., 2003), although discriminatory power from PD seems to be less compared to patients with MSA-P. Moreover, because putaminal diffusivity overlapped in MSA-P and PSP patients (Nicoletti, Lodi, et al., 2006; Seppi et al., 2003), discrimination between these two APDs is not possible. There are few 3.0 T diffusion imaging studies and the results are inconsistent, possibly due to increased SNR increased magnetic susceptibility effects and increased echo-planar image distortion at 3.0 T that may affect diffusion imaging findings compared to 1.5 T (Focke et al., 2011; Schocke et al., 2004; Seppi et al., 2003; Tsukamoto et al., 2012). Diffusivity values in the pons, cerebellum and putamen at 3.0 T were found to be significantly higher and FA values lower in MSA than in PD or controls.