Category: MSA, PSP, CBS: Neuroimaging
Objective: There is a need for objective methods to assess disease progression in multiple system atrophy (MSA). This study aimed to identify brain perfusion patterns that predict the severity of motor symptoms.
Background: MSA is a neurodegenerative disease characterized by autonomic dysfunction, parkinsonism, and cerebellar ataxia. Reliable biomarkers to objectively assess disease progression are currently lacking.
Method: Brain perfusion SPECT images using 123I-IMP from 117 MSA patients were analyzed using principal component regression. Patients were divided into training (n=70; MSA-C: MSA-P = 42:28) and validation cohorts (n=47; MSA-C: MSA-P = 27:20). Additionally, 17 healthy controls matched for age and sex were included. Brain perfusion patterns predictive of motor symptoms were derived from the training cohort: MSA Ataxia pattern (MSA-AP) predicting International Cooperative Ataxia Rating Scale (ICARS) scores and MSA Parkinsonism pattern (MSA-PP) predicting Unified Parkinson’s Disease Rating Scale (UPDRS) scores. These patterns were validated in the validation cohort and healthy controls.
Results: Patient characteristics (n=117) included an average age of 64.6±9.6 years, 53 females, and disease duration of 2.1±1.3 years, with no significant differences between training and validation groups. MSA-AP pattern showed hypoperfusion in the cerebellum, brainstem, and thalamus, with hyperperfusion in the occipital and motor cortices. MSA-PP showed hypoperfusion in the thalamus, caudate nucleus, and cingulate gyrus, with hyperperfusion in the cerebellum. Both patterns were significantly higher in MSA patients compared to healthy controls (p<0.001). Predicted motor symptom scores correlated with actual scores (ICARS: R²=0.18, p=0.003; UPDRS: R²=0.23, p<0.001). MSA-AP scores were significantly higher in the MSA-C group (p=0.003), and MSA-PP scores were significantly higher in the MSA-P group (p=0.015).
Conclusion: Specific brain perfusion patterns associated with motor symptoms in MSA were identified, suggesting their utility as objective biomarkers for symptom assessment.
To cite this abstract in AMA style:
Y. Nakano, A. Sugiyama, S. Hirano, Y. Nakagawa, M. Tamura, T. Yamamoto, Y. Koizumi, Y. Suzuki, K. Yamagishi, Y. Chishiki, S. Kuwabara, Y. Kitayama. Brain perfusion patterns associated with motor symptoms in multiple system atrophy [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/brain-perfusion-patterns-associated-with-motor-symptoms-in-multiple-system-atrophy/. Accessed October 22, 2026.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/brain-perfusion-patterns-associated-with-motor-symptoms-in-multiple-system-atrophy/