Objective: This present case-control study was aimed to investigate both morphological and signal intensity changes in susceptibility weighted imaging(SWI) of the Lentiform Nucleus (LN) for discriminating parkinsonism predominant Multiple System Atrophy (MSA-P) from PD.

Background: It remains challenging to make differential diagnosis between atypical parkinsonism and idiopathic Parkinson’s disease(PD) especially in early stage. Susceptibility weighted imaging (SWI) is a new technique and is promising for the differential diagnose between the MSA-P and PD.But the easily and the measurable morphological changes of the lentiform nucleus (LN) atrophy or the mean signal intensity changes of the LN is not reported before.

Method: We retrospectively included the patients with MSA, PD and sex and aged matched controls between Jan 2016 and Nov 2019 in our Movement Disorder Center who underwent 3T MR imaging of the brain including SWI sequence. Two movement disorder specialists reviewed the medical record and made the final diagnosis and two experienced neuroradiologists analyzed the MRI images independently according to a defined radiological protocol which included draft the ROI, morphological measurement of the LN and the signal intensity.

Results: 19 patients with MSA-P, 19 with PD and 19 controls were enrolled in this study including 13 patients with MSA-P and 9 with PD in their early stage(no more than 2 years of disease duration). We found significant decrease in short diameter (SD), ratio of the SD and the long diameter (SLDr) and increase in signal intensity standard deviation (SIsd) of the LN in MSA-P, compared with PD and controls (P＜0.05). When combined these three index, the sensitivity and specificity were 94.7%, 63.2% for MSA-P vs PD. More important, a significant decrease in SLDr was found in MSA-P compared with PD in their early stage, with high specificity of 92.3% and low sensitivity of 44.4%.

Conclusion: The morphological narrowing and the inhomogeneous signal intensity of the posterior region of LN were the characteristics of MSA-P compared with the PD and control group. The morphological change is potential marker to differentiate MSA-P with PD in the early stage.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/morphology-and-signal-changes-of-the-lentiform-nucleus-based-on-susceptibility-weighted-imaging-in-parkinsonism-predominant-multiple-system-atrophy/