Category: MSA, PSP, CBS: Neuroimaging
Objective: To clarify the clinical significance of neuroimaging markers in multiple system atrophy (MSA) by (1) examining concordance among putaminal MRI markers across sequences, (2) evaluating their relationships with contralateral parkinsonian motor severity, and (3) linking olivopontocerebellar (OPC) imaging signs to specific cerebellar dysfunction.
Background: Multimodal MRI markers, such as the putaminal rim sign and pontocerebellar atrophy, are established diagnostic features of MSA. However, their utility in tracking continuous, region-specific disease progression remains unclear.
Method: 94 MSA patients (50 MSA-P, 44 MSA-C) underwent 3.0T MRI evaluating putaminal rim hypointensity scores (DWI/SWI), lateral putaminal ADC hyperintensity, and infratentorial signs . Clinical severity was assessed using side-specific MDS-UPDRS III subscores and UMSARS. Analyses utilized Cohen’s κ, Spearman correlations, and Mann-Whitney U tests.
Results: Putaminal abnormalities predominated in MSA-P, while infratentorial signs were frequent in MSA-C. Putaminal ADC hyperintensity showed moderate agreement with DWI/SWI abnormalities (κ=0.400-0.617). Crucially, lateralized DWI/SWI scores showed negligible association with contralateral motor severity. In contrast, left putaminal ADC abnormality correlated significantly with higher contralateral (right-sided) tremor, rigidity, and total lateral motor scores. OPC signs consistently associated with worse heel-knee-shin performance, but not midline dysfunction.
Conclusion: Multimodal MRI markers in MSA capture distinct pathological substrates. Iron-sensitive sequences (DWI/SWI) serve as diagnostic “state” indicators, whereas microstructural ADC changes act as “stage” biomarkers coupled to contralateral severity. Furthermore, the left-lateralized imaging-clinical correlation aligns with the complementary dominance hypothesis, advocating for a stratified, mechanism-based approach to future disease monitoring strategies.
To cite this abstract in AMA style:
Y. Zhao, K. Li, Y. Zheng, M. Luan, H. Tang, C. He, J. Liu, F. Li, L. Wei, J. Chen, W. Sun, J. Deng, Z. Wang, Y. Zhu, Y. Sun. Beyond Diagnosis: Putaminal ADC Hyperintensity and Infratentorial Signs Reflect Motor Severity in MSA [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/beyond-diagnosis-putaminal-adc-hyperintensity-and-infratentorial-signs-reflect-motor-severity-in-msa/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/beyond-diagnosis-putaminal-adc-hyperintensity-and-infratentorial-signs-reflect-motor-severity-in-msa/