Objective: This study aimed to quantify spatial patterns of multimodal MRI abnormalities in basal ganglia (BG) and brainstem-cerebellar (Stem-CB) regions and define structural MRI findings that correlate with clinical characteristics.

Background: The variability of the severity and regional distribution of pathological process in BG and Stem-CB systems results in clinical heterogeneity and represents the motor subtype of multiple system atrophy (MSA).

Methods: We simultaneously measured R2*, mean diffusivity (MD), and volume in the subcortical structures (BG, thalamus, Stem-CB) of 39 probable MSA and 22 control subjects. Principal component analysis (PCA) and Structural equation modeling (SEM) were performed to show a model consisting of multiple inter-dependencies.

Results: Structural MRI alterations were found to be significantly interrelated within BG as well as Stem-CB regions in MSA patients. PCA extracted four factors: three factors reflected alterations in R2*, MD and volume of the BG region including the caudate nucleus, putamen, and pallidum, and the remaining one factor represented degenerative changes in MD and volume of Stem-CB region. In SEM, a latent variable reflecting Stem-CB degeneration did not show a significant correlation with the other latent variables associated with BG degeneration. Putaminal MD values and a PCA-driven factor reflecting MD values in the BG showed a significant correlation with motor severity.

Conclusions: Multimodal structural MRI abnormalities in MSA appear to be segregated into BG and Stem-CB related factors that can be associated with the clinical phenotype.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/spatial-correlation-and-segregation-of-multimodal-mri-abnormalities-in-multiple-system-atrophy/