Usefulness of combined fractional anisotropy and apparent diffusion coefficient values for detection of involvement in multiple system atrophy

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 78; no. 7; pp. 722 - 728
• Main Authors: Ito, Mizuki, Watanabe, Hirohisa, Kawai, Yoshinari, Atsuta, Naoki, Tanaka, Fumiaki, Naganawa, Shinji, Fukatsu, Hiroshi, Sobue, Gen
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.07.2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: ADC; Aged; Anisotropy; apparent diffusion coefficient; Atrophy; Biological and medical sciences; Cerebellum - pathology; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; dorsolateral putaminal hyperintensity; DPH; Female; fractional anisotropy; HCB; hot cross bun; Humans; Male; Matched-Pair Analysis; Medical sciences; Middle Aged; MSA; MSA-C; MSA-P; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; multiple system atrophy; Multiple System Atrophy - diagnosis; multiple system atrophy if cerebellar features predominate; multiple system atrophy if parkinsonian features predominate; Neurology; Parkinson Disease - diagnosis; Parkinson's disease; Pons - pathology; Putamen - pathology; receiver operating characteristic; region of interest; ROC; ROI; Sensitivity and Specificity; Multiple system atrophy; Nervous system diseases; Diffusion coefficient; Medical screening; Anisotropy
• ISSN: 0022-3050; 1468-330X; 1468-330X
• DOI: 10.1136/jnnp.2006.104075

Objective: To determine whether apparent diffusion coefficient (ADC) values and fractional anisotropy (FA) values can detect early pathological involvement in multiple system atrophy (MSA), and be used to differentiate MSA-P (multiple system atrophy if parkinsonian features predominate) from Parkinson’s disease (PD). Methods: We compared ADC and FA values in the pons, cerebellum and putamen of 61 subjects (20 probable MSA patients, 21 age matched PD patients and 20 age matched healthy controls) using a 3.0 T magnetic resonance system. Results: ADC values in the pons, cerebellum and putamen were significantly higher, and FA values lower in MSA than in PD or controls. These differences were prominent in MSA lacking dorsolateral putaminal hyperintensity (DPH) or hot cross bun (HCB) sign. In differentiating MSA-P from PD using FA and ADC values, we obtained equal sensitivity (70%) and higher specificity (100%) in the pons than in the putamen and cerebellum. In addition, all patients that had both significant low FA and high ADC values in each of these three areas were MSA-P cases, and those that had both normal FA and ADC values in the pons were all PD cases. Our diagnostic algorithm based on these results accurately diagnosed 90% of patients with MSA-P. Conclusion: FA and ADC values detected early pathological involvement prior to magnetic resonance signal changes in MSA. In particular, low FA values in the pons showed high specificity in discriminating MSA-P from PD. In addition, combined analysis of both FA and ADC values in all three areas was more useful than only one.