We read with interest the article by Kraft et al1 in the February 1999 issue of the ARCHIVES on the combination of hypointense and hyperintense signal changes on T2-weighted magnetic resonance imaging (MRI) sequences in the putamina of patients with multiple system atrophy (MSA). This study carefully analyzed the frequency of dorsolateral putaminal hypointensity associated with the hyperintense lateral rim on T2-weighted images (1.5 T) in various types of parkinsonism: Parkinson disease (PD), progressive supranuclear palsy (PSP), and multiple system atrophy–parkinsonism (MSA-P). The authors question whether this is "a specific marker of MSA." The immediate conclusion derived from their results is that this signal pattern is 100% specific for MSA-P, since none of the PSP and PD patients displayed it, compared with 60% of the MSA-P patients.
Macia F, Yekhlef F, Ballan G, Delmer O, Tison F. T2-Hyperintense Lateral Rim and Hypointense Putamen Are Typical but Not Exclusive of Multiple System Atrophy. Arch Neurol. 2001;58(6):1024-1026. doi: