Multiple system atrophy (MSA) is a neurodegenerative disorder with progressive motor and autonomic dysfunction. There is a paucity of information on the early neurostructural changes in MSA, especially its subtypes, MSA-P (patients with predominant parkinsonism) and MSA-C (patients with predominant cerebellar signs). This study investigates the abnormalities of grey matter (GM) and white matter (WM) in early MSA and its subtypes using multi-modal voxel-based analysis.
Materials and methods
Twenty-six patients with MSA with duration of symptoms ≤ 2.5 years (mean duration: 1.6 ±0.9 years) were assessed clinically and with 3T MRI. Voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) were performed to identify the structural changes in MSA and its subtypes. The GM changes and diffusion parameters of WM tracts were correlated with the clinical scores. The results were compared with MRI of 25 age- and gender-matched healthy controls.
The early structural changes in MSA included GM loss of the cerebellum and subcallosal gyrus with widespread involvement of supratentorial and infratentorial WM fibres. In MSA-C, GM loss was limited to the cerebellum with WM changes predominantly affecting the infratentorial WM and association tracts. In contrast, MSA-P did not demonstrate any GM loss and the WM involvement was mainly supratentorial. There was no significant correlation between structural changes and clinical severity score.
In early MSA, WM microstructure was more affected than GM. These changes were greater in MSA-C than in MSA-P, suggesting variable deterioration in the subtypes of MSA.
• Structural changes in early multiple system atrophy were evaluated using multi-modal neuroimaging.
• White matter was more affected than grey matter in early MSA.
• Clinical variables did not correlate with early structural changes.
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Diffusion tensor imaging
European multiple system atrophy study group
Inferior cerebellar peduncle
Inferior fronto-occipital fasciculus
Middle cerebellar peduncle
Magnetic resonance imaging
Cerebellar ataxia predominant multiple system atrophy
Parkinsonism predominant multiple system atrophy
Multiple system atrophy
North American multiple system atrophy study group
Superior longitudinal fasciculus
Unified multiple system atrophy rating scale
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The scientific guarantor of this publication is Dr. Pramod Kumar Pal.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
The authors report no financial interests or conflicts of interest.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects in this study.
Institutional review board approval was obtained.
• case-control study
• performed at one institution
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Dash, S.K., Stezin, A., Takalkar, T. et al. Abnormalities of white and grey matter in early multiple system atrophy: comparison of parkinsonian and cerebellar variants. Eur Radiol 29, 716–724 (2019). https://doi.org/10.1007/s00330-018-5594-9