Brain Magnetic Resonance Imaging in Multiple-System Atrophy and Parkinson Disease: A Diagnostic Algorithm | Movement Disorders | JAMA Neurology | JAMA Network
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Original Contribution
May 2002

Brain Magnetic Resonance Imaging in Multiple-System Atrophy and Parkinson Disease: A Diagnostic Algorithm

Author Affiliations

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.

Arch Neurol. 2002;59(5):835-842. doi:10.1001/archneur.59.5.835

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.