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Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryCurrent TOCInstructions for authors
J Neurol Neurosurg Psychiatry. Nov 2002; 73(5): 517–523.
PMCID: PMC1738131

Differentiating multiple system atrophy from Parkinson's disease: contribution of striatal and midbrain MRI volumetry and multi-tracer PET imaging

Abstract

Objectives: The differential diagnosis between typical idiopathic Parkinson's disease (PD) and the striatonigral variant of multiple system atrophy (MSA-P) is often difficult because of the presence of signs and symptoms common to both forms of parkinsonism, particularly at symptom onset. This study investigated striatal and midbrain findings in MSA-P and PD patients in comparison with normal controls with the use of positron emission tomography (PET) and three dimensional magnetic resonance imaging (3D MRI) based volumetry to increase the differential diagnostic accuracy between both disease entities.

Methods: Nine patients with MSA-P, 24 patients with PD, and seven healthy controls were studied by MRI and PET with 6-[18F]-fluoro-L-dopa (FDOPA), [18F]fluoro-deoxyglucose (FDG), and 11-C-Raclopride (RACLO). Striatal and extrastriatal volumes of interest (VOI) were calculated on the basis of the individual MRI data. The PET data were transferred to the VOI datasets and subsequently analysed.

Results: MSA-P differed significantly from PD patients in terms of decreased putaminal volume, glucose metabolism, and postsynaptic D2 receptor density. The striatal FDOPA uptake was equally impaired in both conditions. Neither MRI volumetry nor PET imaging of the midbrain region further contributed to the differential diagnosis between PD and MSA-P.

Conclusions: The extent and spatial distribution of functional and morphological changes in the striatum permit the differentiation of MSA-P from PD. Both, multi-tracer PET and 3D MRI based volumetry, may be considered equivalent in the assessment of different striatal abnormality in both disease entities. In contrast, MRI and PET imaging of the midbrain does not provide a further gain in diagnostic accuracy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Jankovic J. Parkinsonism-plus syndromes. Mov Disord. 1989;4 (Suppl 1):S95–119. [PubMed]
  • Wenning GK, Tison F, Ben Shlomo Y, Daniel SE, Quinn NP. Multiple system atrophy: a review of 203 pathologically proven cases. Mov Disord. 1997 Mar;12(2):133–147. [PubMed]
  • ADAMS RD, VANBOGAERT L, VANDEREECKEN H. STRIATO-NIGRAL DEGENERATION. J Neuropathol Exp Neurol. 1964 Oct;23:584–608. [PubMed]
  • Andrews JM, Terry RD, Spataro J. Striatonigral degeneration. Clinical-pathological correlations and response to stereotaxic surgery. Arch Neurol. 1970 Oct;23(4):319–329. [PubMed]
  • Quinn N. Multiple system atrophy--the nature of the beast. J Neurol Neurosurg Psychiatry. 1989 Jun;Suppl:78–89. [PMC free article] [PubMed]
  • Hughes AJ, Colosimo C, Kleedorfer B, Daniel SE, Lees AJ. The dopaminergic response in multiple system atrophy. J Neurol Neurosurg Psychiatry. 1992 Nov;55(11):1009–1013. [PMC free article] [PubMed]
  • Colosimo C, Albanese A, Hughes AJ, de Bruin VM, Lees AJ. Some specific clinical features differentiate multiple system atrophy (striatonigral variety) from Parkinson's disease. Arch Neurol. 1995 Mar;52(3):294–298. [PubMed]
  • Ito H, Kusaka H, Matsumoto S, Imai T. Striatal efferent involvement and its correlation to levodopa efficacy in patients with multiple system atrophy. Neurology. 1996 Nov;47(5):1291–1299. [PubMed]
  • Brooks DJ, Ibanez V, Sawle GV, Quinn N, Lees AJ, Mathias CJ, Bannister R, Marsden CD, Frackowiak RS. Differing patterns of striatal 18F-dopa uptake in Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. Ann Neurol. 1990 Oct;28(4):547–555. [PubMed]
  • Brooks DJ, Ibanez V, Sawle GV, Playford ED, Quinn N, Mathias CJ, Lees AJ, Marsden CD, Bannister R, Frackowiak RS. Striatal D2 receptor status in patients with Parkinson's disease, striatonigral degeneration, and progressive supranuclear palsy, measured with 11C-raclopride and positron emission tomography. Ann Neurol. 1992 Feb;31(2):184–192. [PubMed]
  • Antonini A, Leenders KL, Vontobel P, Maguire RP, Missimer J, Psylla M, Günther I. Complementary PET studies of striatal neuronal function in the differential diagnosis between multiple system atrophy and Parkinson's disease. Brain. 1997 Dec;120(Pt 12):2187–2195. [PubMed]
  • Schulz JB, Skalej M, Wedekind D, Luft AR, Abele M, Voigt K, Dichgans J, Klockgether T. Magnetic resonance imaging-based volumetry differentiates idiopathic Parkinson's syndrome from multiple system atrophy and progressive supranuclear palsy. Ann Neurol. 1999 Jan;45(1):65–74. [PubMed]
  • Gray F. Neuropathologie des syndromes parkinsoniens. Rev Neurol (Paris) 1988;144(4):229–248. [PubMed]
  • Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):181–184. [PMC free article] [PubMed]
  • Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967 May;17(5):427–442. [PubMed]
  • Gilman S, Low P, Quinn N, Albanese A, Ben-Shlomo Y, Fowler C, Kaufmann H, Klockgether T, Lang A, Lantos P, et al. Consensus statement on the diagnosis of multiple system atrophy. American Autonomic Society and American Academy of Neurology. Clin Auton Res. 1998 Dec;8(6):359–362. [PubMed]
  • Garnett ES, Firnau G, Nahmias C. Dopamine visualized in the basal ganglia of living man. Nature. 1983 Sep 8;305(5930):137–138. [PubMed]
  • Wienhard K, Pawlik G, Herholz K, Wagner R, Heiss WD. Estimation of local cerebral glucose utilization by positron emission tomography of [18F]2-fluoro-2-deoxy-D-glucose: a critical appraisal of optimization procedures. J Cereb Blood Flow Metab. 1985 Mar;5(1):115–125. [PubMed]
  • Hume SP, Myers R, Bloomfield PM, Opacka-Juffry J, Cremer JE, Ahier RG, Luthra SK, Brooks DJ, Lammertsma AA. Quantitation of carbon-11-labeled raclopride in rat striatum using positron emission tomography. Synapse. 1992 Sep;12(1):47–54. [PubMed]
  • Wienhard K, Eriksson L, Grootoonk S, Casey M, Pietrzyk U, Heiss WD. Performance evaluation of the positron scanner ECAT EXACT. J Comput Assist Tomogr. 1992 Sep-Oct;16(5):804–813. [PubMed]
  • Wienhard K, Dahlbom M, Eriksson L, Michel C, Bruckbauer T, Pietrzyk U, Heiss WD. The ECAT EXACT HR: performance of a new high resolution positron scanner. J Comput Assist Tomogr. 1994 Jan-Feb;18(1):110–118. [PubMed]
  • Pietrzyk U, Herholz K, Fink G, Jacobs A, Mielke R, Slansky I, Würker M, Heiss WD. An interactive technique for three-dimensional image registration: validation for PET, SPECT, MRI and CT brain studies. J Nucl Med. 1994 Dec;35(12):2011–2018. [PubMed]
  • Patlak CS, Blasberg RG. Graphical evaluation of blood-to-brain transfer constants from multiple-time uptake data. Generalizations. J Cereb Blood Flow Metab. 1985 Dec;5(4):584–590. [PubMed]
  • Eidelberg D, Moeller JR, Dhawan V, Spetsieris P, Takikawa S, Ishikawa T, Chaly T, Robeson W, Margouleff D, Przedborski S, et al. The metabolic topography of parkinsonism. J Cereb Blood Flow Metab. 1994 Sep;14(5):783–801. [PubMed]
  • Antonini A, Schwarz J, Oertel WH, Beer HF, Madeja UD, Leenders KL. [11C]raclopride and positron emission tomography in previously untreated patients with Parkinson's disease: Influence of L-dopa and lisuride therapy on striatal dopamine D2-receptors. Neurology. 1994 Jul;44(7):1325–1329. [PubMed]
  • Kaasinen V, Ruottinen HM, Någren K, Lehikoinen P, Oikonen V, Rinne JO. Upregulation of putaminal dopamine D2 receptors in early Parkinson's disease: a comparative PET study with [11C] raclopride and [11C]N-methylspiperone. J Nucl Med. 2000 Jan;41(1):65–70. [PubMed]
  • Schrag A, Kingsley D, Phatouros C, Mathias CJ, Lees AJ, Daniel SE, Quinn NP. Clinical usefulness of magnetic resonance imaging in multiple system atrophy. J Neurol Neurosurg Psychiatry. 1998 Jul;65(1):65–71. [PMC free article] [PubMed]
  • Gilman S, Koeppe RA, Junck L, Kluin KJ, Lohman M, St Laurent RT. Patterns of cerebral glucose metabolism detected with positron emission tomography differ in multiple system atrophy and olivopontocerebellar atrophy. Ann Neurol. 1994 Aug;36(2):166–175. [PubMed]
  • Kume A, Takahashi A, Hashizume Y, Asai J. A histometrical and comparative study on Purkinje cell loss and olivary nucleus cell loss in multiple system atrophy. J Neurol Sci. 1991 Feb;101(2):178–186. [PubMed]
  • Fulham MJ, Dubinsky RM, Polinsky RJ, Brooks RA, Brown RT, Curras MT, Baser S, Hallett M, Di Chiro G. Computed tomography, magnetic resonance imaging and positron emission tomography with [18F]fluorodeoxyglucose in multiple system atrophy and pure autonomic failure. Clin Auton Res. 1991 Mar;1(1):27–36. [PubMed]
  • De Volder AG, Francart J, Laterre C, Dooms G, Bol A, Michel C, Goffinet AM. Decreased glucose utilization in the striatum and frontal lobe in probable striatonigral degeneration. Ann Neurol. 1989 Aug;26(2):239–247. [PubMed]
  • Churchyard A, Donnan GA, Hughes A, Howells DW, Woodhouse D, Wong JY, Kalnins RM, Mendelsohn FA, Paxinos G. Dopa resistance in multiple-system atrophy: loss of postsynaptic D2 receptors. Ann Neurol. 1993 Aug;34(2):219–226. [PubMed]
  • Schocke MFH, Seppi K, Esterhammer R, Kremser C, Jaschke W, Poewe W, Wenning GK. Diffusion-weighted MRI differentiates the Parkinson variant of multiple system atrophy from PD. Neurology. 2002 Feb 26;58(4):575–580. [PubMed]
  • Piccini P, de Yebenez J, Lees AJ, Ceravolo R, Turjanski N, Pramstaller P, Brooks DJ. Familial progressive supranuclear palsy: detection of subclinical cases using 18F-dopa and 18fluorodeoxyglucose positron emission tomography. Arch Neurol. 2001 Nov;58(11):1846–1851. [PubMed]
  • Karbe H, Grond M, Huber M, Herholz K, Kessler J, Heiss WD. Subcortical damage and cortical dysfunction in progressive supranuclear palsy demonstrated by positron emission tomography. J Neurol. 1992 Feb;239(2):98–102. [PubMed]
  • STEELE JC, RICHARDSON JC, OLSZEWSKI J. PROGRESSIVE SUPRANUCLEAR PALSY. A HETEROGENEOUS DEGENERATION INVOLVING THE BRAIN STEM, BASAL GANGLIA AND CEREBELLUM WITH VERTICAL GAZE AND PSEUDOBULBAR PALSY, NUCHAL DYSTONIA AND DEMENTIA. Arch Neurol. 1964 Apr;10:333–359. [PubMed]
  • Steele JC. Progressive supranuclear palsy. Brain. 1972;95(4):693–704. [PubMed]
  • Fearnley JM, Lees AJ. Striatonigral degeneration. A clinicopathological study. Brain. 1990 Dec;113(Pt 6):1823–1842. [PubMed]
  • Castro ME, Pascual J, Romón T, Berciano J, Figols J, Pazos A. 5-HT1B receptor binding in degenerative movement disorders. Brain Res. 1998 Apr 20;790(1-2):323–328. [PubMed]
  • Rakshi JS, Uema T, Ito K, Bailey DL, Morrish PK, Ashburner J, Dagher A, Jenkins IH, Friston KJ, Brooks DJ. Frontal, midbrain and striatal dopaminergic function in early and advanced Parkinson's disease A 3D [(18)F]dopa-PET study. Brain. 1999 Sep;122(Pt 9):1637–1650. [PubMed]
  • Ghaemi M, Rudolf J, Hilker R, Herholz K, Heiss WD. Increased pineal Fdopa uptake is related to severity of Parkinson's disease--a PET study. J Pineal Res. 2001 May;30(4):213–219. [PubMed]
  • Firnau G, Sood S, Chirakal R, Nahmias C, Garnett ES. Cerebral metabolism of 6-[18F]fluoro-L-3,4-dihydroxyphenylalanine in the primate. J Neurochem. 1987 Apr;48(4):1077–1082. [PubMed]
  • Tison F, Normand E, Jaber M, Aubert I, Bloch B. Aromatic L-amino-acid decarboxylase (DOPA decarboxylase) gene expression in dopaminergic and serotoninergic cells of the rat brainstem. Neurosci Lett. 1991 Jun 24;127(2):203–206. [PubMed]
  • Brown WD, Taylor MD, Roberts AD, Oakes TR, Schueller MJ, Holden JE, Malischke LM, DeJesus OT, Nickles RJ. FluoroDOPA PET shows the nondopaminergic as well as dopaminergic destinations of levodopa. Neurology. 1999 Oct 12;53(6):1212–1218. [PubMed]
  • Ito K, Morrish PK, Rakshi JS, Uema T, Ashburner J, Bailey DL, Friston KJ, Brooks DJ. Statistical parametric mapping with 18F-dopa PET shows bilaterally reduced striatal and nigral dopaminergic function in early Parkinson's disease. J Neurol Neurosurg Psychiatry. 1999 Jun;66(6):754–758. [PMC free article] [PubMed]
  • Asato R, Akiguchi I, Masunaga S, Hashimoto N. Magnetic resonance imaging distinguishes progressive supranuclear palsy from multiple system atrophy. J Neural Transm. 2000;107(12):1427–1436. [PubMed]

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