Characterization and diagnostic potential of diffusion tractography in multiple system atrophy. (April 2021)

• Record Type: Journal Article
• Authors: Beliveau, Vincent; Krismer, Florian; Skalla, Elisabeth; Schocke, Michael M.; Gizewski, Elke R.; Wenning, Gregor K.; Poewe, Werner; Seppi, Klaus; Scherfler, Christoph
• Is Part Of: Parkinsonism & related disorders. Volume 85(2021)
• Page Start: 30
• Page End: 36
• Publication Date: 2021-04
• Subjects: Multiple system atrophy -- Tractography -- Diagnosis -- Middle cerebellar peduncle -- Putamen; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2021.02.027
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Introduction: Microstructural integrity of the middle cerebellar peduncle (MCP) and the putamen captured by diffusion-tensor imaging (DTI) is differentially affected in the parkinsonian and cerebellar variants of multiple system atrophy (MSA-P, MSA-C) compared to Parkinson's disease (PD). The current study applied DTI and tractography in order to 1) characterize the distribution of DTI metrics along the tracts of the MCP and from the putamen in MSA variants, and 2) evaluate the usefulness of combining these measures for the differential diagnosis of MSA-P against PD in the clinical setting. Methods: Twenty-nine MSA patients (MSA-C, n = 10; MSA-P, n = 19), with a mean disease duration of 2.8 ± 1.7 years, 19 PD patients, and 27 healthy controls (HC) were included in the study. Automatized tractography with a masking procedure was employed to isolate the MCP tracts. DTI measures along the tracts of the MCP and within the putamen were acquired and jointly used to classify MSA vs. PD, and MSA-P vs. PD. Putamen volume was additionally tested as classification feature in post hoc analyses. Results: DTI measures within the MCP and putamen showed significant alterations in MSA variants compared to HC and PD. Classification accuracy for MSA vs. PD and MSA-P vs PD using diffusion measures was 91.7% and 89.5%, respectively. When replacing the putaminal DTI measure by a normalized measure of putamen volume classification accuracy improved to 95.8% and 94.7%, respectively. Conclusion: Multimodal information from MCP tractography and putamen volume yields excellent diagnostic accuracy to discriminate between early-to-moderately advanced patients with MSA and PD. Highlights: DTI measures of the MCP and putamen were described in MSA-P, MSA-C, PD, and HC. DTI metrics were significantly altered in MSA variants compared to PD and HC. In 16% of MSA-P patients, the putamen had normal DTI values but reduced volume. Using both DTI and volume measures instead of only DTI improved classification.