Abnormalities of white and grey matter in early multiple system atrophy: comparison of parkinsonian and cerebellar variants

• Published in: European radiology Vol. 29; no. 2; pp. 716 - 724
• Main Authors: Dash, Santosh Kumar, Stezin, Albert, Takalkar, Tejashree, George, Lija, Kamble, Nitish L, Netravathi, M, Yadav, Ravi, Kumar, Keshav J., Ingalhalikar, Madhura, Saini, Jitender, Pal, Pramod Kumar
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2019; Springer Nature B.V
• Subjects: Abnormalities; Adult; Aged; Atrophy; Autonomic nervous system; Basal ganglia; Brain research; Case-Control Studies; Central nervous system diseases; Cerebellum; Cerebellum - diagnostic imaging; Cerebellum - pathology; Diagnostic Radiology; Diffusion Tensor Imaging - methods; Female; Fibers; Gray Matter - diagnostic imaging; Gray Matter - pathology; Head and Neck; Humans; Imaging; Internal Medicine; Interventional Radiology; Magnetic Resonance Imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Morphometry; Movement disorders; Multiple System Atrophy - diagnostic imaging; Multiple System Atrophy - pathology; Neurodegeneration; Neurodegenerative diseases; Neuroimaging; Neurology; Neuroradiology; Parkinsonian Disorders - diagnostic imaging; Parkinsonian Disorders - pathology; Patients; Radiology; Substantia alba; Substantia grisea; Ultrasound; White Matter - diagnostic imaging; White Matter - pathology; Cerebellum; Neuroimaging; Multiple system atrophy; Diffusion tensor imaging
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-018-5594-9

Objective
Multiple system atrophy (MSA) is a neurodegenerative disorder with progressive motor and autonomic dysfunction. There is a paucity of information on the early neurostructural changes in MSA, especially its subtypes, MSA-P (patients with predominant parkinsonism) and MSA-C (patients with predominant cerebellar signs). This study investigates the abnormalities of grey matter (GM) and white matter (WM) in early MSA and its subtypes using multi-modal voxel-based analysis.
Materials and methods
Twenty-six patients with MSA with duration of symptoms ≤ 2.5 years (mean duration: 1.6 ±0.9 years) were assessed clinically and with 3T MRI. Voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) were performed to identify the structural changes in MSA and its subtypes. The GM changes and diffusion parameters of WM tracts were correlated with the clinical scores. The results were compared with MRI of 25 age- and gender-matched healthy controls.
Results
The early structural changes in MSA included GM loss of the cerebellum and subcallosal gyrus with widespread involvement of supratentorial and infratentorial WM fibres. In MSA-C, GM loss was limited to the cerebellum with WM changes predominantly affecting the infratentorial WM and association tracts. In contrast, MSA-P did not demonstrate any GM loss and the WM involvement was mainly supratentorial. There was no significant correlation between structural changes and clinical severity score.
Conclusion
In early MSA, WM microstructure was more affected than GM. These changes were greater in MSA-C than in MSA-P, suggesting variable deterioration in the subtypes of MSA.
Key Points
• Structural changes in early multiple system atrophy were evaluated using multi-modal neuroimaging.
• White matter was more affected than grey matter in early MSA.
• Clinical variables did not correlate with early structural changes.