Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1998 Jul;65(1):65–71. doi: 10.1136/jnnp.65.1.65

Clinical usefulness of magnetic resonance imaging in multiple system atrophy

A Schrag 1, D Kingsley 1, C Phatouros 1, C Mathias 1, A Lees 1, S Daniel 1, N Quinn 1
PMCID: PMC2170147  PMID: 9667563

Abstract

OBJECTIVES—To determine the sensitivity, specificity, and positive predictive values of a selection of abnormal findings in the putamen and infratentorial structures on routine magnetic resonance imaging for distinguishing between multiple system atrophy, idiopathic Parkinson's disease, and age matched controls.
PATIENTS AND METHODS—Two neuroradiologists blindly and independently rated axial T2 weighted and proton density MRI of 44 patients with multiple system atrophy, 47 patients with idiopathic Parkinson's disease, and 45 controls. High field (1.5 T) scans were available in 16patients with multiple system atrophy, 15 patients with idiopathic Parkinson's disease, and 16 controls. All other patients had 0.5T scans.
RESULTS—On both 0.5 and 1.5 T scans the following items had high specificity but low sensitivity: putaminal atrophy, a hyperintense putaminal rim, and infratentorial signal change. Finding any infratentorial abnormality gave higher sensitivity but lower specificity. Putaminal isointensity or hypointensity relative to globus pallidus, absolute putaminal hypointensity, and altered size of the olives were not useful discriminators. The overall sensitivity was 73% on 0.5T and 88% on 1.5 T scans. The specificities of these findings for multiple system atrophy in comparison to idiopathic Parkinson's disease and controls on 0.5 T were 95% and 100% respectively, and on 1.5 T were 93% and 91% respectively. Finding any of the described abnormalities on MRI gave a positive predictive value of 93% on the 0.5 T machine, and 85% on the 1.5 T scanner.



Full Text

The Full Text of this article is available as a PDF (165.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Antonini A., Leenders K. L., Meier D., Oertel W. H., Boesiger P., Anliker M. T2 relaxation time in patients with Parkinson's disease. Neurology. 1993 Apr;43(4):697–700. doi: 10.1212/wnl.43.4.697. [DOI] [PubMed] [Google Scholar]
  2. Drayer B. P., Olanow W., Burger P., Johnson G. A., Herfkens R., Riederer S. Parkinson plus syndrome: diagnosis using high field MR imaging of brain iron. Radiology. 1986 May;159(2):493–498. doi: 10.1148/radiology.159.2.3961182. [DOI] [PubMed] [Google Scholar]
  3. Hughes A. J., Ben-Shlomo Y., Daniel S. E., Lees A. J. What features improve the accuracy of clinical diagnosis in Parkinson's disease: a clinicopathologic study. Neurology. 1992 Jun;42(6):1142–1146. doi: 10.1212/wnl.42.6.1142. [DOI] [PubMed] [Google Scholar]
  4. Konagaya M., Konagaya Y., Iida M. Clinical and magnetic resonance imaging study of extrapyramidal symptoms in multiple system atrophy. J Neurol Neurosurg Psychiatry. 1994 Dec;57(12):1528–1531. doi: 10.1136/jnnp.57.12.1528. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kume A., Shiratori M., Takahashi A., Kato T., Ito K., Tadokoro M., Sakuma S. Hemi-parkinsonism in multiple system atrophy: a PET and MRI study. J Neurol Sci. 1992 Jul;110(1-2):37–45. doi: 10.1016/0022-510x(92)90007-8. [DOI] [PubMed] [Google Scholar]
  6. Landis J. R., Koch G. G. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159–174. [PubMed] [Google Scholar]
  7. O'Brien C., Sung J. H., McGeachie R. E., Lee M. C. Striatonigral degeneration: clinical, MRI, and pathologic correlation. Neurology. 1990 Apr;40(4):710–711. doi: 10.1212/wnl.40.4.710. [DOI] [PubMed] [Google Scholar]
  8. Olanow C. W. Magnetic resonance imaging in parkinsonism. Neurol Clin. 1992 May;10(2):405–420. [PubMed] [Google Scholar]
  9. Pastakia B., Polinsky R., Di Chiro G., Simmons J. T., Brown R., Wener L. Multiple system atrophy (Shy-Drager syndrome): MR imaging. Radiology. 1986 May;159(2):499–502. doi: 10.1148/radiology.159.2.3961183. [DOI] [PubMed] [Google Scholar]
  10. Quinn N. Multiple system atrophy--the nature of the beast. J Neurol Neurosurg Psychiatry. 1989 Jun;Suppl:78–89. doi: 10.1136/jnnp.52.suppl.78. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Savoiardo M., Strada L., Girotti F., Zimmerman R. A., Grisoli M., Testa D., Petrillo R. Olivopontocerebellar atrophy: MR diagnosis and relationship to multisystem atrophy. Radiology. 1990 Mar;174(3 Pt 1):693–696. doi: 10.1148/radiology.174.3.2305051. [DOI] [PubMed] [Google Scholar]
  12. Schulz J. B., Klockgether T., Petersen D., Jauch M., Müller-Schauenburg W., Spieker S., Voigt K., Dichgans J. Multiple system atrophy: natural history, MRI morphology, and dopamine receptor imaging with 123IBZM-SPECT. J Neurol Neurosurg Psychiatry. 1994 Sep;57(9):1047–1056. doi: 10.1136/jnnp.57.9.1047. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Stern M. B., Braffman B. H., Skolnick B. E., Hurtig H. I., Grossman R. I. Magnetic resonance imaging in Parkinson's disease and parkinsonian syndromes. Neurology. 1989 Nov;39(11):1524–1526. doi: 10.1212/wnl.39.11.1524. [DOI] [PubMed] [Google Scholar]
  14. Testa D., Savoiardo M., Fetoni V., Strada L., Palazzini E., Bertulezzi G., Girotti F. Multiple system atrophy. Clinical and MR observations on 42 cases. Ital J Neurol Sci. 1993 Apr;14(3):211–216. doi: 10.1007/BF02335661. [DOI] [PubMed] [Google Scholar]
  15. Wakai M., Kume A., Takahashi A., Ando T., Hashizume Y. A study of parkinsonism in multiple system atrophy: clinical and MRI correlation. Acta Neurol Scand. 1994 Oct;90(4):225–231. doi: 10.1111/j.1600-0404.1994.tb02712.x. [DOI] [PubMed] [Google Scholar]
  16. Wenning G. K., Jäger R., Kendall B., Kingsley D., Daniel S. E., Quinn N. P. Is cranial computerized tomography useful in the diagnosis of multiple system atrophy? Mov Disord. 1994 May;9(3):333–336. doi: 10.1002/mds.870090311. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES