Table 3.
Magnetic resonance findings in multiple system atrophy.
| Imaging biomarker | Findings | Performance (sensitivity/specificity, AUC) | References |
|---|---|---|---|
| PONS | |||
| Sagittal area | MSA-P vs. PD <553 mm2 | 61.7/75.0% | Moller et al. (45) |
| MSA-C vs. PD <538 mm2 | 81.0/82.8% | ||
| Midbrain/pons ratio | MSA-P vs. PSP >0.215 | 76/80% | Moller et al. (45) |
| MSA-C vs. PSP >0.275 | 96.0/81.2% | ||
| MSA-C vs. PD >0.290 | 81.0/79.9% | ||
| MRPI | MSA-P vs. PSP <12.9 | 100/100% | Quattrone et al. (46) |
| Signal on PD-w images | Hot cross bun sign | ——– | Way et al. (128) |
| Diffusivity | Increased | ——– | Nicoletti et al. (58, 90) |
| Pellecchia et al. (94, 99) | |||
| Schocke et al. (91) | |||
| Seppi et al. (92) | |||
| Seppi et al. (129, 130) | |||
| Barbagallo et al. (61) | |||
| Chen et al. (64) | |||
| MIDDLE CEREBELLAR PEDUNCLE | |||
| Volume | Decreased | ——– | Quattrone et al. (46) |
| Signal on T2-w images | High signal | ——– | Heim et al. (3) |
| Diffusivity | Increased | 100/100% | Nicoletti et al. (58) |
| MSA-P vs. PD and PSP | |||
| PUTAMEN | |||
| Volume | Reduced | ——– | Seppi et al. (129, 130) |
| Messina et al. (48) | |||
| Scherfler et al. (100) | |||
| Huppertz et al. (94) | |||
| Signal on SWI | Hypointensity | ——– | Seppi et al. (129, 130) |
| Signal on T2/PD-w images | Hyperintense dorsolateral rim | ——– | Seppi et al. (129, 130) |
| Watanabe et al. (126) | |||
| Diffusivity | Increased | ||
| • vs. PD | 90–100/93–100% | Bajaj et al. (72) | |
| • vs. PSP | 100/81.2% | Nicoletti et al. (58) | |
| Pellecchia et al. (94, 99) | |||
| Schocke et al. (91) | |||
| Seppi et al. (92) | |||
| Seppi et al. (129, 130) | |||
| Barbagallo et al. (61) | |||
| R2* | Increased | 77.8/100% | Focke et al. (113) |
| Barbagallo et al. (61) | |||
| Lee et al. (77) | |||
| Susceptibility | Increased vs. PD | AUC: 0.77 | Sjöstrom et al. (74) |
| CEREBELLUM | |||
| Volume | Decreased | ——– | Scherfler et al. (100) |
| Huppertz et al. (94) | |||
| Diffusion | Increased vs. PD and PSP | 100/100% | Nicoletti et al. (65) |
AUC values were reported when available.
AUC, area under the ROC curve; DP, proton density-weighted; HC, healthy controls; MRPI, Magnetic Resonance Parkinsonism Index; MSA, multiple system atrophy; MSA-C, cerebellar variant of MSA; MSA-P, Parkinsonian variant of MSA; PD, Parkinson's disease; PSP-RS, progressive supranuclear palsy with Richardson syndrome; SWI, susceptibility-weighted imaging.