Magnetic resonance T1w/T2w ratio and voxel-based morphometry in multiple system atrophy

S Ponticorvo,P Barone,F Di Salle,M Picillo,R Manara,F Esposito,G Di Salle,M T Pellecchia,R Erro,M C Russillo

doi:10.1038/s41598-021-01222-5

Abstract

Diagnosis of multiple system atrophy (MSA) may be improved by using multimodal imaging approaches. We investigated the use of T1-weighted/T2-weighted (T1w/T2w) images ratio combined with voxel-based morphometry to evaluate brain tissue integrity in MSA compared to Parkinson’s disease (PD) and healthy controls (HC). Twenty-six patients with MSA, 43 patients with PD and 56 HC were enrolled. Whole brain voxel-based and local regional analyses were performed to evaluate gray and white matter (GM and WM) tissue integrity and mean regional values were used for patients classification using logistic regression. Increased mean regional values of T1w/T2w in bilateral putamen were detected in MSA-P compared to PD and HC. The combined use of regional GM and T1w/T2w values in the right and left putamen showed the highest accuracy in discriminating MSA-P from PD and good accuracy in discriminating MSA from PD and HC. A good accuracy was also found in discriminating MSA from PD and HC by either combining regional GM and T1w/T2w values in the cerebellum or regional WM and T1w/T2w in the cerebellum and brainstem. The T1w/T2w image ratio alone or combined with validated MRI parameters can be further considered as a potential candidate biomarker for differential diagnosis of MSA.

Highlights

Diagnosis of multiple system atrophy (MSA) may be improved by using multimodal imaging approaches
In this study we performed a multi-parametric evaluation of tissue integrity assessing both T1w/T2w ratio images and voxel-based morphometry on GM and WM tissue density to investigate whole brain damage in MSA patients as compared to Parkinson’s disease (PD) patients and healthy controls (HC) and evaluate a potential semi-quantitative biomarker for differential diagnosis with PD
We found MSA patients to have GM atrophy in bilateral putamen and cerebellum and WM atrophy in the cerebellum/brainstem compared to both PD patients and HC

Summary

Introduction

Diagnosis of multiple system atrophy (MSA) may be improved by using multimodal imaging approaches. We investigated the use of T1-weighted/T2-weighted (T1w/T2w) images ratio combined with voxel-based morphometry to evaluate brain tissue integrity in MSA compared to Parkinson’s disease (PD) and healthy controls (HC). A good accuracy was found in discriminating MSA from PD and HC by either combining regional GM and T1w/T2w values in the cerebellum or regional WM and T1w/T2w in the cerebellum and brainstem. The T1w/T2w image ratio alone or combined with validated MRI parameters can be further considered as a potential candidate biomarker for differential diagnosis of MSA. The differential diagnosis between MSA, the parkinsonian subtype, and Parkinson’s disease (PD), the most frequent α-synucleinopathy, may be difficult due to the presence of common clinical features, as demonstrated by the relatively high rate of misdiagnosis at post-mortem e valuation[4]. Compared to other quantitative MRI techniques, it has the advantage that images can be acquired during routine clinical examination and without complex modeling of the MR signal, with high spatial resolution and sensitivity to neurodegenerative changes[7,8,9]

Methods

Results

Conclusion