Abstract
OBJECTIVES:Parkinson’s disease (PD) and the parkinsonian variant of multiple system atrophy (MSA-P) are distinct neurodegenerative disorders that share similar clinical features of parkinsonism. The morphological alterations of these diseases have yet to be understood. The purpose of this study was to evaluate gray matter atrophy in PD and MSA-P using regions of interest (ROI)-based measurements and voxel-based morphometry (VBM).METHODS:We studied 41 patients with PD, 20 patients with MSA-P, and 39 controls matched for age, sex, and handedness using an improved T1-weighted sequence that eased gray matter segmentation. The gray matter volumes were measured using ROI and VBM.RESULTS:ROI volumetric measurements showed significantly reduced bilateral putamen volumes in MSA-P patients compared with those in PD patients and controls (p<0.05), and the volumes of the bilateral caudate nucleus were significantly reduced in both MSA-P and PD patients compared with those in the controls (p<0.05). VBM analysis revealed multifocal cortical and subcortical atrophy in both MSA-P and PD patients, and the volumes of the cerebellum and temporal lobes were remarkably reduced in MSA-P patients compared with the volumes in PD patients (p<0.05).CONCLUSIONS:Both PD and MSA-P are associated with gray matter atrophy, which mainly involves the bilateral putamen, caudate nucleus, cerebellum, and temporal lobes. ROI and VBM can be used to identify these morphological alterations, and VBM is more sensitive and repeatable and less time-consuming, which may have potential diagnostic value.
Highlights
Multiple system atrophy (MSA) is a sporadic, adult-onset disease predominantly characterized by motor symptoms, such as varying degrees of parkinsonism and cerebellar ataxia
Demographic and clinical features The demographic data of the subjects are summarized in region of interest (ROI) results The correlation coefficients for intergroup consistency in the measurement of intracranial volume (ICV), putamen volume, caudatum volume, and pallidum volume were 0.99, 0.98, 0.99, and 0.95, respectively
The multivariate analysis of covariance (MANCOVA) for ROIs revealed the bilateral putamen (F=3.50, po0.01) and bilateral caudate nucleus (F=5.50, po0.001) were the main effects associated with distinct diagnoses
Summary
Multiple system atrophy (MSA) is a sporadic, adult-onset disease predominantly characterized by motor symptoms, such as varying degrees of parkinsonism and cerebellar ataxia. Received for publication on August 19, 2019. Accepted for publication on March 20, 2020. Clinical differentiation between Parkinson’s disease (PD) and MSA-P remains a challenge for neurologists. According to the existing literature, some scholars have proposed that magnetic resonance T2*-weighted gradient echo imaging and diffusion-weighted imaging are of diagnostic value for differentiating MSA-P from PD [1,2]. The morphological differences between MSA-P and PD have yet to be fully understood. Magnetic resonance imaging (MRI) has been extensively used in brain morphometry. Brain morphological studies designed to compare MSA with PD have not yielded consistent results [4]. Ghaemi et al proposed that MSA-P differed significantly from PD in terms of decreased
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