Hyperintense Putaminal Rim Sign Is Not a Hallmark of Multiple System Atrophy at 3T

• Published in: American Journal of Neuroradiology Vol. 26; no. 9; pp. 2238 - 2242
• Main Authors: Lee, Wei-Hsing, Lee, Chau-Chin, Shyu, Woei-Cherng, Chong, Pau-Nyen, Lin, Shinn-Zong
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.10.2005; American Society of Neuroradiology
• Subjects: Adult; Biological and medical sciences; Brain; Electrocardiography. Vectocardiography; Electrodiagnosis. Electric activity recording; Eye; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Multiple System Atrophy - diagnosis; Multiple System Atrophy - pathology; Nervous system; Parkinson Disease - pathology; Putamen - pathology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radionuclide investigations; Multiple system atrophy; Nervous system diseases; Sign; Radiodiagnosis
• ISSN: 0195-6108; 1936-959X; 1432-1920

Hyperintense putaminal rim (HPR) on the T2-weighted imaging, which has been observed in our daily practice while reading 3T brain images, has been described as a finding typical of multiple system atrophy (MSA). We hypothesized that the HPR sign is not an exclusive hallmark of MSA at a high magnetic field strength, but rather may be a normal finding. Ten consecutive clinically healthy age-matched adults who showed recognizable HPR at 3T were subsequently examined on a 1.5T imaging system within 2 hours. MR examination included axial T2-weighted fast spin-echo (FSE), fluid attenuated inversion recovery (FLAIR) on a 3T scanner, and equivalent T2-weighted FSE at 1.5T. MR images were obtained parallel to the intercommissural plane. All the images were interpreted by 2 experienced neuroradiologists. All 10 subjects (3 men and 7 women; aged 52 +/- 6.1 years [range, 44-61 years], expressed as mean +/- SD) with the positive HPR sign on axial T2-weighted FSE at 3T had negative findings at 1.5T. Such hyperintense rim was also vague or absent on the 3T-FLAIR images. Our data suggest that the HPR at 3T scans is a nonspecific, normal finding. FLAIR may be helpful in discriminating between normal subjects and patients with MSA in case of isolated HPR at 3T.