Objective: A systematic review and meta-analysis was performed to evaluate the diagnostic accuracy of DWI in the differential diagnosis of the parkinsonian variant of multiple system atrophy (MSA-P) and Parkinson´s disease (PD).

Background: Numerous studies using diffusion-weighted imaging (DWI) have shown that putaminal diffusivity is increased in patients with MSA-P as compared with PD patients.

Methods: Studies on DWI were identified through a systematic PubMed search. Papers were selected based on stringent inclusion criteria; minimum requirement was the involvement of MSA-P and PD patients and either documented true positive, true negative, false positive and false negative rates or overall sample size and reported sensitivity and specificity. Meta-analysis was performed using the hierarchical summary receiver operating characteristics curve approach.

Results: The PubMed search resulted in 793 results of which 9 studies were deemed relevant. Putaminal diffusivity was assessed in 127 patients with MSA-P, 262 patients with PD and 70 healthy controls (HC). The meta-analysis showed an overall sensitivity of 90% (95% confidence interval: 76.7% – 95.8%) and an overall specificity of 93% (95% confidence interval: 80.0% – 97.7%) to discriminate MSA-P from PD based on putaminal diffusivity.

Conclusions: Although putaminal diffusivity in general yields good sensitivity and specificity in distinguishing clinically diagnosed cases with MSA-P from PD, the large confidence intervals demand further research as to the reasons of this large variability.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diffusion-weighted-mri-discriminates-parkinsons-disease-from-the-parkinsonian-variant-of-multiple-system-atrophy-a-meta-analysis/