A distinct neuromelanin magnetic resonance imaging pattern in parkinsonian multiple system atrophy
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RESEARCH ARTICLE
Open Access
A distinct neuromelanin magnetic resonance imaging pattern in parkinsonian multiple system atrophy Rita Moiron Simões1,2, Ana Castro Caldas2,3, Joana Grilo3,4,5, Daisy Correia3,4, Carla Guerreiro3,6,7, Patrícia Pita Lobo2,3,8, Anabela Valadas2,3,8, Marguerita Fabbri3,9, Leonor Correia Guedes2,3,8, Miguel Coelho3,8, Mario Miguel Rosa4,8, Joaquim J. Ferreira2,3,4* and Sofia Reimão4,6,7
Abstract Background: Parkinsonian variant of multiple system atrophy is a neurodegenerative disorder frequently misdiagnosed as Parkinson’s disease. No early imaging biomarkers currently differentiate these disorders. Methods: Simple visual imaging analysis of the substantia nigra and locus coeruleus in neuromelanin-sensitive magnetic resonance imaging and nigrosome 1 in susceptibility-weighted sequences was performed in thirty patients with parkinsonian variant of multiple system atrophy fulfilling possible/probable second consensus diagnostic criteria. The neuromelanin visual pattern was compared to patients with Parkinson’s disease with the same disease duration (n = 10) and healthy controls (n = 10). Substantia nigra semi-automated neuromelanin area/ signal intensity was compared to the visual data. Results: Groups were similar in age, sex, disease duration, and levodopa equivalent dose. Hoehn & Yahr stage was higher in parkinsonian multiple system atrophy patients, 69% of whom had normal neuromelanin size/signal, significantly different from Parkinson’s disease patients, and similar to controls. Nigrosome 1 signal was lost in 74% of parkinsonian multiple system atrophy patients. Semi-automated neuromelanin substantia nigra signal, but not area, measurements were able to differentiate groups. Conclusions: In patients with parkinsonism, simple visual magnetic resonance imaging analysis showing normal neuromelanin substantia nigra and locus coeruleus, combined with nigrosome 1 loss, allowed the distinction of the parkinsonian variant of multiple system atrophy from Parkinson’s disease and healthy controls. This easy and widely available method was superior to semi-automated measurements in identifying specific imaging changes in substantia nigra and locus coeruleus. Keywords: Multiple system atrophy, Neuromelanin, Susceptibility-weighted imaging, Nigrosome 1, MRI
* Correspondence: [email protected] 2 CNS-Campus Neurológico Sénior, Torres Vedras, Portugal 3 Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in thi
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