Objective: To evaluate the grey matter (GM) and white matter (WM) changes in patients with Multiple System Atrophy (MSA) using MRI.

Background: MSA is a neurodegenerative disease that presents with varying combination of parkinsonism, cerebellar ataxia, autonomic dysfunction and pyramidal signs.  The exact neural correlates of MSA symptoms still remain elusive. Comprehensive evaluation of structural changes using the techniques of Voxel based morphometry (VBM) and diffusion tensor imaging (DTI) of MSA patients can be useful for understanding the pathophysiology of disease.

Methods: Thirty patients with MSA (M:F:17:13) and 25 matched healthy controls were recruited for this study. All subjects underwent detailed clinical examination and severity of symptoms was quantified using standard rating scales. All subjects underwent brain scan in a 3-T MR scanner and the GM and WM changes were assessed using Voxel Based Morphometry (VBM) and Tract Based Spatial Statistics (TBSS) analysis.

Results: Demographic details are provided in table-1. In patients with MSA, GM atrophy was noted in bilateral cerebellum and left subcallosal gyrus (p <0.05, FWE corrected). MSA-P patients showed low GM volume  in the left superior and medial frontal gyrus, bilateral putamen, left globus pallidus, insula and right medial frontal gyrus. MSA-C patients showed GM atrophy in bilateral cerebellum (p<0.05, FWE corrected).

TBSS revealed reduced FA values in the cerebellar peduncles (CP), anterior limb of internal capsule, body of corpus callosum (CC) and corona radiata. Increased MD values were seen in CP, body of CC and cingulum compared to controls. On comparing MSA-C with controls, reduced FA values were noted in middle and inferior CP, corticospinal tract (CST), anterior and posterior limb of internal capsule, body of CC, cingulum (p<0.05, FWE corrected). Higher MD values were noticed in MCP, pontine crossing tract, CC, medial lemniscus, corona radiata of MSA-C in patients compared to controls. MSA-P patients showed significantly reduced FA values in anterior thalamic radiation, CST and superior longitudinal fasciculus and higher MD values in superior corona radiata and posterior limb of IC compared to controls.

Conclusions: Significant cortical and subcortical loss of GM was present in the cerebellum, cerebellar peduncles, putamen, thalamus and different areas of frontal lobe. Extensive WM changes were also seen in the MSA patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/structural-brain-changes-in-patients-with-multi-system-atrophy-a-vbm-and-dti-based-study/